HEALTH POLICY IN ACTION

Duke-Margolis hosted a special launch event of North Carolina’s State Transformation Collaborative (STC) on Duke’s Durham campus. The STC partners, including North Carolina Department of Health and Human Services Division of Health Benefits, the Health Care Payment Learning & Action Network (LAN), and the U.S. Center for Medicare & Medicaid Services (CMS) participated in the launch of this public-private partnership that aims to improve the health of North Carolinians through improving population health, enhancing patient experience, reducing health care costs, and decreasing administrative demands on health care providers while simultaneously advancing health equity.

During the launch, stakeholders discussed the priorities of the STC’s short- and long-term goals. The STC aims to change the way patients pay for care through value-based payment arrangements, and will push health equity through aligned quality measures and collaborative data collection to create “care that doesn’t leave anyone behind,” as Center Director Mark McClellan said.

Read more about the STC on the project webpage. The launch was also featured in Hea!thcare Innovation’s article, “NC Collaborative Launches With Focus on Equity, Aligned Quality Measures.”

Duke-Margolis recently launched a three-year project to advance home-based primary care and Age-Friendly Health Systems supported by The John A. Hartford Foundation. While primary care has gradually shifted outside of traditional clinical settings, the COVID-19 pandemic emphasized the need for home-based care to treat more populations effectively. Duke-Margolis is collaborating with the National Home-Based Primary Care Learning Network, the Home Centered Care Institute, and the American Academy of Home Care Medicine to amplify evidence-based policy efforts to scale up home-based primary care. Learn more about the project here and receive regular updates on the this work, including emerging policies and provider-specific resources, by signing up for a newsletter specific to this issue here.

COVID GAP released two of their Accountability Reports this month to discuss the latest in news surrounding the COVID-19 pandemic. Duke-Margolis is a founding member of COVID GAP, which identifies key issues and recommendations for improving the pandemic response on a national and global level. Read the reports on their main site here.

This month, COVID GAP also published two articles on their blog:

Value-based payment (VBP) arrangements could advance health equity as it ensures greater access to high-cost medical products and therapies. Duke-Margolis researchers Beena Bhuiyan Khan, Ethan Chupp, Victoria Gemme, and Aparna Higgins co-authored a white paper, “Performance Measurement Strategies in Value-Based Payment Arrangements,” that addresses challenges and offers policy recommendations for supporting the development of VBP arrangements for medical products. Read what they advised here.

This spring, Duke-Margolis will launch a new two-year project funded by the Kate B. Reynolds Charitable Trust, “Generating Evidence-Based Recommendations for Centering Equity in North Carolina Medicaid Value-Based Payment Design.” Research Director Rebecca Whitaker and research team members Yolande Pokam Tchuisseu, Samantha Repka, Katie Huber, Sara Debab, Will Bleser, Rushina Cholera, Andrea Thoumi, and Rob Saunders will examine how a VBP model design affects rural and historically marginalized populations. Through a mixed methods approach using community-engaged research strategies and claims-based simulations of payment model components, Duke-Margolis researchers will elevate issues identified by advocates and community members and articulate practical recommendations for the design of VBP models within North Carolina's Medicaid program to help reduce observed racial and ethnic health inequities in the state.

Duke-Margolis researchers Will Bleser, Frank McStay and Mark McClellan, together with Visiting Fellow David Muhlestein, co-authored a Health Affairs article, “Accountable Care In 2023: Evolving Terminology, Current State, And Priorities,” that discussed the history the definition of accountable care, and how the evolution of accountable care terminology offers insight into its opportunities and challenges. They provide an overview of the current public and private payer engagement in accountable care models and the of key issues facing policymakers and the health care industry to translate the promise of accountable care into greater adoption and success. The article is part of the Health Affairs Forefront series on “Accountable Care for Population Health.” Read more about the evolving vision of accountable care here.

Duke-Margolis researchers Sherrie Wang, Jonathan Gonzalez-Smith, Cara Smith, Mark McClellan and Robert Saunders co-authored an article in Health Affairs: "Value-Based Care And A Path To Achieve Comprehensive Care In The Safety-Net." This article follows a webinar on the same topic of value-based payment reform, which Duke-Margolis hosted on February 28. Learn more about the event here, and read the article here.

Duke-Margolis convened an expert workshop to share learnings of practices that can address or mitigate risks that may arise from the use of personal health information used in or generated from emergent technologies and methodologies in clinical research. The workshop brought together a range of stakeholders, including industry representatives, clinical researchers, patient voices, and data privacy and security experts, to discuss and assess existing tools and practices that may be applied to new and emerging data privacy and security challenges arising in the clinical research space. Stakeholders also discussed implementation of best practices and explored potential paths forward that could meet data privacy needs while preserving data utility. Read more about the event here.

Duke-Margolis hosted a webinar to discuss strategies to address the challenges of providing whole-person care and improving care in the safety net through value-based payment reform. Through presentations, panels, and open discussion, this event explored key policy and payment opportunities at both the federal and state level to support broader safety net engagement in VBP. The webinar featured a diverse panel of perspectives from federal agencies including the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and other US Department of Health and Human Services agencies. Click here to read more about the project and event.

