HEALTH POLICY IN ACTION

Since FDA’s emergency use authorization of the first COVID-19 monoclonal antibodies treatment in November 2020, there have been many efforts to improve access to and administration of these treatments. Duke- Margolis Center released a new report highlighting promising practices to overcome obstacles to using these treatments. The Center also issued a series of one-page summaries that lay out practical approaches that health systems, community providers, long-term care facilities, testing sites, and in-home infusion practices can take across three domains: streamlining the care process, educating patients and providers, and expanding their access footprint. Co-authored by Center researchers Marta Wosińska, Anna Zavodszky, Morgan Romine, and Mark McClellan, the report also addresses remaining payment problems that will prevent settings, such as in-home infusion, from being a viable option for patient access at scale. Read the full report, “Promising Practices for Promoting Utilization of COVID-19 Monoclonal Antibody Treatments,” and accompanying one-page summaries.

As part of its health policy leadership on antibody treatments, Duke-Margolis held a webinar featuring antibody manufacturers Eli Lily and Company and Regeneron and representatives of health systems, infusion centers, long-term care facilities, and state and Federal government to discuss promising antibody practices at all levels to encourage their equitable distribution and use. Meeting recordings and other event materials are available here.

Duke-Margolis Center publications were cited more than 15 times in the newly released National Academies of Sciences, Engineering, and Medicine’s report, Allocating COVID-19 Monoclonal Antibody Therapies and Other Novel Therapeutics. Read the report here.

Duke-Margolis published a new issue brief, “Redesigning Maternity Care for the COVID-19 Era and Beyond” co-authored by Center researchers Yolande Pokam Tchuisseu, Rebecca Whitaker, Jeremy Jacobs, Susan Dentzer and Robert Saunders. In this work, the team sought to understand key Medicaid and commercial payer policy changes made to maternity care in response to the pandemic. They found that to maintain innovations developed during the pandemic, maternity care and payment reforms need to enable more community-based supports,; more use of technologies for remote monitoring; and continued support for interventions, such as telehealth consultations and virtual group visits. Read the brief here.

Core Faculty Members Nathan Boucher and Courtney Van Houtven urge substantive reform of the nation’s US long-term services and supports (LTSS) system in new a policy brief they co-authored, “COVID-19: The Time for Collaboration Between Long-Term Services and Supports, Health Care Systems, and Public Health Is Now.” The authors note, “COVID-19 has exposed the many deficits of the US LTSS system and made clear the interdependence of LTSS with public health. The opportunity for reform is now.” Read the brief here.

Duke-Margolis student Sahil Sandhu, along with Core Faculty members Janet Prvu Bettger and Monica Lemmon, co-authored a commentary, “Addressing the Social Determinants of Health During the COVID-19 Pandemic: Ensuring Equity, Quality, and Sustainability,” in Family & Community Health. The authors outline key considerations for primary care clinics implementing programs that identify and address patients’ social needs in a way that promotes equity, quality, and sustainability. Read the commentary.

Center Director, Mark McClellan, and former FDA Commissioner Scott Gottlieb address the potential of an oversupply of COVID-19 vaccines by April and urge government at every level to expand access in a Wall Street Journal op-ed, “What to Do When There’s a Covid-19 Vaccine Glut.” Read the commentary here.

Core Faculty Member Charlene Wong and Duke School of Medicine student Sarah Freeman published a commentary called “Winning the Hearts and Minds of Young Adults in the COVID-19 Pandemic.” Read the commentary here

Duke-Margolis contributed its subject matter expertise to the newly released ad campaign, “It’s Up to You,” from the Ad Council and COVID Collaborative’s COVID-19 Vaccine Education Initiative. Learn more about the campaign here and by visiting GetVaccineAnswers.org (DeTiDepende.org in Spanish).

Duke-Margolis researchers Christina Silcox, Andrea Thoumi, and David Anderson participated in the RADx-UP COVID-19 Equity Evidence Academy 2021: Translating Innovations in Testing. RADx-Up is researching COVID-19 testing patterns in communities across the country and data on disparities in infection rates, disease progression and outcomes. Its Equity Evidence Academy is an engaged conference approach to understand the state-of-the-science, or the current evidence of COVID-19 testing and related factors in the populations. Learn more about RADx-UP here.

Visiting Senior Policy Fellow Hemi Tewarson joined the Biden Administration’s first public meeting on vaccine distribution as a panelist on how to use data to improve equitable distribution of vaccines. Hemi also presented at the 30^th Annual Health Care Forecast Conference hosted by the University of California, Irvine School of Medicine. This event forecast health care economic and political outlooks, focusing on the impact of COVID-19 and how it will affect health care coverage and delivery and policy. Hemi provided her perspective on state health policy priorities during and following the COVID-19 pandemic. Learn more here.

