December 2023

DIRECTOR'S MESSAGE

Today, December 1, 2023, marks an important day in these parts: it is the first day of North Carolina’s Medicaid expansion. While this date is circled in red on many calendars, it took years, even decades, to get here. Certainly, an event as momentous as this required many people and organizations working across multiple domains; the Sheps Center is one of those contributors. Projects at the Center over the past 20 years have chronicled the health, economic, and workforce effects of Medicaid generally and expansion specifically; investigators have provided ad hoc support to the State and other partners in terms of data and key considerations. 

Working with the State is not a new endeavor for us; 25 years ago, Sheps researchers estimated the number of children eligible for NC Health Choice, North Carolina’s State Children's Health Insurance Program (S-CHIP). Medicaid expansion is a great example of what we do here at Sheps and demonstrates the ultimate impact of our work. Much like our research on aging, chronic illness, and long-term care – which prevents falls among our seniors, improves care for those with dementia, and betters health through nutrition – years of work with Medicaid is now contributing to over 600,000 North Carolinians receiving insurance coverage. As the December holidays approach, you may be stuck sitting next to your annoying uncle who asks what “health services research” is; it’s nice to remember that in the end, the impact is on individuals whose lives are just a little bit better because of what we do.

SHEPSTER SPOTLIGHT!

Sam Morgan is the Research Administration team lead for the group of Research Administrators that serve the Sheps Center on behalf of the Office of the Vice Chancellor for Research Service Center. They work with the study teams at the Center to apply for and manage research funding. This includes budgeting and finance, research compliance, contracting and all other administrative aspects related to research at UNC. Sam and his growing team are a key component to the success of the Center and its brand. Sam’s colleagues at the Service Center who also support the Sheps Center include Nicole Eggleston, Tina Lathia, Emily Abshier, Eva Keele, and Lisa Foust.

Sheps Open House held during URW 2023

On Tuesday October 24th, the Sheps Center hosted an IT Core Open House. This event was part of a larger UNC Research Core Tour, which was organized during University Research Week 2023. As an introduction, Sheps Center Deputy Director for Data Analysis and IT, Brian Cass, spoke briefly on the history of the Center and what IT services and teams are available. The highlight of the open house was having researchers and data scientists showcase many projects that are supported by Sheps data and IT services, demonstrating the interdisciplinary nature of the Sheps Center.

AHRQ NRSA T32 Refunded for Another Five Years

For 34 years the Sheps Center has offered a fellowship, available to predoctoral and postdoctoral trainees, that is focused on health services research and policy analysis. The program is supported by a National Research Service Award (NRSA) Institutional Training Grant from the Agency for Healthcare Research and Quality (AHRQ). We are excited to announce that this summer the fellowship was renewed for another five years leading to a successful recruitment for Year 35 which is currently underway.



This interdisciplinary cohort is represented by several different departments and divisions: hematology, sociology, surgery, maternal & child health, oncology, epidemiology, nutrition, and pharmaceutical outcomes & policy. Trainees participate in weekly seminars consisting of presentations and works-in-progress. They also present their work at national conferences such at AcademyHealth's Annual Research Meeting. The fellowship provides these trainees with dedicated office space and access to Sheps resources and data.

The fellowship is also supported by generous donations to the Center, which enables trainees to attend conferences, allowing them opportunities to network and make connections which is crucial in the job market of health services research.

North Carolina Medicaid's 1115 Waiver aims to shift the state's Medicaid programs from fee-for-service payments to a capitated payment system to improve Medicaid beneficiary health outcomes, enhance program viability, and address substance use disorders. The waiver is comprised of two key components: restructuring delivery and payment systems, and addressing the statewide opioid epidemic and substance use treatment needs. The Sheps Center is conducting the external evaluation through interviews, focus groups, surveys, and administrative data analyses.  The evaluation team recently submitted the Managed Care (MC) Interim Evaluation Report, which specifically focuses on the elements related to transforming the delivery and payment systems, initiated on July 1, 2021. Utilizing data sources such as Medicaid enrollment and claims, the report offers initial evaluation findings on quality of care, process of care, and health outcomes, emphasizing the initial goals of system transformation.

