HEALTH POLICY IN ACTION

COVID Global Accountability Platform’s (COVID GAP’s) Accountability Reports highlight and analyze recent developments, track progress toward national, regional, and global targets, and identify high-priority recommendations for a more effective, efficient, and equitable pandemic response and preparedness. Drawing on data across many sources, our Duke-Margolis and Global Health Innovation Center team tracks important measures of progress on commitments and remaining gaps, helping to hold leaders and organizations to account on these actions. The Accountability Reports are now tracking COVID booster doses administered globally. More details including updated reports and new brand-new data visuals are available on the COVID GAP website.

Perceived failures in response to COVID-19 and other health emergencies, have highlighted the need for faster, more effective communications between outbreak-affected countries and the World Health Organization and for mechanisms to improve international health regulation compliance. COVID GAP team member Nellie Bristol explores these issues and outcomes of the recent World Health Assembly in a new blog, Slow Progress in Updating International Health Regulations at 75th World Health Assembly.

Duke-Margolis researchers Katie Huber, Christina Silcox, Morgan Romine, and Mark McClellan co-authored an issue brief, “Health Care Data Reporting Beyond the Public Health Emergency: Payment Policies to Support Public Health Surveillance and Population Health.” The issue brief highlights the need for coordinated multi-stakeholder solutions to provide more timely, reliable, and efficient data to respond to COVID-19 and future infectious disease threats, and shows how regulations from the Centers for Medicare & Medicaid Services (CMS) related to data reporting and payment incentives are a critical part of supporting such solutions. The authors also submitted the issue brief along with a comment letter to CMS in response to its annual Medicare inpatient prospective payment system proposed rule. Read more about their issue brief and comment letter.

RESEARCH

Duke-Margolis digs into equity and risk adjusted payments to providers participating in Medicare’s alternative payment models, which are a critical element of accountable or “value-based” care.

Duke-Margolis researchers Mark Japinga, Robert Saunders, and Mark McClellan, together with former colleague--now Tufts medical student Michael Zhu, note that risk adjustment, which provides financial incentives for plans and providers to attract and retain individuals with high levels of need, is falling behind in supporting broader health care policies goals, such as improving equity.

In general, Duke-Margolis researchers find that existing risk adjustment systems lead to overpayments for some because it uses unrepresentative data (only data from Traditional Medicare) and has different incentives for certain types of value-based plans and models. The paper discusses how to equalize and align these incentives in the short term. The recommended approach should allow payments to be accurate as health care transitions to more coordinated care, such as from value-based care arrangements. Read the paper here.

In a Health Affairs Forefront blog, “Reducing Child Food Insecurity After COVID-19: Policy Innovations And Cross-Sector Partnerships,” Core Faculty Member Rushina Cholera and her co-author discuss how the pandemic has spurred widespread momentum to address long-standing inequities and improve child food security. Read the full article here.

A host of Duke-Margolis Core Faculty, researchers, and Scholars participated in the AcademyHealth’s 2022 Annual Research Meeting. Following are highlights of the research:

Margolis Scholar Ethan Borre co-authored an article in eClinicalMedicine with former Margolis Scholar Minahil Shahid, former Duke-Margolis Intern Mohini Johri, Core Faculty Member Osondu Ogbuoji and Deputy Director Gillian Sanders Schmidler entitled “Validation of the Decision model of the Burden of Hearing loss Across the Lifespan (DeciBHAL) in Chile, India, and Nigeria.” This study sought to extend Decision model of the Burden of Hearing loss Across the Lifespan (DeciBHAL), previously validated in the United States, to three international settings: Chile, India, and Nigeria. Click here to read the research.

Duke-Margolis Researchers Jonathan Gonzalez-Smith, Humphrey Shen, Christina Silcox published “Moving Ahead of the Pack: Understanding Health System Priorities on AI-Enabled Clinical Decision Support” in AAMI News, with funding from the Gordon and Betty Moore Foundation, describing key themes AI vendors should consider when developing AI products targeting the health care industry. Read their work here.

3:00 – 4:00 PM ET

In January 2022, Duke-Margolis Center for Health Policy and the U.S. Food and Drug Administration (FDA) convened a group of experts to discuss clinical endpoints relevant to clinical trials and innovative measurement strategies with the overall goal of supporting the development of safe and effective treatments for those living with NPC. This follow-up webinar will provide an overview of the key themes and future directions shared during the January 2022 workshop and presented in the recently released workshop summary report. Click here for more information and register. 

