2016 New Investigators
Hilary Barnes, Ph.D., C.R.N.P.
Research Topic: General Health Services Research (funded by AcademyHealth)
Institution: University of Pennsylvania
Research Title: The Longitudinal Effect of Scope of Practice Regulations on Nurse Practitioners Supply, Medicaid Acceptance, and Access to Care within Physician Practices
Under The Affordable Care Act, millions of individuals have gained coverage through health insurance expansion causing an increase in demand for healthcare services. Many health policy experts worry about provider shortages and limited access to care, especially for Medicaid beneficiaries. Strategies to improve access to care include expanding the supply and availability of nurse practitioners (NP). However, restrictive NP scope of practice (SOP) regulations may limit the effectiveness of NPs in meeting demand. Research has found that the least restrictive NP practice environments are most promising in increasing the availability of NPs and practice Medicaid acceptance. However, little is known about the longitudinal effects of NP SOP on the number of NPs in ambulatory practices and subsequent access to care. The purpose of this study is to examine the longitudinal effect of changes in NP SOP on the presence of NPs in ambulatory practices, practice Medicaid acceptance, and patient access to care. NP SOP reform is an ongoing debate at both state and federal levels. The findings from this study have the potential to inform SOP regulation reform so that states are able to ensure a sufficient number of healthcare providers to meet growing patient demand.
Hilary Barnes is a postdoctoral research fellow in the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. She is a family nurse practitioner and received her Ph.D. in Nursing Science from Widener University in Chester, Pennsylvania (2013). Her research focuses on the nurse practitioner (NP) workforce and the influence of state-level practice and reimbursement policies on NP workforce distribution, practice Medicaid acceptance, and access to care. Dr. Barnes is also interested in the impact of NP-delivered care on patient outcomes in ambulatory settings. She holds a B.A. from Skidmore College, a B.S.N. from the University of Pennsylvania, and a M.S.N. from Widener University. Her clinical background includes emergency nursing, surgery/surgical oncology, and addiction/behavioral health. Dr. Barnes is also a Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania.
Joseph Benitez, Ph.D.
Research Topic: General Health Services Research (funded by AcademyHealth’s President Fund)
Institution: University of Louisville
Research Title: What are the Effects of Medicaid Non-Expansion on Disproportionate Share Hospital Care?
Hospitals receiving funding under the Medicaid Disproportionate Share Hospital (DSH) program will begin receiving reduced payments per the Affordable Care Act (ACA). DSH-funded hospitals in many areas help to anchor local health care safety nets by providing a substantial share of care to patients with limited resources to pay. Adverse effects of the DSH cuts were anticipated to be offset by reductions in uninsurance facilitated through state-based Medicaid eligibility expansions, however many states did not expand Medicaid. Not expanding Medicaid may place some hospitals at financial risk which may exacerbate existing disparities in access to hospital care. Because of the financial realities of many hospitals, it is important to characterize the impacts of non-expansion on hospital performance and patient care; this research focuses on the expansions’ effects on hospital volumes of uncompensated care, hospital operating margins, and hospital coverage mixes.
Joseph Benitez is an assistant professor in the Department of Health Management and Systems Sciences in the University of Louisville’s School of Public Health and Information Sciences. He received a Ph.D. (2015) from the Division of Health Policy and Administration at the University of Illinois-Chicago. His major scope of research interests include: 1) public policy related to health and healthcare, 2) access to care & health disparities among the medically underserved, and 3) evaluating the effects of public investments in the healthcare safety net and disadvantaged populations. Dr. Benitez is also a faculty affiliate of the Commonwealth Institute of Kentucky—a multidisciplinary collaborative for population health improvement and health policy analysis at the University of Louisville. Presently, Dr. Benitez is focusing on the effects of the ACA-related Medicaid expansions on access to care and health care utilization. In some of his other projects focusing on the impacts of expanding Medicaid, he is investigating the effects of raising eligibility limits on out of pocket medical expenditures, discontinuous Medicaid coverage (i.e. churning), and disparities in access to care and utilization of preventive medical services.
Christine Gunn, Ph.D., M.A.
Research Topic: General Health Services Research (funded by AcademyHealth)
Institution: Boston University
Research Title: Perceptions of Breast Density Notifications Among a Low-Literacy Population: An Opportunity for Patient-Centered Communication
This research seeks to assess the impact of the newly enacted breast density notification mandate for women undergoing mammography in Massachusetts. State breast density laws have been advocated on the premise that notification will increase knowledge and empower women to make informed decisions about breast cancer screening, yet there is no evidence that this goal has been attained. Legislating the content of breast density notification letters has potential negative effects on the provision of patient-centered care, particularly if the letters are not appropriate for a wide range of health literacy levels. If certain populations do not understand these notifications and therefore do not receive screening services in parity with majority populations, existing disparities in breast cancer outcomes may be exacerbated. The project aims to understand women’s awareness and understanding of breast density, perceptions of breast cancer risk, and subsequent screening behaviors following the receipt of a letter indicating they have dense breasts. Qualitative interviews will be conducted with women aged 40-75 who have undergone a mammogram at a local safety-net hospital and received a notification of dense breast findings. Results will guide the development of a revised patient notification letter and policy brief to initiate changes in how notifications are written and disseminated, particularly to women with low literacy levels.
Christine Gunn is a research assistant professor at the Boston University School of Medicine, Section of General Internal Medicine, with a joint appointment at the Boston University School of Public Health, Department of Health Policy and Management. Her research is primarily conducted within the Women’s Health Unit, a National Center of Excellence in Women’s Health. Her doctoral dissertation was funded in part through the Susan G. Komen Post-Baccalaureate Training Program in Disparities Research. She received her Ph.D. in Health Services Research from the Boston University School of Public Health in 2015.
Dr. Gunn’s research addresses how patients and providers communicate and make decisions about screening and prevention. She focuses on the multitude of ways in which women are signaled to be at risk for developing breast cancer, with a particular interest in how current screening processes affect vulnerable populations who suffer poorer breast cancer outcomes. Her current projects focus on re-designing screening communication processes for low literacy women and those with limited English proficiency. Dr. Gunn has extensive experience in qualitative research methods and uses a mixed methods approach to studying cancer risk and prevention behaviors.
Andrew Roberts, Pharm.D., Ph.D.
Research Topic: Medicaid (funded by Association for Community Affiliated Plans)
Institution: Creighton University
Research Title: Dissecting Medicaid Lock-in Program Circumvention: Lessons for Drug Abuse Policy
Medicaid lock-in programs (MLIP) are a highly prevalent policy intervention intended to curb prescription drug abuse and misuse. Patients enrolled in MLIPs are “locked in” to, typically, one prescriber and one pharmacy for Medicaid coverage of prescriptions for opioid analgesics and other select high-risk medications. Momentum is building for broader implementation of MLIP-type policies to address the prescription drug abuse epidemic despite a very limited evidence base supporting MLIPs as a tool for mitigating problematic opioid use and improving public health outcomes. This sequential explanatory mixed methods study aims to address this gap in knowledge by examining opioid use trajectories among patients enrolled in the North Carolina MLIP. This project seeks to provide new understanding about how lock-in policies influence opioid-seeking behavior, the potential limitations of the MLIP policy strategy, and the appropriate role of MLIPs and related programs in our policy efforts against prescription drug abuse.
Andrew Roberts currently serves as assistant professor in the Department of Pharmacy Sciences at the Creighton University School of Pharmacy and Health Professions, as well as Program Faculty in Creighton’s Center for Health Services Research and Patient Safety. His health services research program aims to improve the quality, accessibility, and outcomes of medication use, particularly in low-income populations. Dr. Roberts’s current work is focused on improving the public health benefit of policy interventions designed to combat prescription drug abuse and prevent overdose deaths.
Dr. Roberts received his Ph.D. from the Division of Pharmaceutical Outcomes and Policy at the UNC Eshelman School of Pharmacy in Chapel Hill, North Carolina. He also completed a NRSA T32 postdoctoral fellowship from the Cecil G. Sheps Center for Health Services Research at University of North Carolina at Chapel Hill. Prior to his graduate research training, Dr. Roberts earned his Doctor of Pharmacy from Drake University.
Sherri Rose, Ph.D.