The evaluation study period spans from November 1, 2019 to February 28, 2023 with Standard Plans launching on July 1, 2021, a significant component of the waiver. The analysis compares trends before and after the launch, accounting for observable variables and addressing the effects of the COVID-19 pandemic, utilizing interrupted time series models.

The Advanced Medical Home (AMH) program was introduced to provide and coordinate care management. It features three levels, each with increasing care management obligations. The report outlines the AMH program's structure by examining whether there were differences in outcome measures between level 3 AMH and levels 1-2 AMHs, accounting for varying factors such as beneficiary and practice-level characteristics.

The report is currently under review by the Centers for Medicare & Medicaid Services and will be released to the public upon review completion.

Despite widespread recognition that social determinants of health are critical to improving health care outcomes, limited progress has been made in integrating care for patients’ medical needs and social needs, such as housing insecurity, food insecurity, and transportation. In their prior work, the team identified that the lack of effective partnerships spanning health care and social service organizations is a critical barrier to successful efforts to address patients’ social needs to influence their health and health care outcomes. 

With support from The Duke Endowment (TDE), a team led by Valerie Lewis, PhD in partnership with researchers at Duke University and New York University will be identifying successful partnership approaches between health care and social service organizations to inform policymakers, payers, health care providers, community-based organizations, and other stakeholders to accelerate the development of effective partnerships to integrate care for medical and social needs. In addition, the project focuses on three states taking very different approaches to addressing health-related social needs (NC, MN, and NY) to understand the role policy can play. 

To launch the project, the team recently held a virtual convening of 30 stakeholders representing federal and state policymakers, health care providers, health care payers, and social service providers to understand challenges and opportunities faced in trying to establish such partnerships within the landscape of their state’s policies. Building off learnings from the convening, the team will now collect in-depth data across the three states through interviews and in-person site visits. The project will generate evidence on best practices in cross-sector partnerships as well as how policy can facilitate or accelerate these partnerships.

Food as Medicine for Families (FAME-F), American Heart Association, PI: Seth Berkowitz, MD, MPH

This project proposes a 2x2 factorial randomized clinical trial of medically tailored meal delivery (MTM) (N=100). The study will compare feeding the entire household vs. feeding a specific individual on changes in diet quality, and it will compare using an in-person delivery driver vs. a shipping company to deliver the meals on loneliness. This is a pilot trial, meant to help determine the optimal design of subsequent MTM interventions.

FOCUS, Gilead Sciences, PI: Nick Piazza, MD

The United States Preventative Services Task Force recommends HIV screening for all adolescent and adult patients aged 15-65 years old and anyone who is pregnant, and recommends hepatitis C virus screening for adult patients 18-79 years old. Many patients at risk of infection often do not have regular access to primary and preventative care and often their only exposure to healthcare occurs during a hospital encounter. This project aims to utilize hospital encounters as touch points with unscreened patients to provide screening. 

Rural Hospitals: Who Owns Them & the Effect of Hospital Mergers and Acquisitions on Local Economic Outcomes, Arnold Ventures, PI: Tyler Malone, PhD

This research project on rural hospitals has two components. The first component examines the ownership of rural hospitals and whether ownership type differs by hospital and local community characteristics. The second component investigates the effect of rural hospital mergers and acquisitions (M&As) on local economic outcomes. 

CaroNova Access Health Data & Analysis, NC Healthcare Foundation, PI: Erica Richman, PhD, MSW

The Sheps Center and CaroNova will partner in transferring North Carolina Healthcare Association (NCHA) data to the Sheps Center so Sheps data scientists can ingest the data, process it into dashboard tables that can be entered into NCHA’s Tableau dashboard, and then send it back to the data owner. The process will be automated to the extent possible so that each year following year one will take less effort to complete. Together, Sheps and CaroNova will craft and execute a data-sharing agreement and a member of the Sheps team will be available to annually present findings to CaroNova/NCHA leadership. 

Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity Program (AIM-AHEAD), NIH, Co-PIs: Junier Oliva, PhD & Sean Sylvia, PhD

Through a unique marriage of AI methodological research and behavioral science, the long-term objective is to develop an approach that complements, rather than substitutes for, provider and patient knowledge. In this two-year study, the team has the following specific aims: 1) Build a digital platform for human + AI joint decision-making experiments and assess the causal effects of AI-generated support information on patient and provider making; 2) Develop novel algorithms that learn how to summarize and highlight key patient case attributes and AI explanations to transparently support human decision-making; 3) Assess the feasibility and acceptability of AI-enabled decision support tools for patients and providers in community centers. 

Caroline Foster, PhD

Sheps Project Manager

Caroline joined UNC over the summer from her previous role as project manager in a corporate public health consulting environment. At the Sheps Center she serves as the project manager for three of Dr. Valerie Lewis’ projects, focusing on health care payment and delivery reform.

Kevin Lee

Integrated Research Solutions (SIRS)

Kevin started working with the Sheps Integrated Research Solutions (SIRS) team in June 2023 as the new junior software engineer. Kevin is also a US Army Veteran and continues to serve in the National Guard. He has been a fantastic addition to the team, helping on multiple projects - especially the Heart2Heart study.

Brooke Lombardi, PhD, MSW

Workforce Research Program

Brooke is a Research Associate with the Carolina Health Workforce Research Center and the Behavioral Health Workforce Research Center. Her work focuses on the intersection of sexual victimization and the perinatal period (conception to one-year postpartum); screening for post-traumatic stress disorder during the perinatal period; and promoting clinician competencies in caring for survivors of trauma during the perinatal period.

Mark Heinen

Program on Aging, Chronic Illness, and Long-Term Care

Mark is a Research Assistant at the Sheps Center. He has worked with autistic adults and children providing instructional support for acquiring daily living skills, assistance with developing independent communication, and increasing enrichment through community engagement. His interest in research stems from his passion for increasing the quality of services and care to vulnerable populations, and the furthering of disability rights.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC), UNC-Chapel Hill, UNC Health Alliance, and Duke Health joined forces for Healthy Food First, a randomized controlled trial working to improve food security and high blood pressure.

A healthy diet has been shown to improve health, but food insecurity makes it difficult for individuals to follow a healthy diet. Though the harms of food insecurity are clear, the best way to intervene is not. The Healthy Food First clinical trial aims to compare different ways of providing access to healthy food to improve health—in particular blood pressure. Participants receive either a food box delivered to their house twice per month or a $40 food subsidy for the grocery store, with or without additional health coaching from a community health worker.

Blue Cross NC is the sponsor of the study, and their staff participate as study investigators. UNC-Chapel Hill researchers, Darren DeWalt, MD, MPH, Seth Berkowitz, MD, MPH and Alice Ammerman, DrPH are leading the study in partnership with UNC Health Alliance who provided community health workers and dietician support for participants. Duke Health helped to recruit participants from their health system. Blue Cross NC, utilizing support of its data scientists and analysts, will conduct an analysis of participant claims data after the study concludes to examine the impact the intervention had on insurance costs.

PUBLICATION SPOTLIGHT

Dr. Paul Lanier's recent paper, "Comparing Medicaid Expenditures for Standard and Enhanced Therapeutic Foster Care," examined Medicaid costs for 1,190 youth who received therapeutic foster care services in North Carolina in 2018-2019. This paper follows up on prior work supporting the effectiveness of these community-based services to reduce utilization of higher levels of behavioral health care. The team analyzed claims data in the years before and after initiation of services. They found that youth who received therapeutic foster care had increasing costs in the years prior to service initiation, then had a significant and sustained reduction in costs after services were initiated. Further, they found that this trend was similar for both standard and enhanced therapeutic foster care services. This is the first study in the United States to examine costs of care for children receiving therapeutic foster care and has provided important evidence for state policymakers and other partners seeking to improve access to effective community-based services that can also reduce overall costs of care.

A full list of Sheps Center publications from August 2023 - November 2023 can be found here.