Advancing Clinical Trials at the Point of Care (ACT@POC^TM) hosted its first public meeting to explore barriers to broader trial participation by clinicians at the point of care and opportunities for overcoming these barriers. The meeting brought together Federal government, health system, industry, digital tools, and other stakeholders invested in reimagining clinical trials. Starting with a keynote by Janet Woodcock, participants reinforced the need for building better evidence generation infrastructure and trust to ensure buy-in from providers, patients, and other staff needed to operationalize point of care trials. Follow-on discussion noted approaches for improving cardiovascular disease treatment and pandemic preparedness, streamlining data collection, and reducing the burden on provider participation with policy enactment at the health system and national levels. The meeting recording and materials are available here.

The Duke-Margolis Summer Experience provides students with opportunities to gain exposure to the field of health policy through scholarship and mentored research opportunities. The 37 2022 Duke-Margolis interns work closely with their mentors on research projects related to the Center’s core focus areas of Health Care Transformation, Biomedical Innovation, and Education and Workforce Development as well as the cross-cutting themes of Health Equity, Global Health, and COVID Response. In addition to gaining experience in qualitative and quantitative research and receiving training and coaching on research skills/presentations/writing skills, the interns participate in Margolis Seminars, the Summer Research Symposium, and the Center’s Journal Club as well as build relationships with their peers through social events and team projects. Click here for more information about this summer’s class.

Duke-Margolis Core Faculty Member Nathan Boucher was awarded a CMS grant, along with four key partners—the NC Coalition for Aging, PHI, National Domestic Workers Alliance (NC Chapter), and Appalachian State University—for a project that focuses on direct care work for older adults/adults with disabilities cared for through home and community-based services. The researchers intend to define and unify recruitment, training, and credentialing of direct care workers in North Carolina, with an emphasis on implementing policy shifts and supports for direct care workers in the field.

Margolis Core Faculty Member Virginia Wang and former Margolis Summer Intern Anupama Warrier published a synthesis and commentary that discusses the effects of dialysis provider consolidation on clinical innovation and the implications on recent federal initiatives in kidney care. To read the full commentary, “Market consolidation and innovation in US dialysis” in Advances in Chronic Kidney Disease click here.

The founder of Duke-Margolis Center for Health Policy and CEO Emeritus, HealthCare Partners LLC, Robert Margolis will serve as the closing plenary speaker at the upcoming National Primary Care Transformation Summit, July 26-29. Click here for more programing information and to register.

Center Director Mark McClellan joined a recent Race to Value podcast in which he discusses the future of value-based care with Eric Weaver and Daniel Chipping of The Institute for Advancing Health Value. Click here to listen to their discussion. 

Former CMS Administrators Mark McClellan, Tom Scully, and Duke Trustee Nancy-Ann DeParle addressed the future of the Medicare program and its sustainability at an Alliance for Health Policy briefing. Click here to view.

Duke-Margolis Core Faculty Member Whitney Robinson was awarded the Carol J. Rowland Hogue Award for Outstanding Mid-Career Achievement. The annual award recognizes mid-career scientists who have made exceptional contributions to the practice of epidemiology. Click here to learn more about Whitney’s work and the history of this award. Congratulations Whitney!

Nora Emmott, MPH is a Senior Policy Analyst with the Biomedical Innovation team, where she focuses on Real World Evidence. Nora comes to Duke-Margolis from UNC Gillings School of Global Public Health where she earned her Master’s in Public Health and served as a Research Assistant with the UNC School of Medicine. She was previously a summer fellow at the Massachusetts Health Policy Commission where she studied social determinants of health policy. Prior to UNC, she was a Research Assistant with the All of Us Research Program at Massachusetts General Hospital in Boston. Nora holds a Bachelor’s in Public Health and Women's Studies from the University of Massachusetts- Amherst.

Greeshma James is a Policy Analyst with the health equity team, where she focuses on child health equity and policy. Greeshma is a 2022 graduate of the UNC Gillings School of Global Public Health, where she earned an MPH in Maternal, Child, and Family Health. During graduate school, she provided support in implementing an evidence-informed sex trafficking curriculum in schools and youth development centers across North Carolina and worked as a research assistant on HPV vaccine communication projects. Greeshma received her BS in Biomedical Sciences from the University of South Florida.

Frank McStay, MPA, re-joins the Center as an Assistant Research Director on the Health Care Transformation team. Frank was a member of Duke-Margolis in its earliest days. Since his time with Duke, he has been a senior policy advisor and health policy advisor at Baylor Scott & White in Dallas, TX, where he handled special projects, regulatory and legislative policy; spearheaded applied health policy research; and represented the system in several national and state associations. Frank’s portfolio at the Center focuses on fast turnaround projects about pressing payment and delivery reform topics.