The overarching goal of my research is to find ways to address rising costs and inadequate quality in health care. These issues unite my research areas:
Delivery Innovations
How patients get medical care in the United States is changing rapidly--and much of this care occurs outside the confines of an in-person visit with a physician. Patients can now communicate with their physician via patient portals, have a “visit” with a physician on their smartphone, or be diagnosed or treated at a local drugstore. Our research group has been on the forefront of assessing such innovations. We have conducted a broad range of work, including:
- Telemedicine & eVisits
- Telemedicine for Specialist Input with a focus on stroke care
- Remote patient monitoring
- Symptom Checkers & ChatGPT
- Retail Clinics
- Urgent care centers, Free-standing emergency departments
- Electronic Consultations and Referrals
Consumerism, Price Transparency, Benefit Design
We've seen a rapid growth in high-deductible health plans (i.e., coverage with lower premiums and higher deductibles than a traditional plan); thus, patients are paying more and more out-of-pocket for their health care. One assumption that underlies this shift in costs is that greater financial responsibility will drive patients to seek care from lower cost providers. We have conducted a number of studies to understand the impact of high-deductible health plans, assess whether patients are shopping for care, impact of alternatives to deductibles, and determine whether price transparency drives people to choose lower-cost providers and decrease spending.
Costs and Quality Measurement
Improving costs and quality in the health care system requires accurate and reliabile measurement. We have conducted studies in several areas.
We have taken advantage of the increasing use of electronic medical records used to log patient data and advances in natural language processing (a.k.a. NLP, in which a computer is trained to “read” text to identify relevant data) to develop new methods for measuring the quality of care.
Many entities that purchase health insurance are profiling physicians on their relative costs and using these cost profiles to help patients identify physicians who are high cost or low cost. Our research group has examined many questions in this area. What is the reliability of cost profiles? How do different attribution rules (which power these profiles) work? What is the relationship between quality and costs? What is the association between prices and quality? Do patients benefit from these tools?
Annual Physicals & Annual Wellness Visits
Annual physicals or preventive health examinations are the most common reasons an adult in the U.S. sees a physician. In prior work, we have described how these visits are being used, and in several perspectives, I have questioned whether we should encourage all adults to receive such a visit.
Alternative Payment Models
There is wide-spread interest in moving away from the fee-for-service system. I have assessed several new alternative payment models including Maryland's global budgets for hospitals, pay-for-performance incentives, and bundled payments for joint replacement.