HBHI is pleased to announce five pilot grant awardees for our 2024 cohort.  We sought pilots which advance HBHI’s mission to incubate or accelerate collaborative research within the domains of at least one of the HBHI strategic pillars:

Market competition and healthcare policy

Health delivery performance

Health of populations and health equity

Innovation – health technology and systems

Read about the winning pilots and teams below.  Congratulations on such excellent proposals!

Comparing competing incentives to improve health equity among Medicare Advantage Plans

PI: Andrew Anderson, PhD (PI), Assistant Professor, Health
Policy & Management, Bloomberg School of Public Health. Denis Agniel (Co-I) is a statistician at the RAND Corporation. Jonathan Weiner, DrPH (Advisor), Professor, Health Policy & Management, Bloomberg School of Public Health.

Project Description: This project proposes to assess the consequences of integrating a Health Equity Index (HEI) into the Centers for Medicare and Medicaid Services (CMS) Star Ratings Program by 2027. With an emphasis on the potential unintended consequences of the HEI, which could disproportionately affect different beneficiary groups, the project aims to compare equity consequences of HEI component indicators using various scoring approaches. Leveraging Medicare Advantage data from 2019, the research will include multiple patient groups and simulate quality improvement scenarios to understand the impact on MA plans under different incentive scenarios. The project's goal is to provide evidence-based recommendations for effective health equity measurement choices, aligning incentives with the goal of improving care among historically disadvantaged groups within the CMS Star Ratings Program. The findings are intended to shed light on potential MA plan behavior under these new incentives, contributing to the ongoing efforts to address health disparities in Medicare Advantage programs.

Leveraging Discontinuities in Network Adequacy Criteria to Evaluate the Effects of Provider Networks

PI: Mark K. Meiselbach, PhD Assistant Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Kelly E. Anderson, PhD, MPP, Assistant Professor, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, David M. Anderson, MSPPM, PhD Candidate, Department of Population Health Sciences, Duke University, Sih-Ting Cai, PhD, Postdoctoral Fellow, O’Neill School of Public and Environmental Affairs, Indiana University

Project Description: The Centers for Medicare & Medicaid Services (CMS) invest substantial resources each year to monitor the adequacy of Medicare Advantage (MA) provider networks with the intention of ensuring that beneficiaries have sufficient access to care. Yet, no research has estimated the causal effects of network regulation and design in MA on patient care utilization, outcomes, and costs. Estimating the causal effects of provider networks is inherently challenging due to the non-random selection of plans by beneficiaries (e.g., beneficiaries with greater needs may select plans with a broader selection of providers to treat those needs). In this pilot project, we will test the feasibility of a new innovative approach that leverages regulatory discontinuities to estimate the effects of provider networks.

Rural-Urban Disparities in Access to Physical Therapy for Medicare Beneficiaries with Musculoskeletal Pain – Is Tele-rehabilitation the Solution?

PI: Kevin McLaughlin, DPT, School of Medicine, Department of Physical Medicine and Rehabilitation, Richard Skolasky, ScD, School of Medicine, Department of Orthopaedic Surgery

Project Description: Physical therapy (PT) has been shown to reduce pain and disability, as well as downstream health care utilization among patients with musculoskeletal pain. There are barriers to attending PT, especially among those living in rural parts of the country. Tele-rehabilitation has been proposed as a means of improving access to PT for patients in rural areas. However, little to no research has been conducted to examine tele-rehabilitation utilization since telehealth coverage expanded in 2020. It is also unclear what influence this has had on overall utilization of PT services among Medicare beneficiaries living in rural areas. As such, we propose to examine rural-urban differences in PT utilization for musculoskeletal pain among Medicare beneficiaries before and after telehealth expansion. We will also specifically examine the number of beneficiaries that utilized tele-rehabilitation and how tele-rehabilitation utilization is affected by factors such as provider availability, local internet connectivity, and Medicare coverage type.

Can Real-Time Patient Information Improve Physician Decision-Making? Evidence from a Digital Health App

PI: Jonathan Elliott, Johns Hopkins & Milena Almagro, University of Chicago Booth School of Business

Project Description: This project seeks to understand the impact that real-time patient-specific information obtained via digital health technologies has on physician decision-making and patients’ outcomes. Digital health as an industry has grown rapidly in recent years, and individual health trackers have comprised a major part of that growth. This project will use a novel dataset provided by a digital health application used by a substantial fraction of all individuals in the U.S. with hemophilia, a very serious disease that prevents blood from clotting. This dataset has the unique feature of tracking patients’ drug intake (via infusions), their symptoms (bleeding), and monitoring of this information by their physicians. Since we observe whether or not information was provided by the app to the physicians, we plan to isolate the impact of this information on prescribing behavior and patients’ health outcomes, which in this context consists of bleeding.

Caregivers in the Workplace: A Convening to Develop A Profile of Employer Best Practices     

PI:  Kate Miller, PhD, Bloomberg School of Public Health, Kevin Frick, PhD, Carey Business School, Joanne Kenen, Bloomberg School of Public Health, Karen Shen, PhD, Bloomberg School of Public Health, Kali Thomas, PhD, School of Nursing, Jennifer Wolff, PhD, Bloomberg School of Public Health

Project Description: Significant policy attention has been devoted to supporting workers with childcare responsibilities – a topic that received notable attention during the COVID-19 public health emergency.15,16 Less consideration has been given to workers who help a spouse or partner, sibling, parent, or friend.15 Employer practices such as workplace leave benefits, schedule flexibility, respite care benefits, and protections from job discrimination could support family caregivers, but are poorly understood.5 An understanding of the uptake of these practices, implementation barriers and facilitators, and effects of these practices is needed.