External Newsletter: May 2020

COVID-19 RESPONSE:

HEALTH POLICY IN ACTION

NATIONAL

Mark McClellan, former CMS administrator Andy Slavitt, and other health care leaders published a full-page op-ed in USA Today reinforcing key pieces of the overall strategy to #OpenSafely .

Core Faculty Member Don Taylor discussed COVID-19 testing in nursing homes on US News & World Report , CNN, and North Carolina’s WRAL. This national coverage on testing on nursing homes was spurred by Don’s commentary published today in STAT News . Dr. Taylor was also guest on NPR’s State of Things to discuss about nursing homes and SARS COV2 testing.

Deputy Director Marta Wosińska is on the Advisory Board for the COVID Tracking Project , a volunteer organization launched by The Atlantic dedicated to collecting and publishing the data required to understand the COVID-19 outbreak in the United States .

On May 6, Mark McClellan participated in a webinar with Senator Toomey of Pennsylvania on the steps that are needed for the state to safely proceed on the road map to reopen. Watch the recording here .

The House Committee on Energy & Commerce held a teleconference on May 8 at 12pm ET on COVID-19 testing, contact tracing and surveillance with Center Director Mark McClellan, Andy Slavitt, and Avik Roy.

Mark McClellan participated in a briefing on May 13 for members of the House Select Subcommittee on the Coronavirus Crisis on COVID-19 Testing, Tracing, and Targeted Containment. View the recording here.

STATE

Core Faculty Member Aaron McKethan discusses his research in an article from The Hill on rising numbers of coronavirus cases in states where they seek to reopen their economies, including Texas, North Carolina, and Arizona.

Core Faculty Member Don Taylor, along with Duke Forge and Duke SSRI, published their sixth iteration of the North Carolina Social Distancing Survey. Read more here.

Duke-Margolis authors, in collaboration with Blue Cross and Blue Shield of North Carolina, published a commentary in the North Carolina Medical Journal about the state’s approach to health care payment and delivery reform. The commentary explores the steps taken to date and details further actions needed in four complementary areas to achieve system-wide transformation. Read more here.

A new Health Affairs blog by Duke-Margolis authors in collaboration with Aledade and Leavitt Partners analyzes proposed changes to the Medicare Shared Savings Program in response to COVID-19.

The blog post estimates how these changes may affect ACOs, supporting some changes while modifying others or recommending new changes for CMS consider in order to stabilize the ACO program, which is poised for better COVID care than status quo. The work represents a growing coalition of support among many ACO leaders and ACO policy experts for preserving fundamental program incentives instead of pausing everything.

INTERNATIONAL

Janet Prvu Bettger, ScD, FAHA, Duke-Margolis Core Faculty Member, and Andrea Thoumi, MPP, MSc, Duke-Margolis Research Director, Global Health published a commentary in BMJ Global Health on the effects of COVID19 on rehabilitation services in 12 countries. We share adjustments to the delivery of rehabilitation services, solutions and recommendations. It is critical to recognize that rehabilitation services are essential and that the demand for rehabilitation will only increase during COVID-19. Hospitalized patients with COVID-19 will require therapy to recover and other people will experience decline in physical and cognitive functioning due to delays in care.

Core Faculty Member Gavin Yamey co-authored an article in Health Affairs about the need for our COVID response to be multilateral and international in scope in order to be effective. He was also a guest on WWLAMFM to discuss what we in the US can learn from China, South Korea, New Zealand, Singapore and other countries in how they’ve handled COVID-19.

Kushal Kadakia, BA, Rhodes Scholar, and Andrea Thoumi, MPP, MSc, Duke-Margolis Research Director, Global Health published a blog in Brookings Future Development identifying four opportunities to renew the commitment to the health-related Sustainable Development Goals. They propose that the SDGs provide the agenda for a sustainable global response to COVID19 – a response that should not lead to the neglect of the critical elements for equitable, affordable health care for all.

RESEARCH

SUBMIT YOUR COVID-19 QUESTIONS TO DECISION MODELERS

We are reaching out to you to help us build a repository of decision maker questions related to the COVID-19 pandemic and response.

As part of the Society for Medical Decision Making (SMDM) COVID-19 Decision Modeling Initiative (CDMI) , the Moore Foundation partnered with SMDM , Johns Hopkins University , Duke University , and the University of Michigan to fund a rapid response grant initiative.

The SMDM CDMI grant program seeks to develop and advance new ideas and scalable approaches to address uncertainties during the COVID-19 pandemic by catalyzing innovation in decision models for rapid uptake and impact.

To inform this effort we are compiling (and prioritizing) questions relevant to decision making by policymakers, clinical providers, and health system administrators.

And we need your questions!

Submit your questions here.

Questions related to COVID-19 response in terms of (1) population health, (2) diagnosis, testing, and evaluation, (3) health system operations, (4) treatment and vaccination, and (5) individual and population well being are all in scope.

Questions submitted before June 30 ^th will be incorporated into our grant review prioritization process. As appropriate we will also look to connect the decision modeling teams to decision makers whose uncertainties may be informed by their modeling efforts.

For more information about SMDM-CDMI, visit here.

We welcome any feedback about this initiative at CDMIpriorities@smdm.org .

Duke-Margolis/Alexandria Summit Webinar: Developing and Scaling COVID-19 Vaccines

DUKE-MARGOLIS COVID-19 VACCINES WEBINAR

On May 13, Duke-Margolis and the Alexandria Summit hosted a webinar for more than 1,100 attendees on Developing and Scaling COVID-19 Vaccines .

