Research

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Our active research projects are of three types: Health Policy Research, Health Reform Implementation, and Health Policy Communication. Click Active Projects for descriptions of each of our current projects.

The purpose of health policy research is to improve health policy debates, policy development, and implementation. CHPRE work is directed at the national, state, and local levels, for all three have unique roles to play in enabling health policy to improve real people’s lives. We research both health insurance and delivery system topics, wherein population health is an increasingly important focus since comprehensive health reform has become national policy (at least for now).

Len Nichols and CHPRE key part of Virginia team that won a State Innovation Model Grant from CMMI/CMS

VCHI-logoThe Center for Medicare and Medicaid Innovation, the part of CMS created by the Affordable Care Act, announced in December 2014 that the Virginia Center for Health Innovation along with multiple partners, including the Center for Health Policy, Research & Ethics, was awarded a $2.6 million federal grant to develop new statewide health care models built around a series of aggressive public health goals ranging from reductions in tobacco use to improved mental health care. Len Nichols’ effort will be enhanced by that of 2 graduate research assistants on the project, Kyung Min Lee and Maryam Mohammed.

The one-year grant will provide financial and technical support beginning early this year to develop the Virginia Health Innovation Plan.  The goal of the plan is to devise sustainable ways to lower cost, improve quality and improve health outcomes for all Virginians, regardless of insurance status.

The initiative will incorporate the following population health goals:

  • Lower rates of tobacco use and obesity
  • Prevention and management of cardiovascular disease, diabetes, respiratory disease and high-risk pregnancy
  • Better care for selected mental and oral health conditions through improved integration with primary care

The Virginia Health Innovation Plan (VHIP) will be developed by the Virginia Center for Health Innovation (VCHI) in collaboration with public and private stakeholders and policy experts at consulting firms and universities including George Mason. More than 800 individuals and 300 organizations are already working collaboratively as part of VCHI’s Virginia Health Innovation Network. Participants include health plans, telehealth organizations, education and research institutions, health care providers, pharmaceutical and laboratory companies, private businesses, and community and consumer organizations. CHPRE researchers’ roles will be to help devise sustainable payment reforms to support the initiatives, help select metrics to be used by public and private stakeholders, help develop a sustainability plan for the overall initiative, and to lead the design of an evaluation strategy for the VHIP as a whole.

For more information see:

https://governor.virginia.gov/newsroom/newsarticle?articleId=7484

http://innovation.cms.gov/initiatives/state-innovations-model-design-round-two/

 

Using Provider Payment Incentives to Reduce Health Disparities in Fairfax County

October 24, 2014 – Len Nichols, PhD, Professor and Director of the Center for Health Policy Research and Ethics, and Kalahn Taylor-Clark, PhD, Assistant Professor in the Department of Health Administration and Policy and Senior Advisor to the Center for Health Policy Research and Ethics, were awarded a three-year grant for $488,000 from the Robert Wood Johnson Foundation titled, “Effects of Payment Incentives on Care Processes in a Network Serving Multi-Ethnic Uninsured Populations.”

Funding for this project grew out of a long standing partnership among the Center for Health Policy Research and Ethics, Fairfax County Health Department, and Molina Healthcare (Molina), a clinical contractor that provides health services to low-income families and individuals who do not have access to insurance of any kind, public or private. Fairfax County contracts with Molina to manage three health clinics within the Community Health Care Network (CHCN), which are located in areas that have a disproportionately high number of low-income and uninsured residents. “Molina, under Fairfax County’s arrangement, is a perfect partner for this work. [They have] health plans, medical clinics, and a health information management solution. No other organization of its kind performs all three essential functions,” says Dr. Nichols. Dr. Taylor-Clark adds, “Our goal for this project is to reduce health disparities that we see in this population by building on existing payment incentives and rewarding provider teams for better connecting patients to appropriate services in areas related to cholesterol-lowering drugs, cervical cancer screening, and smoking cessation counseling.”

The team hypothesizes that providing incentives to clinicians and their support staff will encourage them to deliver themselves or refer patients to clinical or social services that address these health issues that disproportionally impact this population. Examples of incentives include: encouraging more smoking cessation counseling and referrals for patients, increasing access and number of pap smears provided by clinicians, and increasing appropriate use of statins. Along with the project’s newest partners, Health Management Associates and research led by Catherine Gallagher, PhD, Director of the Cochrane Collaboration College for Policy, the team will conduct in-depth interviews with key health care specialists to understand patient barriers to treatment and determine better opportunities for improved health outcomes. Patient surveys will also be conducted to better understand their experiences of medical care, including barriers to care and perspectives on patient/provider communication. With fewer new physicians choosing to go into primary care, the need for this support for underserved populations is crucial to improving better health outcomes.

Written by Caroline Valentino

Mason Selected to Evaluate CareFirst Medical Home Program

Nurse tending patient in intensive care.By Michele McDonald

George Mason University is part of an elite group to evaluate CareFirst BlueCross BlueShield’s Patient-Centered Medical Home (PCMH) program, one of the largest in the nation, CareFirst announced on March 11.

George Mason, along with a joint team from Harvard University, Brandeis University and the Massachusetts Institute of Technology, as well as a team from Westat Research Corp., will study the PCMH program. Mason has a five-year, $5.4 million contract, says Len Nichols, principal investigator for the Mason team and director of Mason’s Center for Health Policy Research and Ethics in the College of Health and Human Services (CHHS).

How well a patient’s health improves while under a physician’s care, not how many services are given, is a benchmark for patient-centered programs, Nichols says. “The patient’s health is at the center of the focus as opposed to just services and tests for the patient,” he says.

Patient-centered care also means the patients themselves play an active part in their own health care, Nichols says. That’s critical because many patients with chronic conditions typically have two or more. For example, someone with heart disease may also be diabetic.

“You have to manage care for chronic patients very carefully,” Nichols says.

In addition, the patient-centered programs are a response to cost pressures and an effort to re-examine how care is delivered to patients, Nichols says. “I think it is a game-changer for our national conversation about how to contain costs,” he says.

CareFirst has more than 3,600 participating primary care physicians and nurse practitioners covering about one million CareFirst members in Maryland, Northern Virginia and the District of Columbia. CareFirst showed total health care costs for PCMH members in 2011 were 1.5 percent lower than expected. Nearly 60 percent of physician groups participating in 2011 earned incentives based on the attainment of savings and quality performance, according to CareFirst information. 

“The approach has great promise since it links physician incentives to higher quality care, better outcomes and lower costs,” Nichols says.

Mason’s evaluation is expected to show how well that promise is fulfilled. 

“Our PCMH program is a critical component of our efforts to reduce health care costs while improving health care quality,” said CareFirst President and CEO Chet Burrell in a statement announcing Mason’s selection as a PCMH evaluator. “The program has grown tremendously, and we are pleased with the early results that we have seen. In selecting these leading institutions and organizations to evaluate the program, we will get a thorough, independent look at every aspect of the program. We want to know what works well, what could work better, whether the program is truly changing the behavior of physicians and patients and much more.” 

Mason’s team includes three health economists, a professor of nursing, a physician and a consumer engagement expert who can detail what can help bring patients into the program.

A multidisciplinary team is essential to give the program a thorough examination, Nichols says. “You need multiple perspectives,” he says. “You need all hands on deck.”

In addition to Nichols, the Mason team members are: