Policy Matters: A monthly newsletter for Duke Faculty and Staff from the
Duke-Margolis Center for Health Policy
Policy Matters: April 2018
Features

The National Clinician Scholars Program (NCSP), an interdisciplinary, community-partnered research program for physicians and nurses, has added a new institution to its prestigious consortium: Duke University.

“Duke is the perfect site to join us at this time,” said Linda Sarna, PhD, RN, FAAN, national board chair for the NCSP and dean of the UCLA School of Nursing. “They already have a strong community focus, and their nursing and medical schools are ranked among the top in the country.”
The NCSP was launched two years ago with four founding sites: UCLA, Yale, University of Pennsylvania, and University of Michigan. The program offers the opportunity for post-doctoral nurses (DNP and PhD) and physicians who have completed their clinical training to serve as leaders, researchers, and change agents in health care, community health, and public policy as full partners. Read More.
Have you read our annual report?
Learn more about the Center's program portfolio and aspirations. You can get it online -- or request hard copies by emailing Ellen de Graffenreid.


News
Making the Case for Value-Based Payment Reform in Children’s Health Care
Child and adolescent health in the United States continues to lag behind that of other industrialized nations, with the US health care system falling short in tackling current threats (eg, childhood obesity and substance use epidemics) as well as future threats (eg, rising adult health disparities that may reflect adverse childhood influences). The emphasis on short-term financial returns partly explains this failure insofar as well-being outcomes for children are best measured over the long term. Attracting the attentions of payers and policy makers to increased and innovative funding for children’s health care has been difficult, as more costly adult needs often overshadow child-specific needs. The move toward value-based payment reform presents a critical opportunity for children’s health providers to make the case for the value of high-quality children’s health care, which warrants increased resources, and payment models that are specifically designed to improve children’s short- and long-term health and well-being outcomes.
Read more from Charlene Wong, MD, MSPH, Mark McClellan, MD, PhD, and Harvard's James Perrin, MD, in JAMA Pediatrics.
The Evolving Pharmaceutical Benefits Market
Pharmaceutical benefit managers (PBMs), a once obscure segment of the health care financing landscape, have become industrial behemoths in the US health sector. In 2017, the top PBMs had revenues that exceeded those of the top pharmaceutical manufacturers, for example, Express Scripts reported revenue of $100 billion while Pfizer had revenues of $52 billion. By one count, “drug channel” companies, which include PBMs and drug distributors, comprise 6 of the top 25 companies on the Fortune list of the top 500 US companies ranked by revenue. Read more from Kevin Schulman, MD, and Barak Richman, PhD in their JAMA Viewpoint.
Initial Analysis of 2018 Enrollment in Health Insurance Exchanges
When does the cost of care become toxic?
Can the cost of health care be bad for you? In the January/February issue of the North Carolina Medical Journal, Drs. Caroline Sloan and S. Yousuf Zafar at Duke University examine the “financial toxicity” of cancer care in an article titled, “Ask Early and Ask Often: How Discussing Costs Could Save Your Patient’s Life.”

The authors write that out-of-pocket costs, which have increased particularly in cancer care, can have a toxic effect on patients and their families. Although the Affordable Care Act has created out-of-pocket maximums ($6,850 for an individual in 2016), Sloan and Zafar write “even this amount, which is roughly equivalent to 22% of the median annual personal income in the United States, can be harmful.”
In addition to out-of-pocket costs for care, patients face other financial losses like decreased savings and more time off of work. Read more in the North Carolina Medical Journal.
A Framework for Evaluating Medicaid Buy-in Proposals
Read more from David Anderson and Emma Sandoe on the Health Affairs blog.
Funding innovation in neglected diseases
Concerted action is required to reverse downward trends in research and development.
Neglected diseases are those with insufficient markets to attract investment from the drug industry. They primarily affect populations living in low income countries and include malaria, tuberculosis, and diarrhoeal diseases.

Public and philanthropic funding is required to develop new health technologies to control these diseases. While funding from public-private partnerships helped to bring 37 new treatments for neglected diseases to market between 2000 and 2011, this represented just 4% of all new therapeutic products registered during this period. As neglected diseases cause about 11% of the global burden of disease, there is clearly a “persistent insufficiency” in research and development (R&D). 1 Except for a one-off injection of funding for Ebola and other African viral haemorrhagic fevers, funding for product development for neglected diseases has shown a downward trend since 2009. Read more from Gavin Yamey in the BMJ.
Events
Margolis Seminar
The Margolis Seminar, held from noon-1:30 pm every other Friday, is a venue for sharing work in process and expertise across Duke University and with the Duke-Margolis team in Washington, DC. If you are interested in being added to the mailing list, please contact Hilary Campbell.
April 16, 2018 - 8:30 am to 4:45 pm
National Press Club, 529 14th Street NW, Washington, D.C. 20045

Duke Population Health Sciences Summer Institute
June 4-6, 2018
The DPHS Summer Institute at Duke University is a unique opportunity to gain foundational knowledge and applied skills in population health research while learning from leading experts in this growing field.
Who It’s For
The Summer Institute is open to anyone looking for an introduction to the population health sciences field.
  • Health care and health services research industry professionals
  • Academics at Duke and other institutions
  • Undergraduate and graduate students

June 14, 2018 -
8:30 am to 5:00 pm
This public event will focus on the range of non-traditional pharmaceutical approaches being developed to combat bacterial infections. Speakers will address the importance of development in this area, the full spectrum of technologies currently under development, and the outstanding scientific challenges in assessing efficacy of these products in pre-clinical and clinical settings. Discussion will help to prioritize challenge areas in which additional considerations and research will need to be developed moving forward. Registration information will be available soon!
Awards, Honors and Presentations
Greg Daniel, PhD, MPH, was an invited panelist at the Innova-FDA Think Tank meeting and will be an invited speaker at the American College of Medical Quality meeting on April 12.

Robert Califf, MD, and Mark McClellan, MD, PhD, are two of the former FDA Commissioners expressing concerns about right to try legislation.

Here is a health care proposal that could actually work -- Read more from David Anderson in The Hill.

Christina Silcox, PhD, gave an invited talk at the FasterCures Patients Count Leadership Council Meeting on April 4 on the topic of Using Real-World Evidence to Meet Health Care Challenges

Duke-Margolis had four panels selected for the upcoming Academy Health Conference:
  • Policy roundtable panel. Speakers: Charlene Wong, Rob Saunders, Mary Brunette (NH Medicaid), Susan Goold (MI IHPI), Tom Hoerger (RTI)
  • A team led by Charlene Wong and Mark McClellan submitted an overall abstract on Medicaid incentives that was accepted for a platform presentation
  •  Madhu Vulamiri's cost-effectiveness analysis of Medicaid incentives for smoking cessation was accepted for a poster presentation
  • Connor Moseley’s (Duke medical student) child-focused abstract was accepted for a poster symposium presentation

More than 5000 people attended or viewed the NEJM Catalyst event co-chaired by Peter Ubel, MD, and Eric Peterson, MD: Patient Behavior Change: Building Blocks for Success.

More than 200 people attended the Duke-Margolis and McKinsey & Co. event: Why consumers are crucial for building a sustainable health care system. Duke-Margolis speakers included Charlene Wong, MD, MSPH, and Krishna Udayakumar, MD, MBA.
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 dukemargolis@duke.edu.