Research and Impact
Research Highlights
Implications of Pharmacy Benefit Manager Consolidation on Pharmaceutical Access and Related Disparities
Faculty involved: Amelia Bond, Pragya Kakani, Sean Nicholson
Ensuring medication access is an important public health priority. One important and under-explored factor that may influence medication access is increasing market concentration of pharmaceutical benefit managers (PBM), intermediaries engaged by health plans to manage prescription drug benefits, including designing formularies and pharmacy networks. PBM concentration may place financial pressure on pharmacies causing their closure or limiting new openings, especially in low-income and minoritized communities. In this study, CHPC faculty will use econometric methods to evaluate whether PBM concentration impacts pharmacy availability to inform antitrust policy.
School Medicaid Expansions and School-based Health Services
Faculty involved: Angelica Meinhofer, Maria Fitzpatrick, Peter Rich
School-based health services may address the healthcare needs of low-income children by providing primary, preventive, rehabilitative, and mental health care directly in schools, a convenient point of access that overcomes healthcare barriers such as transportation, time, cost, and care discontinuity. This project led by CHPC faculty is studying the effects of state school Medicaid expansions on Medicaid-funded school-based health services. Outcomes include (1) Medicaid provider enrollment by school districts, (2) school-based health services availability, and (3) number of students served. This study is part of a broader research agenda focused on understanding how school-based health services influence child health and related disparities.
Effect of Medicaid Expansion on Pharmacy Availability in Disproportionately Black and Hispanic Neighborhoods
Faculty involved: Pragya Kakani, Will Schpero, Sean Nicholson
The underuse of high-value medications is a major public health concern. Minoritized communities, which often bear a greater burden of disease, are especially affected. One important structural barrier to medication use among Black and Hispanic patients is limited access to pharmacies. Insurance expansions, which improve health care affordability and increase demand for prescription drugs, may meaningfully impact pharmacies’ financial health, thus improving pharmacy access. In this study, CHPC faculty are examining whether expansion of Medicaid eligibility under the Affordable Care Act increases the number of pharmacies in disproportionately Black and Hispanic neighborhoods.
Racial and Ethnic Disparities in Access to the Medicaid Transportation Benefit and Implications for Patient Outcomes
Faculty involved: William Schpero, Jamila Michener, Colleen Carey, Arnab Ghosh, Yasin Civelek, Martin Shapiro
Transportation is a critical social determinant of health care access, with over 3.6 million Americans lacking physical means to attend medical appointments. Since its inception, Medicaid has been federally mandated to provide transportation services through its non-emergency medical transportation (NEMT) benefit. In recent years, several states have argued that NEMT is unnecessary and have obtained federal approval to limit eligibility. In this study, CHPC faculty are examining the impact of NEMT policy on access to care, its association with racial/ethnic disparities in clinical outcomes, and the most effective ways to improve NEMT policies to mitigate these disparities.
Collaborative on Media and Messaging for Health and Social Policy
Faculty involved: Jeff Niederdeppe, Neil Lewis Jr., Jamila Michener, Colleen Barry
The collaborative is comprised of three interrelated hubs, including a Media Tracking Hub to track media discourse on health policy topics and understand how this coverage engages with broader narratives of racial justice and health equity; a Media Impact on Mindsets and Values Hub which conducts rapid-response survey-based experiments to assess the impact of common and aspirational media frames of health equity on support for policy interventions to address them; and a Engagement, Dissemination, and Implementation Hub to explore news production opportunities and constraints for journalists, health policymakers. and advocates and to disseminate results using a multi-modal approach to reach various actors in the media ecosystem.
Association of Optum Ownership of Physician Practices With Medicare Advantage Risk Scores
Faculty involved: R. Tyler Braun, Dhruv Khullar, Larry Casalino, Derek Lake, Sean Nicholson, Michael Richards
Optum, a subsidiary of UnitedHealth Group (UHG), is now a major employer of U.S. physicians, raising questions about insurer-owned practices (“payviders”) and patient risk scores that affect insurer payments. This cross-sectional study analyzed Hierarchical Condition Category (HCC) risk scores for Medicare beneficiaries at 24 Optum-acquired practices versus non-acquired regional practices from 2007 to 2022. Results showed that Medicare Advantage (MA) beneficiaries, especially those insured by UHG, at Optum-owned practices had significantly higher risk scores. In 2022, UHG MA beneficiaries at Optum practices had an average risk score of 2.13 versus 1.79 at non-payvider practices, leading to about $2,800 more per patient annually from the government. Policymakers should assess how insurer ownership of practices influences risk adjustment and payments.