Research Topic: General Health Services Research (funded by AcademyHealth)
Institution: Harvard Medical School
Research Title: Improving Medicare Advantage Plan Payment Risk Adjustment with Machine Learning
The trajectory of risk adjustment methodology, particularly as practiced in payment models developed by the federal government, has been largely frozen for decades, failing to incorporate statistical advances that could yield more accurate formulas. This is a potentially costly oversight, as risk adjustment is extensively employed in plan payment, where it attempts to control for the impact of consumers choosing their own health plans. Currently, these models are estimated using classical linear regression. Therefore, a strong limitation of risk adjustment procedures in the federal Medicare Advantage managed health care program is that the estimation techniques have not adapted to include newer methods, such as machine learning. Insurers are responsible for reporting the diagnostic conditions used to calculate patient risk scores, and enrollees with more diagnostic conditions obtain larger payments from the government. This leaves insurers incentivized to code more intensely to increase revenues. The core goal of this project is to study how improving estimation techniques changes the performance of risk adjustment compared to existing formulas.
Sherri Rose is an assistant professor in the Department of Health Care Policy at Harvard Medical School. Her work is centered around developing and integrating innovative statistical approaches to advance public health and health care research. Broadly, Dr. Rose's methodological research focuses on nonparametric machine learning for causal inference and prediction. Within health policy, Dr. Rose works on risk adjustment and health care program impact evaluation, and is a faculty member in the Healthcare Markets and Regulation Lab at Harvard. She also co-leads the Health Policy Data Science Lab. Dr. Rose received her Ph.D. in Biostatistics from the University of California, Berkeley where she coauthored the book "Targeted Learning: Causal Inference for Observational and Experimental Data for the Springer Series in Statistics.”
Yhenneko Taylor, Ph.D., M. Stat.
Research Topic: Maternal and Child Health (funded by March of Dimes)
Institution: Carolinas HealthCare System
Research Title: Insurance Status and Healthcare Experiences of Urban Pregnant Women
Low-income women experience multiple barriers to adequate utilization of prenatal care and are less likely to have early initiation of prenatal care, which exacerbates their higher risk for poor pregnancy outcomes. This study will evaluate how patterns of care and outcomes differ between commercially-insured and uninsured/Medicaid-insured women in Mecklenburg County, North Carolina, a state that did not expand Medicaid eligibility criteria as allowed by the Patient Protection and Affordable Care Act (ACA) of 2010. Using a retrospective analysis of hospital clinical and billing data and analysis of survey responses, this research will characterize patterns of healthcare use and experiences of low-income pregnant women while accessing healthcare during the preconception, prenatal and postpartum period. Findings from this study will inform a community-based participatory approach to designing and testing interventions to improve access to care and health outcomes.
Yhenneko Taylor serves as the director of outcomes research and evaluation for Dickson Advanced Analytics at Carolinas HealthCare System. Her research areas include health disparities and program evaluation with a focus on maternal and child health and chronic diseases. Her most recent work includes an analysis of the impact of wealth and literacy on the content of prenatal care among women in West Africa and an evaluation of the impact of shared decision making on quality of life among children with asthma. Dr. Taylor received her masters in statistics from North Carolina State University and her Ph.D. in health services research from the University of North Carolina at Charlotte.
2015 New Investigators
Michel Boudreaux, Ph.D., M.S.
Research Topic: Maternal and Child Health (funded by March of Dimes)
Institution: University of Maryland
Research Title: Born on Reform: Infant Health and Health Reform in Massachusetts
This project investigates the effect of Massachusetts health reform on infant and maternal health. Unlike previous expansions of public health insurance, the Massachusetts reform did not condition eligibility on pregnancy. Women gained coverage prior to critical periods in early pregnancy. Data will come from the Detailed Natality Files which includes information on prenatal care, birth weight, gestational age at birth, Apgar scores, and maternal hypertension. Overall impacts and reductions in race based disparities will be considered. To isolate causal impacts, a quasi-experiment design that compares changes in Massachusetts to changes in a set of control states will be used.
Michel Boudreaux is an assistant professor in the Department of Health Services Administration in the School of Public Health, University of Maryland, College Park. He received a Ph.D. (2014) in health services research, policy, and administration from the University of Minnesota. Boudreaux conducts research in two primary areas. His substantive area of interest is in the evolution of health and socioeconomic position across the life-course and between generations, with a special emphasis on the impacts of health policy in early childhood. He also conducts survey methods research that focuses on the measurement of health insurance and health care access in federal surveys. His work has appeared in Health Affairs, Health Services Research, Medical Care, Medical Care Research and Review, and Inquiry.