A team of clinicians, faculty, and researchers across Duke University and Duke-Margolis, including Jessica Beliveau, Janet Prvu Bettger, Dave Anderson, Rushina Cholera, Charlene Wong, and Rebecca Whitaker, sought to understand how, during the COVID-19 pandemic and before North Carolina’s Medicaid transformation, Medicaid coverage affects access to care and health outcomes for low income, underserved North Carolinians. The team conducted a retrospective analysis of North Carolina Medicaid claims data. The project, Informing North Carolina’s COVID-19 Pandemic Response: Projected Service Needs of Medicaid Beneficiaries includes three distinct sub-projects focused on: 1) examining changes in Medicaid coverage among Medicaid-insured children and adults, 2) examining behavioral health-related service needs in advance of Medicaid transformation, and 3) characterizing new enrollment to Medicaid during the COVID-19 pandemic. The team will present their research findings and policy implications during a NC Medicaid “All Hands” meeting on March 4th. This project is funded by the Kate B. Reynolds Charitable Trust.

Duke-Margolis researchers Yolande Pokam Tchuisseu, Andrea Thoumi, and Hemi Tewarson co-authored, with the National Governors Association, “A Case Study of the Michigan Coronavirus Task Force on Racial Disparities,” the first of several case studies on state action to address COVID-19 inequities. This case study explores Michigan’s approach, key features, results to date, and lessons learned. Read the case study and more about the COVID-19 Health Equity Learning Network here. View Michigan’s Fox 17 coverage of the case study.

North Carolina Council on Health Care Coverage continued its work to identify ideas on how to improve health care coverage for the 1.2 million uninsured in the state. Duke Margolis convened the fourth and final meeting of the Council and is working on its behalf to finalize guiding principles to aid the state in developing plans to increase health care coverage for North Carolinians. Learn more about the Council.

Rhode Island Lt. Gov. Daniel McKee named Duke-Margolis Visiting Senior Policy Fellow Hemi Tewarson to his advisory panel on the state’s continued response to the coronavirus pandemic, including vaccination efforts. Read more about the advisory group here. Hemi commented on state’s efforts regarding vaccination in the Washington Post.

Core Faculty member Gavin Yamey penned a commentary In Nature, “Rich countries should tithe their vaccines,” where he contends that game theory suggests that donating doses can help nations of all income levels. Read the commentary. Gavin addresses global inequities in vaccine distribution and access in this BBC interview. 

RESEARCH

Core Faculty Member Barak Richman co-authored a Wall Street Journal essay on “How to Quiet the Megaphones of Facebook, Google and Twitter”. Read his essay here.

Duke-Margolis researchers Katie Greene, Kirk Williamson, Hemi Tewarson and Mark McClellan co-authored a policy paper entitled “An Agenda for Ending the Addiction Crisis: Key Priorities and Considerations for the Biden Administration.” Read the paper here.

Duke-Margolis Health Equity Policy Fellow Andrea Thoumi and colleagues at the Duke Global Health Innovation Center are co-authors of “Reinforcing locally led solutions for universal health coverage: a logic model with applications in Benin, Namibia and Uganda,” published in BMJ Global Health. The authors present an approach for low- and middle-income countries to gain more control of their development assistance programming by increasing accountability, multi-stakeholder collaboration, and evidence-based technical support. Read the article here.

Duke-Margolis researcher Hannah Crook, James Zheng, Will Bleser, Rebecca Whitaker, Jasmine Masand, and Robert Saunders published an issue brief in Milbank Memorial Fund entitled “How Are Payment Reforms Addressing Social Determinants of Health? Policy Implications and Next Steps” on how value-based payment reforms are addressing social needs. Read the brief here.

Margolis Core Faculty Member Mina Silberberg was the lead author for a research article published in the International Journal of Health Promotion and Education entitled, “The role of socioeconomic status in a community-based study of diabetes secondary prevention among African Americans.” Read the article here.

Duke-Margolis student Sahil Sandhu and Core Faculty member Janet Prvu Bettger published "A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting” in the International Journal of Integrated Care. Read the article here.

Duke-Margolis Core Faculty member Nathan Boucher and Duke students Laylla Jimenez and Sarah Cross published an analysis called " ‘He Needed Just About Everything’: Caring for Aging Adults Postincarceration” in the Journal of Applied Gerontology. Read their findings here.

EDUCATION

Duke-Margolis and the School of Medicine’s Office of Regulatory Affairs and Quality will team up again in the Spring 2022 semester for their popular course, “Regulation and Reimbursement of Medical Products: Practice and Policy” (BME 590). Inaugurated in fall 2020, this course fills a health policy gap for undergraduate and graduate students by equipping them with knowledge about key US health care policy and delivery reforms efforts. Students gain an in-depth understanding of the federal regulatory pathway and payment considerations for new medical products. The course instructors, Duke-Margolis researchers Christina Silcox and Marianne Hamilton Lopez, together with ORAQ Director Amanda Parrish, devised a new and innovative teaching tool—a regulation road map—that students followed to achieve regulatory approval and payment of their imaginary medical products. “It was extremely satisfying as an educator to see how much they learned and that they took the time to show us that” said Christina. A new class of students can enroll in “Regulation and Reimbursement of Medical Products: Practice and Policy” (BME 590) for spring 2022.

