Policy Matters: A monthly newsletter for Duke Faculty, Students, and Staff from the
Duke-Margolis Center for Health Policy
Policy Matters: November 2022
Monthly Highlights:
“At the end the day, we have such a terribly inefficient health care system . . . let's change the economic incentives so that a hospital, a physician group thrives because their patients are thriving. Time is growing short. We've got to get this right. We need a movement, we need the American people to say we're fed up, time is up, we've got to do things differently. And that's what we're trying to build.”

Frederick Isasi, Duke-Margolis Advisory Board member and Duke Law alumnus 2003, was the November Duke-Margolis Health Policy Talks Distinguished Speaker. In his presentation at Duke and to a national virtual audience, Fredrick addressed the process involved on the ground to pass the Affordable Care Act and how, more than a decade later, a new imperative has emerged to move the health of our nation forward—a serious, consumer driven movement to hold the health care sector accountable for costs and quality—a value imperative.

Click here to watch a recording of the event and learn more about the Duke-Margolis Health Policy Talks series.
“The Duke-Margolis Center for Health Policy has undoubtedly shaped the trajectory of my educational curriculum. When I first arrived at Duke, I initially planned to major in Biomedical Engineering and conduct biological research on autism. However, by engaging with Margolis-affiliated professors, upperclassmen, and staff, I soon learned that I could maximize my impact by pursuing a career in health policy. The Duke-Margolis Center then helped me capitalize on this interest by connecting me to researchers at Duke and policymakers at the state and federal level. The mentorship from the Center has been pivotal to my academic journey and I hope to continue my work here even as I continue my studies at Oxford."
- Shreyas Hallur, Duke-Margolis Scholar and 2023 Rhodes Scholar

Congratulations Shreyas on receiving the prestigious Rhodes Scholarship. Learn more about Shreyas and the third Duke-Margolis-affiliated Scholar to receive this impressive award.
The Duke-Margolis Center issued a report and recommendations on important steps for Medicare and other health care payment programs to enable more transformative participation by specialty care providers in accountable care payment models. The report, authored by Research Associate Mark Japinga, Senior Research Director Robert Saunders, and Center Director Mark McClellan, recommends creation of Specialty Condition-based Payment Models (SCMs), nested within an Accountable Care Organization (ACO) or other whole person care reforms, as a critical element for engaging specialty care in care transformation strategies. This report was developed and released in parallel to key strategic updates from the Center for Medicare and Medicaid Innovation (CMMI), including their steps to improve “person-centered, value-based specialty care” for beneficiaries. Click here to read the full recommendations and a fact sheet summary of the report.
The Health Affairs Forefront published the third blog in series by Duke-Margolis researchers William Bleser, Yolande Pokam Tchuisseu, Humphrey Shen, Andrea Thoumi, Deborah Kaye, and Robert Saunders. “Advancing Equity Through Value-Based Payment: Implementation and Evaluation To Support Design Goals,” explores opportunities to embed health equity further into attribution—a process that health plans use to assign patients to the providers who are held accountable for their care and a key element of value-based payment (VBP) design—and presents recommendations for advancing health equity during VBP model implementation as well as considerations for evaluating VBP models’ impact on health equity. The Center’s Forefront blog series has examined the design elements of ACO REACH and highlights opportunities to further embed equity into VBP design and implementation. Click here to read the latest blog.
The Gerontologist published an article co-authored by Core Faculty Members Nina Sperber, Courtney Van Houtven, and Nathan Boucher, with funding from the U.S. Department of Veterans Affairs, that demonstrates how research can inform implementation of policy by providing information about experiences of those for whom the policy impacts, in this case caregivers receiving training under a Congressionally mandated expansion of services. Read “Mandated caregiver training in the Veterans Health Administration: Caregiver inquiry informs national dissemination” by clicking here.
The Journal of General Internal Medicine published a review by Duke-Margolis Researchers Ethan Borre, Kamaria Kaalund, Gloria Zhang, Shelby Reed, Osondu Ogbuoji, and Gillian Sanders Schmidler entitled “The Impact of Hearing Loss and Its Treatment on Health-Related Quality of Life Utility: A Systematic Review with Meta-analysis” that identifies and synthesizes current estimates of quality of life for untreated and treated hearing loss. The goal of the review is to inform economic analyses and hearing health care and policy decision-making. Read more about the meta-analysis and what is reveals here.
Duke-Margolis Scholar Ethan Borre joined the Center’s Core Faculty Members Evan Myers and Osondu Ogbuoji and Deputy Director Gillian Sanders Schmidler in an original investigation published in JAMA Health Forum. “Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule” found that additional investment to clarify current uncertainties around optimal adult hearing screening may be a good use of resources. Click here to learn more.
Center Research Associate David Anderson co-authored a Health Affairs Forefront blog that examines the Affordable Care Act Insurance Marketplaces and the ways that the system could reduce frictions and increase retention rates. Read “Rethinking Marketplace Automatic Reenrollment Algorithms,” here.
The COVID Global Accountability Platform (COVID GAP) published two updates to their ongoing series of Accountability Reports, which 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.
Guiding NC Medicaid Value-Based Payment Strategy and Implementation