Melissa Bright, Ph.D., M.S.
Research Topic: Medicaid Managed Care (funded by Association for Community Affiliated Plans)
Institution: University of Florida
Research Title: Transition to Medicaid Managed Care: Impact on Health Quality for Foster Youth
Foster youth demonstrate an array of complex health care needs including comorbidities of physical, mental, and developmental conditions. Unfortunately, less than half of all US states reached performance standards for providing foster youth adequate services to meet their physical health needs. The current project evaluates the impact of managed care on health care quality for foster youth using a two-state comparison and longitudinal design. Health quality indicators will be examined for a state which transitioned foster youth from fee-for-service (FFS) to managed care (Texas) and for a state which primarily enrolled foster youth in FFS during that time (Florida).
Melissa Bright is an assistant research scientist in the Department of Health Outcomes and Policy at the University of Florida College of Medicine and faculty with the Institute for Child Heath Policy at the University of Florida. As a health services researcher, she currently oversees the contracted evaluation for Florida KidCare, the umbrella program for Florida’s Medicaid and Children’s Health Insurance Program (CHIP), examining enrollment trends, caregiver experiences, and quality of care for enrollees. Her research program focuses on childhood adversity (e.g., maltreatment, intimate partner violence, caregiver mental illness) and pediatric health at the levels of the family, the community and clinic, and policy. Her current projects span three interrelated lines: 1) surveillance of adversity among low-income children, 2) understanding the role of the pediatrician in identifying and addressing adversity, and 3) health care delivery systems for foster youth. Additionally, Dr. Bright is interested in the role of child advocacy in the overall health and well-being of foster children and the implementation of care for victims of child maltreatment in Florida’s Guardian ad Litem Program. The ultimate goal of Dr. Bright’s work is to improve the health and health care quality for children who experience or are at risk for experiencing maltreatment.
Eva DuGoff, Ph.D., M.P.P.
Research Topic: General Health Services Research
Institution: University of Wisconsin – Madison
Research Title: Socioeconomic Factors and Pay for Performance Measurement in Medicare Advantage
Recent evidence on the implementation of pay for performance programs suggests that providers serving low socio-economic status (SES) patients are more likely to be penalized, which may have a detrimental impact on care quality and access for disadvantaged populations. This study will assess the influence of patient SES on Medicare Advantage plan performance reported in the Medicare Advantage 5-star program in 2015. This study will provide new evidence to policymakers on the influence of patient-level SES on performance measures.
Eva H. DuGoff is an assistant professor in the Department of Population Health Sciences at the University of Wisconsin-Madison School of Medicine and Public Health. Professor DuGoff ‘s research focuses on two questions: 1) what is optimal health and health care in the context of multiple chronic conditions; and 2) what is the relationship between quality of care and health outcomes.
Professor DuGoff is currently working with Gerard Anderson and colleagues at The Johns Hopkins University Bloomberg School of Public Health on a Commonwealth Fund project examining programs targeting high cost high needs beneficiaries. With the support of the AcademyHealth New Investigator Award (2015), she will study the influence of patient socio-demographic factors on pay for performance measures in the Medicare Advantage program.
At the University of Wisconsin-Madison, Professor DuGoff is an affiliate of the Center for Demography and Ecology and Center for Demography of Health and Aging. Her work has appeared in peer-reviewed journals including Medical Care, Health Services Research, and eGEMs.
Professor DuGoff earned her Ph.D. in public health from The Johns Hopkins University in 2014. From 2008 to 2009, she served as a legislative assistant to Senator Ron Wyden (D-Ore.). She received her M.P.P. from The George Washington University and her B.A. from Georgetown University.
Rachel Hogg, Dr.P.H., M.A.
Research Topic: Population Health (funded by AcademyHealth’s President Fund)
Institution: University of Colorado Denver
Research Title: HealthCare Organization Participation in Public Health Systems and the Efficiency of Service Delivery
The delivery of public health occurs through the combined effort of many government, public, and private organizations, including health care providers such as hospitals, community health centers, and physician organizations. Understanding how effectively and efficiently public health is delivered in communities must take the range of organizations that participate in delivery, planning, or financing into consideration. This study seeks to address gaps in research and literature surrounding the bridging of health care and public health systems by examining how health care organization contributions to the provision of essential public health activities impacts the efficiency at which the activities are delivered.
