Promoting pharmaceutical care to maximize value
A major focus of my work is the development and evaluation of novel strategies to improve the quality of cardiovascular medication use and long-term adherence.
I was the principal investigator of the Post-MI Free Rx and Event and Economic Evaluation (MI FREEE) trial, which enrolled patients discharged from hospital after myocardial infarction and randomized them to receive secondary prevention medications for free or their usual levels of drug insurance coverage. Providing full coverage increased medication adherence, reduced rates of major vascular events and decreased patient out-of-pocket spending without increasing insurer spending. Based on this, Aetna began waiving copayments for post-MI patients in January 2013.
The trial was based on economic models we developed to evaluate the clinical and economic benefits of reducing cost-sharing for medications of proven efficacy in Medicare beneficiaries and those with commercial insurance and policy evaluations of cost-sharing reductions introduced by large insurers and employers.
In ongoing work, I am designing several new trials to evaluate other strategies to improve health care quality. These studies will employ methods my colleagues and I have developed to conduct large simple clinical trials in real-world delivery systems at low-cost. For example, based on my work linking health system complexity on non-adherence to medications for chronic disease, we proposed the creation of a "pharmacy home" and, in partnership with CVS Caremark, are now designing a trial to synchronize medication filling and access.
Comparative and cost-effectiveness research
Comparative effectiveness and cost-effectiveness research are areas of active investigation. In addition to my randomized trials comparing the effectiveness of interventions to improve prescription drug use, I have recently published studies evaluating the comparative effectiveness of venous thrombolism strategies for patients after coronary bypass surgery, novel oral anticoagulants in atrial fibrillation, and strategies to improve adherence to post-MI medications.
I have led a variety of other economic evaluations including the cost-effectiveness of applying the JUPITER trial results of rosuvastatin for patients with elevated high-sensitivity C-reactive protein levels into routine practice and the use of genomic information to guide warfarin therapy for patients with atrial fibrillation. I have also studied the economic consequences of non-evidence-based clopidogrel use.
Delivery redesign and health policy
While my work has centered on pharmaceuticals, my interests also include other methods of enhancing health care quality and I am involved in designing and evaluating a variety of care innovations including retail clinics, ambulatory “ICUs”, methods to identify and target patients who would benefit from quality improvement interventions using electronic health data and mobile technologies to facilitate patient-provider interaction.
I remain very interested in contemporary issues in health care policy and have recently written about "me-too" products, $4 generic medications, the Medicare doughnut hole, conflicts of interest in medical education, drug-company sponsored patient assistance programs and drug importation to U.S. from international sources.