HEALTH POLICY IN ACTION

The COVID Global Accountability Platform (COVID GAP), a joint initiative of COVID Collaborative and Duke University, along with the Open Society Foundations and the Clinton Health Access Initiative (CHAI), announced the launch of a consortium that aims to catalyze and support innovative programs in low- and middle-income countries to increase access to quality-assured, oral anti-viral treatments for COVID-19.

This initiative aims to help jump-start multi-sector efforts that complement other test-and-treat initiatives and commitments announced at the recent Second Global COVID-19 Summit. Read more about the consortium, members, and funding.

On the eve of the Second Global COVID-19 Summit co-hosted by the United States, Senegal, Germany, Indonesia, and Belize, COVID GAP issued an assessment of the global response to the worldwide pandemic. Though there has been significant progress over the past six months, especially on vaccine supply, much more work remains. The COVID GAP Accountability Report highlights and analyzes recent developments, tracks progress toward national, regional, and global targets, and identifies high-priority recommendations for a more effective, efficient, and equitable pandemic response and preparedness. Read more in Issue 1 and Issue 2 of the report, now available on the COVID GAP website.

In a  Health Affairs Forefront blog, Duke-Margolis Policy Research Associate Beth Boyer, Health Equity Policy Fellow Andrea Thoumi, and Core Faculty Member David Ridley propose that the US government create a transferable exclusivity voucher program to motivate drug development for infectious diseases. Under this proposal, the government would reward developers that create a treatment or vaccine for a pre-defined, neglected disease by issuing a voucher to extend the marketing exclusivity for a different, high-demand product. Click here to read to full article.

This month, the nation surpassed more than one million deaths due to COVID-19. Duke-Margolis researchers, including Andrea Thoumi and Kamaria Kaalund, along with colleagues at the UNC Center for Health Equity Research and the Duke Clinical Research Institute issued a policy framework with actionable steps for policymakers, providers, and the National Institutes of Health RADx Underserved Populations (RADx-UP) Initiative to facilitate more equitable COVID-19 testing. Click here to read the framework and here to learn more about NIH’s RADx-Up Initiative.

Recognizing the near-term need for effective implementation of Test to Treat strategies and long-term need for advance planning and potential COVID-19 surge response, Duke-Margolis issued two new papers to shore up the use of rapid testing and treatments as part of comprehensive COVID-19 containment strategies:

Over-the-Counter COVID-19 Testing: Insurance Coverage Strategies to Ensure Equitable Access

Many Americans are using in-home, over the counter (OTC) tests to determine their infection status after symptoms or exposure, and to screen ahead of interactions with others who may be at risk. Over the long term, questions and challenges remain about the best policies for providing equitable access to OTC tests, especially to support broad availability of test to treat to limit the impact of future infections. This policy brief, authored by Katie Huber, Thomas Roades, Aparna Higgins, Christina Silcox, and Mark McClellan, outlines several of those key challenges and proposes policy recommendations to address them. Read the full brief.

The Biden Administration is taking steps to increase timely access to tests and treatment for at-risk individuals who have COVID-19. Despite these steps, there are still a number of near-term challenges to provide the education, infrastructure, and actual testing and therapeutic supplies to the states, providers, and health settings capable of making Test to Treat strategies viable as we move toward more endemic COVID-19. This white paper, by Duke-Margolis authors Brian Canter, Matt D'Ambrosio, Morgan Romine, and Mark McClellan, outlines a set of considerations and specific recommendations for increasing access, particularly through further incentives and payments to enable primary care providers and health systems to support COVID-19 containment. Read more.

RESEARCH

Duke-Margolis Scholar, Shreyas Hallur, intern Sahil Sandhu, and Core Faculty Member Janet Prvu Bettger co-authored an article published in Annals of Family Medicine entitled "Embedding Student Volunteer Affordable Care Act Navigators in a Primary Care Clinic.” The authors address the development of the Student ACA Navigators program to help enroll uninsured individuals in the primary care setting. Read more about the program and their work here.

Duke-Margolis Center researchers and Faculty Members Nancy Allen Lapointe, Mina Silberberg, Virginia Wang, Trevor Lentz, Deborah Kaye, Corinna Sorenson, Robert Saunders, Brystana Kaufman co-authored a commentary in the Journal of the American Geriatrics Society on how health equity must be a component of value-based payment model design and evaluation. Read the commentary, “Improving Health Equity for Older People with Serious Illness through Value-Based Payment Reform,” here.

Duke-Margolis researchers William Bleser, Yolande Pokam Tchuisseu, Humphrey Shen, Andrea Thoumi, Deborah Kaye, Mark McClellan, and Robert Saunders published a two-part blog in Health Affairs Forefront that takes a closer look at improving equity through value-based payment (VBP) model design. The articles discuss and categorize design elements to address equity in CMMI’s new equity-focused VBP model as well as highlight examples of how some states and commercial payers have approached those same design elements. Read Part 1 and Part 2 of the blog series for more information.