Rachel Hogg currently serves as the Public Health Services and Systems Research Postdoctoral Fellow at the University of Colorado Denver School of Public Affairs. Her research focuses on public health system organization and composition, interorganizational relationships, and efficiency analysis in public health service delivery. Hogg obtained her Dr.P.H. in health services management from the University of Kentucky College of Public Health.
Olufunmilola Abraham, Ph.D., M.Sc.
Research Topic: General Health Services Research
Institution: University of Pittsburgh
Research Title: OTC Sleep Aids: Older Adult Medication - Taking Behavior and Safety Risks
There is increasing concern over the safety risks associated with extensive and unintentional misuse of over-the-counter (OTC) sleep medications by older adults. Misuse of these medications may occur because patients are unaware of their risks and regard them as safe because of their availability without a prescription. The Beers Criteria for potentially inappropriate medication use in older adults recommends avoidance of antihistamines (diphenhydramine and doxylamine) commonly found in OTC sleep medications. A sequential exploratory mixed-methods design was used to investigate the prevalence of unintentional misuse of OTC sleep medication and knowledge gaps of older adults. A design will be employed.
Olufunmilola K. Abraham is an assistant professor in the Department of Pharmacy & Therapeutics at the University of Pittsburgh (Pitt) School of Pharmacy. She also has a secondary appointment as an Assistant Professor at the Pitt Clinical and Translational Science Institute (CTSI). Dr. Abraham is an affiliate faculty member in the Pitt Center for Pharmaceutical Policy and Prescribing (CP3). She received her Bachelor of Pharmacy (B.Pharm) degree from University of Lagos in Nigeria, where she practiced as a hospital and community pharmacist. Dr. Odukoya received her M.S. and Ph.D. in Social and Administrative Pharmacy from the University of Wisconsin-Madison (UW) School of Pharmacy. While at UW, she obtained her Ph.D. minor in Industrial and Systems Engineering, focusing on human factors and patient safety. Dr. Abraham is nationally recognized for her extensive research on the impact of e-prescribing on medication safety and pharmacy workflow in community which has been published in several high-quality peer-reviewed journals. Dr. Abraham is a member of the American Pharmacists Association, the Pennsylvania Pharmacists Association, and the American Association of Colleges of Pharmacy.
As a pharmacist and health services researcher, Dr. Abraham's research centers on applying systems engineering approaches to improving patient care processes and health outcomes in community settings. She is currently directing a variety of studies focused on ensuring safe and effective use of medications for individuals with chronic conditions in the community. Her work has been previously supported by the Community Pharmacy Foundation and the University of Pittsburgh CTSI.
Wendy Xu, Ph.D., M.S.
Research Topic: General Health Services Research
Institution: Ohio State University
Research Title: Evaluation of the Utilization and Distributional Effects of Expanding Medicare Coverage of Preventive Cancer Screening under the Affordable Care Act
Under the Affordable Care Act (ACA), Medicare provides full coverage for screening mammography and colonoscopy for breast and colorectal cancers. Before that, a 20% coinsurance rate was applied to these services. There is urgent need to understand the equity issue of insurance coverage. Yet three years later, we still lack important knowledge of the effects of this major change in insurance coverage for screening utilization and its distributional effects. Our project will address this research gap by providing timely estimates of the financial and behavioral impacts of the recent Medicare cancer screening coverage expansion on mammogram and colonoscopy.
Wendy Xu is an assistant professor at the Division of Health Services Management and Policy, College of Public Health, Ohio State University. She received a Ph.D. in Health Services Research Policy & Administration from University of Minnesota. Her research examines the impact of insurance benefit regulations/reforms on health care utilization, costs and cross-subsidization. Her recent projects investigated the effects of state mandated benefits of cancer screenings on consumption and income cross-subsidies, the behavioral and financial consequences of Medicare cancer screening coverage expansions, as well as the complex relationship of quality and costs of care for Medicare diabetic patients. With the support from Academy Health, Wendy currently evaluates the utilization and distributional effects of expanding Medicare coverage of preventive cancer screening under the Affordable Care Act. She is also a co-investigator of a PCORI-funded project studying the care coordination and patient-centered outcomes of children with disabilities using Ohio Medicaid claims data. Wendy has extensive experiences in using large insurance claims data sets as well as survey data sets with advanced statistical tools.