Duke University held its first annual Health Policy Case Competition in February 2021. Co-hosted by Duke-Margolis, the Center’s Student Collaborative on Health Policy (SCOHP), the Duke Consulting Club, and RTI International, this case competition brought together 10 undergraduate teams who competed to create a leading—and very timely—solution to combat vaccine hesitancy in the North Carolina counties of Durham, Robeson, and Wilkes.

Duke-Margolis faculty, researchers and Margolis Scholars served as judges and mentors for the teams participating in this inaugural competition. Out of nine teams, the winning 2021 team, Huzyfa Fazili, Hana Hendi, Maya Ghanem, Katie Heath, and Hannah Shuffer, were awarded first place for their solution, Operation H.E.A.R.D. (Healthcare Equity & Access in Robeson Distribution). Their four-pronged proposal to build trust in the health care system among the Lumbee tribe of Robeson County focused on 1) creating partnerships and trust with tribal leaders and elder groups; 2) education and awareness; 3) implementation, including satellite and mobile vaccination sites; and 4) train local Lumbee people as community health care workers. Learn more here.

Congratulations to Margolis Scholar Lisvel Matos, who was awarded the Substance Abuse Mental Health Service Administration (SAMHSA) Minority Fellowship Program (MFP) grant through the American Nurses Association (ANA). Lisvel is a PhD student at Duke University's School of Nursing. The purpose of the SAMHSA MFP grant at ANA is to reduce various health disparities and improve health care outcomes for racially and ethnically diverse populations by increasing the number of culturally competent behavioral health professionals available to underserved minority populations in the public and private non-profit sectors and in clinical and community-based organizations and institutions. Read more about Lisvel and her award here.

Please join on March 2^nd for this virtual event featuring short presentations by student team members from eight 2020-2021 Bass Connections project teams that are currently tackling research related to the COVID-19 pandemic. The goal of this symposium is generate supportive, open discussion that can help teams advance their research, make connections and examine their work from new points of view. An open discussion will follow the presentations with team members soliciting input and audience feedback. The symposium includes several concurrent sessions on March 2 from 12:00-12:45, 5:00-5:45, and 5:45-6:30 p.m. EST. Register here

Duke-Margolis Center, with the U.S. Food and Drug Administration, convened a public meeting, “Scientific and Ethical Considerations for the Inclusion of Pregnant Women in Clinical Trials,” to discuss the need for clinical research among pregnant people as well as scientific and ethical considerations for the inclusion of this complex population in clinical trials. Meeting recordings and other event materials are available here.

A Center record-setting nearly 4,500 people registered for the Duke-Margolis webinar, “Evaluating RWE from Observational Studies in Regulatory Decision-Making: Lessons Learned from Trial Replication Analyses.” The meeting focused on sharing preliminary results from ongoing trial replication efforts to better understand strengths and limitations of observational studies regarding drug product effectiveness and regulatory decision-making. Meeting recordings and other event materials are available here.

Core Faculty member David Ridley interviewed Center Director Mark McClellan for the Fuqua webinar series, “Health Care Leaders with David Ridley.” View the whole series here.

Duke-Margolis Core Faculty Member Christine Goertz was appointed Chair of the World Federation of Chiropractic Research Committee. Read more about the committee and its work here.

Digital Health Policy Fellow, Christina Silcox was a featured speaker FiscalNote’s Health Care Thought Leadership Series event, “Preparing for the Post-Pandemic Digital Age of Health Care.” Christina will also be a panelist for the next series installment, “What President Biden’s COVID-19 Response Reveals about the Future of Healthcare,” on March 4^th. Learn more and register here.

Research Director Robert Saunders participated as a panelist at a Health Leadership Council (HLC) event for Congressional staffers and the private sector, “A Framework for Private-Public Collaboration on Disaster Preparedness and Response.” His remarks highlighted how to build an improved, strategic private-public approach to disaster preparedness and resilience, drawing on Duke-Margolis and HLC effort with more than 100 private-sector, nonprofit, and government leaders. Read more here.

Duke-Margolis Health Equity Policy Fellow Andrea Thoumi continues outreach efforts to advance the Center’s anti-racism and equality goals, including serving on the Health Equity Research Panel organized by REACH Equity and Duke Med for Social Justice, speaking at Fuqua’s Daring Dialogues: COVID-19, and moderating a Healthcare Access, Equity and Success panel at Fuqua’s Sustainable Business & Social Impact conference. Read more about the event here.

Core Faculty Member Nathan Boucher was appointed to the North Carolina Orange County) Adult Care Home Community Advisory Committee. In addition, his Bass Connections project “Treating Alzheimer’s: Exploring Gene-Therapy and its Social and Health Implications,” was awarded funding through the Bass Connections Brain & Society Theme