Core Faculty Member Trevor Lentz co-authored a perspective, “Delivering Value Through Equitable Care for Low Back Pain: A Renewed Call to Action,” in the Journal of Orthopaedic & Sports Physical Therapy. The author discusses how social determinants of health, implicit provider biases, structural characteristics of the health care system, and health care policies contribute to disparate care for many individuals with lower back pain. Read more here.

Brystana Kaufman, a Duke-Margolis Core Faculty Member, co-authored “Improving Transitions in Care for Patients and Family Caregivers Living in Rural and Underserved Areas: The Caregiver Advise, Record, Enable (CARE) Act” in the Journal of Ageing and Social Policy. The perspective contends that bold action is needed to improve transitions from hospitals to home for aging patients and their family caregivers living in rural and underserved areas. Read more.

As the need for a more rapid and efficient means of rigorous clinical evidence generated about medical products from diverse practice settings increases, so has interest in point-of-care (POC) clinical trials. In a new white paper, Research Assistant Caleigh Propes and Research Director Rachele Hendricks-Sturrup discuss what constitutes a point-of-care clinical trial and identify factors impacting their feasibility, along with possible solutions and a roadmap to improve the feasibility and scalability of point-of-care trials. Read the white paper and learn more about the Duke-Margolis Real-World Evidence (RWE) Collaborative Point-of-Care Trials Working Group. Read more about a related Duke-Margolis effort, the Advancing Clinical Trial at the Point of Care coalition, ACT@POC and their upcoming public meeting.

Core Faculty Member Nathan Boucher and Duke Sanford student Emma Dries published “Developing the Future End-of-Life Health Care Workforce: Lessons Learned From a Survey of Advanced Health Professions Students,” in the American Journal of Hospice and Palliative Care. Their research examines the largest, multidisciplinary U.S. sample to-date, of health professions trainees’ end-of-life care knowledge, attitudes, and intentions and provides guidance for how we can train health professionals to improve population health by optimizing end-of-life care. Read more about their research.

A new report, “Tele-urgent Care for Low-acuity Conditions: A Systematic Review,” authored by Nathan Boucher, details the findings of a systematic review of the Department of Veterans Affairs tele-urgent care program. The evidence may indicate that tele-urgent care may be more likely to increase access via additional resources rather than the redirection of existing patient care use. Read more here.

Postdoctoral Research Associate Michelle Franklin and Core Faculty Member Gary Maslow co-authored “Inequities in Receipt of the North Carolina Medicaid Waiver Among Individuals with Intellectual Disability or Autism Spectrum Disorder” which highlights the need for policy reform to address inequities in access to the NC I/DD Waiver for individuals with intellectual and developmental disabilities as well as the need for innovative strategies to provide services to the 14,000+ people currently to receive the waiver. Read more about this work.

Postdoctoral Health Policy Fellow Salama Freed, Core Faculty Members Brystana Kaufman, Courtney Van Houtven, and Senior Research Director Robert Saunders co-authored “Using a Home Time Measure to Differentiate ACO Performance for Seriously Ill Populations,” published in the Journal of the American Geriatrics Society. The authors found substantial variation across ACOs in the Days at Home measure for seriously ill beneficiaries, suggesting the measure can differentiate between high- and low-value performing provider groups. Read more about this research funded by West Health Policy Institute.

HEALTH POLICY IN THE NEWS

In an interview with The Better Care Playbook, Senior Research Director Robert Saunders and Research Associate Jonathan Gonzalez-Smith discuss the Medicare and Medicaid policy options for expanding access to home-based care for people with complex health needs as well as their recent research exploring potential policy levers for supporting home-based care, with a focus on value-based payment. Read the interview here.

As part of Duke-Margolis’ continued work around development incentives for next-generation antimicrobials, the Center signed on to a letter to the leadership of the House Energy and Commerce Committee urging for the PASTEUR Act to be added to legislation that will reauthorize the Prescription Drug User Fee Agreement (PDUFA). Read the letter here. 

2:00 PM – 5:15 PM ET

The costs of clinical trials are high and are continuing to rise, resulting in slow innovation in many areas and limiting the types of sites that can run clinical trials. ACT@POC is convening a public meeting to explore the barriers to broader clinical trial participation by clinicians and patients at the point of care as well as new opportunities to overcome these barriers. Enabling more meaningful clinical research at the point of care will help close major gaps in clinical trial evidence generation, improve patient care, and move us towards a learning health system. Click here for more information and register for Achieving Broad Participation in Meaningful Clinical Research at the Point of Care. 