Impact Highlights
Senate Request for Information on Primary Care Payment Reform
Faculty Involved: Dhruv Khullar and Amy Bond
Dr. Dhruv Khullar and Dr. Amy Bond submitted a letter to the offices of Senator Whitehouse and Senator Cassidy in response to a Request for Information about ways to support primary care providers through “hybrid” payment reforms. Hybrid payment models are those in which providers receive a mix of fee-for-service and capitated payments, which may offer them the financial stability and flexibility to improve care quality and health outcomes. The letter made several key recommendations, including (1) that payment should reflect the team-based nature of primary care; (2) that investments in primary care payment need not be budget-neutral; (3) that quality measurement should focus on a parsimonious set of meaningful measures; and (4) that payment should be risk-adjusted for medical, social, and regional factors.
Federal Policy on Nursing Home Ownership Transparency
Faculty Involved: Tyler Braun, Mark Unruh, Arian (Hye-Young) Jung, Larry Casalino
Research conducted by Drs. Tyler Braun, Lawrence Casalino, Hye-Young Jung, Mark Unruh, and colleagues on the impact of investments by private equity firms and real estate investment trusts on nursing home quality was influential in shaping a new federal rule on disclosures of nursing home ownership. This includes seminal studies cited by The White House to support initiatives for more transparency and accountability in nursing home ownership proposed in President Biden’s 2022 State of the Union Address and a report written for the US Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. The federal rule includes new requirements for reporting of individuals and entities with a financial interest in nursing homes, including specific provisions for reporting of private equity and real estate investment trust ownership.
Health Care Payment Innovation to Transform Kidney Care
Faculty Involved: Sri Lekha Tummalapalli
Nephrologist and health services researcher Dr. Sri Lekha Tummalapalli led the development of the Optimal Care for Kidney Health MIPS Value Pathway (MVP), in partnership with the Centers for Medicare & Medicaid Services and the American Society of Nephrology Quality Committee. This Merit-based Incentive Payment System (MIPS) Value Pathway aims to be an improvement over the current MIPS program by offering a more focused set of performance measures for nephrologists and nephrology NPs/PAs. The MVP incentivizes high quality, cost-efficient nephrology care and emphasizes continuous improvement and interoperability. The nephrology MVP serves as a case study of collaborative policymaking between a subspecialty professional organization and national regulatory agencies.
Developing Effective Warning Label Messages on Cigarette Packaging and Advertising
Faculty involved: Jeff Niederdeppe, Alan Mathios, Rosemary Avery, Sahara Byrne, Michael Dorf, Amelia Greiner-Safi
Findings from a NIH-funded study led by CHPC faculty cited in U.S. Food and Drug Administration’s Final Rule for “Tobacco Products; Required Warnings for Cigarette Packages and Advertisements,” March 18, 2020. Three papers were also cited in U.S. Food and Drug Administration’s Proposed Rule for “Tobacco Products; Required Warnings for Cigarette Packages and Advertisements,” August 16, 2019.
Understanding Breastfeeding Promotion, Initiation, and Support Across the United States: An Analysis
Faculty involved: Jeff Niederdeppe
Dr. Niederdeppe is a member of the the National Academy of Medicine’s Consensus Committee on Understanding Breastfeeding Promotion, Initiation and Support Across the United States. Work is ongoing and will continue throughout 2024 and into 2025 with a scheduled publication date of mid-2025.
Drug Pricing Reforms at the Centers for Medicare and Medicaid Services
Faculty involved: Colleen Carey
During the 2024/2025 academic year, Dr. Colleen Carey is serving as a Fellow at the Centers for Medicare and Medicaid Services. In this role, Dr. Carey will shape federal policy on drug pricing reforms related to the 2022 Inflation Reduction Act, which gave new powers to the federal government to negotiate prices for drugs in Medicare. Carey’s service sabbatical focuses on drug pricing reforms | Cornell Chronicle