As part of a three-year contract, Duke-Margolis will assist the NC Department of Health and Human Services, Division of Health Benefits with the design and implementation of value-based payment (VBP) reforms to help advance the Department’s goals of better care, healthier people and communities, and smarter spending. Duke-Margolis will provide strategic and technical expertise on value-based care reforms and health care transformation through research, diverse stakeholder convenings, and evidence synthesis to improve health equity, health care quality, outcomes, affordability, and access to care. The contract will build on existing collaborations related to NC Integrated Care for Kids, recent Duke-Margolis research and policy analysis on integrating care for Medicare-Medicaid dually eligible beneficiaries, among other initiatives.
14th Annual Sentinel Initiative Public Workshop

Duke-Margolis hosted the 14th Annual Sentinel Initiative Public Workshop under a cooperative agreement with the Food and Drug Administration (FDA). The workshop featured a keynote from Dr. Patrizia Cavazzoni, Director for the Center for Drug Evaluation and Research (CDER) and presentations and discussions featuring Sentinel Initiative leadership on a range of key issues, including recent studies and applications of Sentinel to protect and promote public health during the ongoing COVID-19 pandemic and emerging monkeypox public health emergency.

Click here to watch the workshop recordings and to download the workshop materials.
Advancing Medicare Advantage Home-base Care

Duke-Margolis hosted a virtual private convening supported by the West Health portfolio to discuss progress to date, challenges, and policy opportunities for increasing offerings and uptake of Medicare Advantage regulatory authorities to offer home-based care and address social drivers of health.
Calling for Mentors: 2023 Margolis Summer Experience (Internship Program)
It may be hard to think about the summer as the leaves are turning color but here we are. Duke-Margolis Center is looking for members of the research and core-faculty teams to serve as summer mentors for our summer 2023 cohort. If you are interested in serving as a mentor and have an opportunity, please email Dev Sangvai and Tiffany Chan.
Margolis Scholars

Margolis Scholar and summer intern Cynthia Dong was the focus of an article published, this month, on Duke Research Blog. The article looks at Cynthia’s entrance into health policy and how, after seeing the health system’s COVID-19 response, led her to design her own major, Health Disparities: Causes and Policy Solution. Read more about Cynthia, her time as a Margolis Scholar, and what she plans on accomplishing after graduation.
The 2022 Learning and Action Network Summit featured a host of Duke-Margolis leaders. The overall goal of the LAN and the LAN Summit is to collaborate and act on strategies that will accelerate the transition to innovative, patient-centered payment models by focusing on equity, access to high-quality and affordable care, engagement of patients, and reduced provider burden.

  • Senior Research Director Rob Saunders moderated an expert panel to learn about the progress of the State Transformation Collaboratives from members in North Carolina, Colorado, Arkansas, and California. The Duke-Margolis Framework for Multi-Payer Alignment, which is funded by Arnold Ventures, has supported these multistakeholder transformation efforts.
  • Research Director Frank McStay moderated a fireside chat between Leah Binder and Jeff Micklos, co-chairs leading the work of the newly launched LAN Accountable Care Action Collaborative (ACAC). The goal of the ACAC is to act as a catalyst to influence the accountable care landscape and increase collaboration and alignment across key stakeholder groups. Indeed, at its core the ACAC is about fostering engagement and partnerships to create shared movement along the accountable care curve.
  • Director Mark McClellan delivered a keynote that highlighted the progress and future in health care transformation relative to CMS’ strategic progress – as well as an overview of the results of the annual LAN survey that tracks alternative payment model adoption across lines of business.
The work of current and former Duke-Margolis Researchers Rebecca Whitaker, Sam Repka, Yolande Pokam Tchuisseu, Abhigya Giri, Susan Dentzer, Janet Prvu Bettger, Gary Maslow, and Rushina Cholera was presented at the Association for Behavioral and Cognitive Therapies 2022 Convention. The poster, Behavioral Health Telehealth Utilization Among Pediatric Medicaid Beneficiaries in North Carolina, featured findings from the Duke-Margolis-led research project on telehealth utilization and access during the COVID-19 pandemic, particularly utilization patterns among pediatric Medicaid beneficiaries in North Carolina.