Duke-Margolis convened a private workshop to explore different, available opioid disposal options andconsider the potential impact and benefits of FDA requiring manufacturers to provide a safe, in-home disposal option. The opioid epidemic is not abating and safe and effective disposal methods for excess medication is one way to help combat the crisis. Duke-Margolis has released a meeting summary, which reviews different disposal methods, including opportunities and challenges related to the different methods. Click here to read the summary.

Equitable Access to Care: Leveraging Telehealth for Medicaid Beneficiaries in North Carolina

Duke-Margolis hosted a Virtual Town Hall to share results from a study, funded by the Kate B. Reynolds Charitable Trust, on telehealth use and equitable access to health care for people with Medicaid insurance in North Carolina.  The event included a panel of representatives from state agencies, healthcare provider groups, and community organizations who discussed the implications of this research for clinical, payment, and regulatory policies that would support equitable access to care for all people enrolled in Medicaid. Click here for the event recording and slide deck.

An FDA public workshop, convened through a grant with the Duke-Margolis, reviewed findings and lessons learned from the RCT-DUPLICATE Demonstration Project. The event, including opening comments by John Concato, Associate Director for RWE Analytics in the FDA’s Office of Medical Policy, was covered by Endpoints News. For more information, including recordings and background reading, can be found here.

During this public conference, stakeholders reviewed progress on strategic real-world data (RWD) and RWE policy development activities and on promising future applications of these data and evidence. Discussion topics included the recent FDA draft guidance for RWD and RWE as well as opportunities for the future of RWE. For more information about the event and to read the recently released white paper “Point-of-Care Clinical Trials: Integrating Research and Care Delivery” visit the event webpage.

Collaboration between academic researchers, industry, clinicians, patient organizations, and regulators can drive innovation and facilitate the use of translational science during clinical development. This two-day workshop focused on best practices for successfully bringing forward evidence generated through translational science for regulatory submissions. For more information, including workshop recordings, click here.

Duke University alumna and former Margolis Intern Julie Uchitel (’19) has been awarded the Knight-Hennessy Scholarship. The award provides full funding for the graduate program of her choice at Stanford University. Learn more about Julie, the scholarship, and her future plans here.

Duke-Margolis intern Sophie Hurewitz was recently included in the Bass Connections feature, “Senior Spotlight: Reflections from the Class of 2022.” Sophie’s work with Bass Connections has inspired her to “pursue my interests in child and family policy, health policy and educational policy alongside an MD degree.” Congratulations, Sophie, and good luck as you begin your work as a research assistant in the Down Syndrome Program in the Division of Developmental Medicine at Boston Children's Hospital.

In another Bass Connections feature, “Six Ph.D. Graduates Who Leveraged Bass Connections for Their Doctoral Training,” Margolis Scholar Ethan Borre was highlighted for his work leading a two-year project on hearing loss and his dissertation entitled “Economic Evaluation and Research Prioritization of Adult Hearing Screening in the United States.” Great job, Ethan.

Earlier this month, the Office of the Provost announced the 18 projects selected for funding, during the 2022-2023 academic year, through The Duke Endowment, which engage topics related to the issue of racial inequality. Duke-Margolis is delighted that Core Faculty Members Kate Bundorf, Brystana Kaufman, and Elizabeth Gifford were among the recipients included in this announcement. Click here to read more about each of proposals that engage with issues of particular relevance to Durham and North Carolina.

Barak Richman, Duke-Margolis Core Faculty Member, is the recipient of the Award for Innovation and Excellence in Teaching for his Ethics and Legal Issues in Health Analytics course. Each year, Master of Science in Quantitative Management students select faculty members to receive these awards based on teaching, approachability, continuous improvement, degree of challenge created for students, and use of innovation in teaching. Congratulations to Barak, and to Core Faculty David Ridley who was voted this year’s runner-up.

Earlier this month, Duke University School of Medicine announced the 2022 Chair’s Research Award recipients. We are proud to note that Duke-Margolis Core Faculty Member Deepshikha Ashana was among the recipients for her proposal, “Racial Disparities in Shared Decision Making for Patients with Acute Respiratory Failure.” Her project will be receiving one year of funding starting July 1, 2022. Learn more.

Senior Research Director Marianne Hamilton Lopez joined ISPOR 2022 as a panelist for their session “What Is the Preferred Approach to US Drug Pricing Reforms: International Reference Pricing or Value Based Pricing?” where she shared her perspective on US drug pricing reform. To learn more about this session and to read the accompanying materials click here.

Core Faculty Member Janet Prvu Bettger and former Margolis intern Sahil Sandhu participated in a webinar entitled, “Interdisciplinary Teams Addressing Social Risks: Workforce Models,” where they highlighted the role of interprofessional teams working to address social risks and needs across the five activities of awareness, adjustment, assistance, alignment, and advocacy. Click here to find out more.

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.