Drug-resistant infections and antimicrobial resistance are a major global public health threat. Duke-Margolis will host a webinar to discuss how to identify and answer clinical questions with antibiotic use data, as well as policy approaches to improve data capture for antibiotic use. Learn more and register here.

Duke-Margolis, in cooperation with the Food and Drug Administration (FDA), will host a virtual workshop on March 8 to discuss how negative controls could support new methodological approaches for casual inference in the Sentinel Initiative. The use of real-world evidence (RWE) to address scientific and regulatory questions at the FDA has increased, but evaluation of RWE for regulatory use depends on a robust casual inference framework. The discussion at this workshop will inform the development of a series of methods demonstration projects aimed at informing this framework.

Neonatal research faces unique challenges, and finding relevant, clinically meaningful outcomes from neonatal studies is often difficult. Duke-Margolis’s hybrid event aims to promote discussion of conducting effective clinical trials in neonates, and to foster collaboration among researchers, clinicians, industry, and regulators in neonatal therapeutics. This meeting also is designed to provide a forum for patients and families to share which clinical benefits they find important. The event will take place virtually via Zoom as well as in-person in Washington, D.C., at the National Press Club. Further details on the event, as well as an agenda and registration links, are found here.

The FDA and Duke-Margolis will host a public workshop to convene key stakeholders to discuss the priorities for the development of digital health technologies (DHTs) for use in clinical trials. This virtual meeting will explore the challenges and opportunities related to the use of DHTs in clinical trials during the drug development process, focusing on accelerometry and other sensor-based measurements. Learn more about the workshop and register here.

New Margolis Scholars have joined Duke-Margolis in Spring 2023. The Duke-Margolis Margolis Scholars Program in Health Policy and Management is a competitive program that offers undergraduate and graduate students the knowledge and abilities to become leaders in health policy.

Meet the new Scholars:

Jada Allen is majoring in Public Policy, minoring in Chemistry, and pursuing the Duke undergraduate Health Policy Certificate. A member of the class of 2025, Jada is from Lumberton, NC and she is an enrolled member of the Lumbee Tribe of North Carolina. Her primary research interests are health equity in rural and BIPOC communities, nutrition and health outcomes, and investment in Native health care systems. She is researching hypertension and self-monitored blood pressure as a member of a Bass Connections team and serves as an Advocate with the Community Empowerment Fund. She is currently serving on the National Council of Urban Indian Health’s Youth Council and worked to address vaccine hesitancy in her tribal community. As a Margolis Scholar, Jada is excited to collaborate with fellow Scholars and Margolis faculty to build on her knowledge and develop innovative, community-centered health policy.

Breanna Barrett is a sophomore at Duke Trinity College of Arts & Sciences pursuing a double major in psychology and global health. Breanna serves on the executive board of Duke Students’ of the Caribbean Association, and on the board of Bench and Bar Pre-Law Society. Breanna is also a SPIRE fellow and works as an Information Technology Receptionist at Duke Law. Breanna participates in research through the Duke-Margolis, working on bringing legal aid into medical centers in order to help patients ameliorate their social and legal determinants of health. As a Margolis Scholar, Breanna hopes to continue working on health equity projects that explore legal aspects of policy research and on the sickle cell disease and maternal health fields that she studied during her Duke-Margolis internship in 2022 and in her global health classes. In the future, Breanna plans on a legal career where she can focus on health law and continue working in health policy. She is thrilled to join this supportive and diverse community and is excited to meet other Scholars.

Freya Gulamali is a member of the Class of 2025 at Duke University and is from Bellevue, Washington. She is majoring in Computer Science and is pursuing a certificate in Health Policy. Freya serves as the co-chair of Campus Engagement for the Student Collaborative on Health Policy and works as a research analyst with Mark Sendak at the Duke Institute for Health Innovation. Her research interests lie at the intersection of health policy and AI, particularly with respect to the capability of machine learning to improve efficiencies in the healthcare system and augment physician capabilities. Freya hopes to pursue an MD/MBA, translating policy into practice to serve patients and promote health equity. Through the Margolis Scholars Program, Freya is looking forward to connecting with others to learn more about how payment models and AI tools can both play a role in health care reform.

Vibhav Nandagiri, Class of 2025, is an undergraduate from Cary, NC, majoring in Biology and International Comparative Studies and is pursuing a Health Policy certificate. At the Wray Lab, Vibhav studies how mutations in noncoding regions of the human genome lead to the development of complex diseases. Through a Bass Connections team, he researches strategies to improve access to mental and behavioral health care for Spanish-speaking youth in North Carolina. He also serves as a research intern at NC Integrated Care for Kids, analyzing food insecurity screening practices and payment incentivization at pediatric clinics. In addition to these research projects, Vibhav is an executive member of the Duke Student Collaborative on Health Policy where he works to pair students with nonprofits, research institutes, and companies advocating for improved health equity. Outside of his health policy work, Vibhav spends his time travelling and competing for Duke Club Tennis, planning the annual TEDxDuke conference, and writing for local news outlets. In the future, Vibhav plans to pursue an MD/MPH and hopes to combine future clinical practice with policymaking. He looks forward for the opportunity to learn from leading policy experts through the Margolis Scholars program.