Dr. Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases, joined Center Director Mark McClellan, followed by an expert panel on vaccine development, and concluding discussion with former FDA Commissioner Scott Gottlieb.

DUKE-MARGOLIS ALUMNI WEBINAR ON COVID-19

On May 27, Duke-Margolis and the Duke Alumni Association hosted a webinar focused on the Center’s COVID-19 response. The event included a moderated discussion with Duke alumnus David Rubenstein, a welcome from Duke President Vince Price, comments from Dr. Bob Margolis, an overview on recent findings and next steps, and highlights from our students’ work on COVID-19 projects.

On Wednesday, May 6, Duke Science & Society hosted a webinar on Coronavirus and the Wealth Gap: Pandemics and Poverty featuring Research Associate Dave Anderson. Learn more here .

PUBLICATIONS

On May 20, Duke-Margolis released published a new report outlining actions needed to further build a critical path for COVID-19 treatments. The report outlines key next steps needed in four areas: 1) creating a clear pathway for promising therapeutics to enter clinical testing; 2) increasing clinical trial effectiveness and capacity; 3) anticipating manufacturing capacity to support rapid access without shortages; 4) conducting critical post-FDA approval studies to improve drug evidence and outcomes. The recommendations are relevant to all potential therapeutics, and the co-authors urge they be considered and enacted in collaboration with world health authorities to ensure global coordination of critical development efforts.

On May 1, Duke-Margolis published two new reports on payment reforms and data interoperability for COVID-19. The first, Health Care Payment to Support COVID-19 Detection and Containment , lays out a number of near-term actions that we believe CMS and private payers can take under existing mechanisms to increase payments to frontline providers to support and incentivize their participation in comprehensive test and trace efforts. Importantly, these payments can and should be linked to incenting the use of more accurate tests and enhanced data collection and reporting steps that will be critical to state and local efforts to understand transmission in their regions. Recommendations cover a range of options that include both alternative payment models and modifications to existing FFS mechanisms - all building on the steps announced by CMS recently .

The second, Data Interoperability and Exchange to Support COVID-19 Containment , outlines three sets of recommendations that can be taken within the next 30 days to further bolster the collection and reporting of data elements for test and trace programs. This includes recommendations to improve demographic data in commercial lab reporting, to supplement case investigations with clinical data, and to make better use of the National Syndromic Surveillance Program.

NEWS

Managing Associate Christina Silcox and Research Director Marianne Hamilton Lopez will teach a Duke University course in the fall about regulation and reimbursement on medical products: practice and policy.

Research Associate Dave Anderson published a piece on The Conversation discussing silver-loading and the Zero Premium effect that led to 200,000 more people being insured on the ACA exchanges.

Assistant Professor in Population Health Sciences Corinna Sorenson and Core Faculty Member Rachel Greenup are co-authors o n a commentary on t he drivers of low value care in breast cancer surgery.

At the 2020 Daytime MBA Awards Ceremony for Students, Faculty, and Staff, Core Faculty Member David Ridley was the runner up in the category of Excellence in Teaching in an Elective Course.

A new article by Duke-Margolis researchers presents a framework for a heart failure longitudinal value-based payment model. The goal of the model is to use its payment and quality incentives and care delivery flexibility to reduce adverse clinical outcomes and prevent disease progression for stage C heart failure patients.

The framework was developed by a multi-stakeholder Learning Collaborative of The Value in Healthcare Initiative , a collaboration of the American Heart Association and the Duke-Margolis Center for Health Policy. The framework details a potential care delivery model, payment approach, triggers to enter and exit the model, quality measurement and evaluation strategy, and needed data sources. The article also describes potential barriers to success and implementation strategies to aid in the development of a pilot of the model framework. Additional work from the Value in Healthcare Initiative will be published over the next two months. For a preview of that work and the state of cardiovascular care value, please also read our Cardiovascular Perspective piece in the same journal issue.

Core Faculty Member Frank Sloan found that ACA Medicaid expansion lowered mortality to causes amenable to medical care, but these gains were mostly counter-balanced by increased opioid overdose deaths.

Core Faculty Member Arti Rai outlines the need for clear and accurate attribution of innovation to all inventors and collaborators around novel and useful drugs including Remdesivir in a new op-ped in STAT News .

Duke-Margolis and NPC post-doctoral fellow Taruja Karmarkar is lead author on a study that examines the need for productivity impacts on value assessment and formulary design.

Core Faculty Member Janet Bettger presented at the WHO/PAHO webinar on Monday, May 11 on policies and partnerships to support rehab services in the care and recovery of hospitalized COVID patients returning home and the tsunami of rehab needs emerging with this pandemic.

At the Virtual ISPOR Conference on May 18, Senio r Research Assistant Kerra Mercon gave a podium presentation titled “Understanding Use of Real-World Data (RWD) and Real-World Evidence (RWE) to Support Effectiveness Labeling Changes."This presentation examined the role of RWD and RWE in supporting regulatory decision-making related to the effectiveness of medical products. We conducted a landscape analysis to understand past regulatory use of RWD and RWE. For each medical product identified, we examined publicly available FDA reviews and product labels to characterize if and how the RWD and RWE supported regulatory decision-making. Based on lessons learned, we provided policy recommendations for advancing the use of RWD and RWE for regulatory decision-making.

Also at ISPOR, Nirosha Mahendraratnam Lederer was on an issue panel titled “Moving from Ideas to Action - What is the Role of Global Collaboration?"

Both Kerra and Nirosha's abstracts will be published in Value in Health . In the meantime, the abstracts are available on the online program.