Rebecca Whitaker, Brianna Van Stekelenburg, and Montgomery Smith joined the Material Health Hub as speakers in their forum discussion on the pursuit of equitable perinatal care. The Duke-Margolis researchers discussed the biggest challenges in maternity care and the need to look toward primary care and population-based payment to meaningfully increase access to equitable perinatal care. Click here to view the meeting materials and a recording of the event.
Duke-Margolis Policy Analyst Kamaria Kaalund presented “A Policy Framework for Community-Based COVID-19 Testing: Lessons from the Radx-up Initiative” at the American Public Health Association (APHA) 2022 Annual Meeting in Boston, MA. The presentation explains five key policy levers for addressing health inequities in COVID-19 and beyond include: access, resource allocation, data, communication and messaging, and payment. Click here to learn more about her work.

Duke-Margolis Core Faculty Member Shelley Hwang co-authored an article, published in the journal Cancer Cell and featured in Duke Daily, detailing the development of a new gene classifier for DCIS recurrence or progression. DCIS is the most common precursor of invasive breast cancer and Shelley’s hope is that this work will “[give] us a real path forward to being able to personalize care by scaling treatments to the risk of cancer progression.” Read the full journal article and the Duke Daily feature.

The work of Core Faculty Member Gary Maslow was featured in the Duke University School of Medicine’s Magnify Magazine detailing his important role in the North Carolina–Psychiatry Access Line or NC-PAL. NC-PAL is a free telephone consultation and education program to help health care providers address the behavioral health needs of pediatric and perinatal patients. Read more about the program and their work here.

Core Faculty Member Deepshikha Charan Ashana co-authored a JAMA viewpoint about the challenge of providing emergency abortion care following the US Supreme Court Dobb’s ruling h this summer. Click here to read the full article.
Research Director Christina Silcox participated in two conferences in November. The topic of the first presentation, associated with the ReGARDD Forum, was “Regulating Innovative Medical Devices: Case examples from AI-enabled health software And Covid-19 testing.” Dr. Silcox also presented at the K-12 COVID-19 Response Across the Nation: What Worked, What We Learned, and What’s Next conference and contributed its panel entitled “The Evolution and Future of Diagnostics in K-12”.
Duke-Margolis Research Associate Victoria Gemme and Policy Analyst Caleigh Propes presented their work at two conferences:

  • At the International Neuroethics Society 2022 Annual Meeting poster session, the team presented “Assessment of Ketamine Treatment Practices for Patients with Post-Traumatic Stress Disorder (PTSD) in the United States.” The work explores the off-label use of ketamine, a dissociative drug, for mental health conditions in the United States and the need to balance novel treatments for unmet medical needs with appropriate safety guardrails for patients. Click here to learn more.
  • Victoria continued to promote her work with Caleigh as she presented during an APHA roundtable presentation entitled "Assessing Ethical Challenges Associated with Direct-to-Consumer (DTC) Telemedicine Clinics: A Case Study Approach" at the American Public Health Association 2022 Annual Meeting. This presentation covered the existing ethical challenges with DTC clinics, using off-label ketamine treatment and treatment for erectile dysfunction as case studies. Click here to learn more.

Core Faculty Member Barak Richman co-authored two new publications.

  • “Are Patient Satisfaction Instruments Harming Both Patients and Physicians?,” a viewpoint published in JAMA, looks at the efforts to measure quality of care and how metric have reliance on patient satisfaction surveys, both in public and private systems. Click here to read the full perspective.

The data use practices of direct-to-consumer (DTC) genetic testing companies, including when and how they share consumer genetic data with third parties, remain controversial. Duke-Margolis Research Director Rachele Hendricks-Sturrup published a collection of curated papers, “Privacy, Security, and Nondiscrimination Best Practices for Direct-to-Consumer (DTC) Genetic Testing Companies,” that aim to further understanding of privacy, security, and non-discrimination best practices for DTC genetic testing companies operating globally as well as the perspectives and concerns of diverse stakeholders. Click here to view the collection.

The Journal of Personalized Medicine published “A Survey of Research Participants’ Privacy-Related Experiences and Willingness to Share Real-World Data with Researchers,” co-authored by lead author Rachele Hendricks-Sturrup. The article offers first insights into how privacy-related experiences, adjusted for age range and education level, may shape the National Institutes of Health ResearchMatch participants’ willingness to share several sources of real-world data sources with precision medicine researchersClick here for a deeper dive into the research.
Team Welcomes
Kristen Ukeomah joins Duke-Margolis Center as a Policy Research Assistant supporting work across the Health Care Transformation workstream. Prior to assuming this role, she was an Associate for Strategy&, a part of the PwC network, for their Health Transformation practice. She comes to the center from the University of Pennsylvania, where she received a B.A. in Health and Societies, with a concentration in Health Policy and Law, and a minor in American Public Policy. Her past research includes evaluating the social construction of the crack cocaine epidemic as a criminal phenomenon as opposed to a health crisis.
Opportunities at Duke-Margolis Center for Health Policy

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.

Submissions Welcome!

Interesting Project? Funding Opportunities? News and Events? 
Awards and Honors? Policy Impact? Op Eds? 
We're looking for ways to highlight your accomplishments and share information.
Email submissions to [email protected].