Dr. Smith is currently a Professor of Clinical Medicine at the University of California at San Francisco. From 2016 through 2019 he co-chaired the Guiding Committee of the Health Care Payment Learning and Action Network

From 1996 through 2013, Smith was the Founding President & CEO of the California HealthCare Foundation, which he led from its formation. An independent endowed philanthropy in Oakland, CA, the Foundation began operations with $500 million in assets, made $650 million in charitable grants under his leadership, and has a current corpus of approximately $720 million.  In those 17 years, Smith helped build the Foundation into a recognized leader in delivery system innovation, public reporting of quality, and applications of new technology in health care. Smith spearheaded the launch of California HealthLine; the CHCF Innovation Fund, which invests in companies advancing the Foundation's mission; and the CHCF Leadership Fellows Program, whose 300 alumni/ae are senior leaders in virtually every clinical enterprise in the state.

He was a 2014 Menschel Senior Policy Fellow at the Harvard School of Public Health.

Dr. Smith has published over 50 articles in peer-reviewed journals and 25 book chapters and monographs. He has consulted for the governments of Kuwait, Denmark, and Singapore, and has been a frequent keynote speaker, including for Microsoft, Health 2.0, Kaiser Permanente, and the Library of Congress.

Before his time at CHCF, Dr. Smith was Executive Vice-President of the Henry J. Kaiser Family Foundation.  Prior to that, he was on the faculty at the Johns Hopkins Schools of Medicine and of Public Health and directed the AIDS clinic there.

Dr. Smith was elected to the National Academy of Medicine in 2001. He chaired the IOM’s Committee on the Learning Healthcare System, which produced the widely publicized 2012 report Best Care at Lower Cost. He serves on the Boards of the Institute for Healthcare Improvement, the Commonwealth Fund, Teladoc Health, Phreesia, Jazz Pharmaceuticals, and the Editorial Board of Health Affairs. He has been honored by the California Legislature, the California Hospital Association, Grantmakers in Health, the Society of General Internal Medicine, and others.

Dr. Smith holds a BA in Afro-American Studies from Harvard College, an MD from the University of North Carolina at Chapel Hill, and an MBA from the Wharton School at the University of Pennsylvania. A Board-certified internist, he maintains an active clinical practice in HIV care at Zuckerberg San Francisco General Hospital.