Ashna Sai is a member of the Class of 2025 in the Duke Trinity College of Arts & Sciences. She is pursuing a self-designed Program II major titled “Health Policy and Racial Disparities in Healthcare.” Ashna is the Founder, President, and Editor-in-Chief of the Duke Journal for Health Equity, which is Duke’s first student-run publication on health disparities and health policy. She is also an undergraduate researcher for both the Tata Lab, studying pulmonary cell biology, and a Bass Connections project team that is combatting Durham’s racial disparities in hypertension prevalence and treatment. Ashna additionally serves as a Community Resource Navigator for the Lincoln Community Health Center and is a long-term volunteer at her local free clinic. As a Margolis Scholar, she is excited to collaborate on projects with the vast network of faculty and fellow Scholars, learn more about leadership building, and engage in health care transformation discussions. After graduating, she aims to be a physician focusing on preventive medicine and health care for the underserved.

Dev Sangvai, a Duke-Margolis Core Faculty Member, was recently named the new President of Duke Regional Hospital. He and Mark McClellan also participated in the Duke Student Collaborative on Health Policy (SCOHP)’s Health Policy Week during a fireside chat on February 10.

Core Faculty Member Herbert Kim Lyerly was quoted in PBS North Carolina’s article, “Duke Researchers use mRNA Vaccine Technology to Work on Cancer Vaccine,” which discusses a new use for the mRNA technology that created successful COVID-19 vaccines. Read the article here.

Core Faculty Member Peter Ubel comments on the demand for primary care physicians in the KTRH article, “It Can Take Months to Get a Doctor’s Appointment.” Read it here.

The Washington Post quoted Core Faculty Member Evan Myers in their article, “Fallopian tube removal advised for more women to prevent ovarian cancer,” which spreads awareness on an option to reduce ovarian cancer risk for those already undergoing a pelvic procedure. Read the article here.

Core Faculty Member Gary Maslow discusses the delicate balance of prescribing mind-altering drugs in the Daily Mail’s article, “Experts slam doctors for 'over-prescribing' cocktails of 13 psychiatric drugs, including Klonopin and Ambien, to midwife mom with post-partum depression who strangled her three kids.” Read it here.

Margolis Scholar alum Joanne Kim authored a report on the gaps in mental health data protection that has resulted in frequent sale of this sensitive information. The report, “Data Brokers and the Sale of Americans’ Mental Health Data,” was widely covered by national media and was published by the Duke University Sanford School of Health Policy through their Cyber Policy Program. Read it here.

Visiting Fellow Jack Leslie published an article in Think Global Health that addresses a pervasive obstacle to public health efforts: lack of trust. Read the full piece here.

Margolis Scholar alum Ethan Borre was recently promoted to become a Commissioner of The Lancet Commission on Global Hearing Loss. The Commission works to innovate new methods for identifying and treating hearing loss on a global scale, and Ethan is one of only a few Commission participants to receive this honor.

Core Faculty Member Kate Bundorf co-authored a paper, “Employer-Sponsored Coverage Stabilized And Uninsurance Declined In The Second Year Of The COVID-19 Pandemic,” published by Health Affairs. Her research tracks insurance coverage during the global pandemic. Read the paper here.

Research Director Rachele Hendricks-Sturrup co-authored “Evidence on the Impact of Direct-to-Consumer Pharmacogenetic Testing,” a chapter within the online Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. The chapter highlights the ethical, legal, and social implications and policy considerations of direct-to-consumer pharmacogenomic testing. Read it here.

Research Associate Jonathan Gonzalez-Smith presented at Advocates for Community Health’s annual member forum on a panel around value-based care and federally-qualified health centers. He discussed findings from Duke-Margolis research around ways to advance safety net participation in payment and care delivery reforms.

Research Director Christina Silcox will speak at Arizona State University’s College of Health Solutions’ virtual Summit, “COVID Testing: What Happens When the PHE Ends?” on March 14 from 11:00 AM – 1:00 PM ET. Register here to join this public event.

Christina will also speak at Duke University School of Medicine's Precision Medicine Forum on March 9 to discuss the topic of "Regulating Artificial Intelligence and Machine Learning." Register for the forum here.

Assistant Research Director Will Bleser presented to the Health Care Transformation Task Force’s Health Equity Advisory Group about the work of the Health Care Payment Learning & Action Network’s Health Equity Advisory Team (HEAT). During this presentation, Will shared the HEAT’s theory of change for advancing health equity through alternative payment models, and the HEAT’s guidance on social risk adjustment.

Director Mark McClellan delivered the keynote address to the HSCA National Pharmacy Forum and Research Associate Stephen Colvill moderated the opening panel for the meeting.

Do you want to be part of health policy in action? Do you want to work on the leading health policy issues confronting cities, states, the nation, and the globe? The Duke-Margolis team is a dynamic, high impact national leader in leveraging policy to ensure high quality, affordable care for all. Multiple positions are currently available with new ones added frequently. Click here to view all of our career opportunities.