Degree: MPH-45 Field of Study: Health Policy Practicum ... · Field of Study: Health Policy Practicum Project Abstracts 2019 ... we will qualified these opportunities with challenges

Degree: MPH-45

Field of Study: Health Policy Practicum Project Abstracts 2019

Practice Organization Project Title and Abstract

Deloitte Telemedicine for Non-Emergent Acute Care: Should Risk-Bearing Medicare ACOs Take the Chance? The Centers for Medicare and Medicaid Services (CMS) have outlined reductions in the previous restrictions on Accountable Care Organizations (ACOs) that desire to use telemedicine for Medicare beneficiary care. Beginning on 1 Jan 2020, ACOs that share in downside financial risk will be able to provide telemedicine services to any beneficiary regardless of geographic location and with home as the originating site of the encounter. ACOs must critically appraise telemedicine services to determine whether to incorporate these services in their efforts to improve health care value. This project focused on whether Medicare ACOs should expand telemedicine services to include coverage of non-emergent acute care – treatment of low-acuity, low-risk conditions such as a sore throat or new back pain. Through a thorough literature review and subject matter expert interviews, we found that telemedicine care improve access to non-emergent acute care. However, quality varies across reasons for care, and the low barriers to access may increase utilization resulting in increases in total cost of care. During the project, I worked with Deloitte to develop skills required to perform as a consultant in the healthcare field. Training included sessions on performing interviews of subject matter experts, on preparing a slide presentation for a client, and on giving a focused oral presentation on research findings. The practicum culminated in a 10-minute oral presentation and slide show before an audience of Deloitte employees.

Massachusetts State Legislature, Office of Representative Christine Barber

Health Policy Strategies in the Massachusetts State Legislature For my practicum, I was based at the Massachusetts State House working with Representative Christine Barber and her legislative aide. I focused on two different bills/topic areas: prescription drug affordability and MassHealth buy-in. My deliverables ranged from more minor tasks (for example writing up talking points for a press conference, summarizing key components of other bills, and attending other legislative briefings) to more substantial products including a memo summarizing literature and policy analysis related to MassHealth buy-in, a draft for the Rep’s testimony for the hearing on her prescription drug bill, and a one-pager for other legislators on MassHealth buy-in. I met on average every other week with Rep Barber and weekly with her aide. It was a great opportunity to learn not only about specific health policy issues but also to experience the culture of the state house and develop a better understanding of how state representatives develop priority areas, make legislative decisions, and serve their constituents.

BIDMC Blockchain Technology In Healthcare: A Review of Use Cases with Public Health Impact While there are several theoretical use cases of blockchain in healthcare, little work has been done to assess the feasibility of implementing these use cases. We worked with Dr. Halamka (BIDMC) to identify key players in the healthcare blockchain space, conduct a series of informational interviews with leaders of these companies, and summarize our findings on where the greatest opportunities are in this space over the next several years. Furthermore, we will qualified these opportunities with challenges to implementation and discuss how potential regulatory reforms could influence stakeholder participation in the blockchain space.

Degree: MPH-45


Wellframe Closing Gaps in Care, Artificial Intelligence Insights for Care Management and Using Machine Learning to Define Impactability I completed a practicum at Wellframe Inc, a Harvard/MIT founded digital health management company that has in this decade become a leader in the field of digital health care management. I participated in a variety of projects including: 1.) Closing Gaps in Care Initiative: extensive literature review of novel (sometimes tech-based) approaches to close high value gaps in care. 2.) Given opportunity to be first author on a paper describing the use of AI in care managment and 3.) For the bulk of my practicum, I worked with my preceptor and his data science team on writing a white paper (to eventually be published in scientific journal) on 'impactability'; using a machine learning framework do determine which patients are most likely to benefit from a healthcare intervention.

DynamiCare Health Identifying and Treating Substance Use in the Criminal Justice System Introduction: DynamiCare Health is a leading tech startup dedicated to offering support and research surrounding recovery from substance addiction. The DynamiCare Health platform consists of a smartphone app for clients and a web-based dashboard for trained counselors. Patients receive texts to perform random substance tests, using pocket-sized breath and saliva testing devices, verified by selfie video. The app also tracks attendance at self-help group meetings and medical appointments. Patients complete mood/craving surveys and reach out to care staff via the app. As they complete tasks, patients earn money on a smart, reloadable debit card which blocks access to bars, liquor stores, and cash. For clinicians, the dashboard offers a real-time view into how their patients are progressing, and the app sends real-time text alerts when patients are at risk - before relapse. Background: DynamiCare has conducted research surrounding members of the Boston, and largely Massachusetts, community and found that a significant portion of people reentering society from imprisonment were having substantial difficulty navigating resources for recovery. They sought an MPH Practicum student to help develop a model for improving access to evidence-based addiction treatment in the criminal justice system. Methods: I helped DynamiCare Health explore and establish partnerships with local, county, and state-level government agencies-- Probation, Parole, Office of Returning Citizens, Office of Recovery Services, Houses of Correction, Drug Court, and the Suffolk County Sheriff's Department. In the process, I met with various actors within the aforementioned entities to assess gaps in their existing treatment models, ways in which technology can be leveraged, how to best fund innovative models of treatment. Results: I created a treatment flow for case managers and probation/parole officers to follow and within it identified barriers. They include: the political environment and political will to adopt technology, the perceived urgency to treat substance use in the municipality/state, funding availability, provider shortages, client distrust with large institutions and fear of punitive action and the client and case managers lack of insight into need for treatment. Future Directions: In the future, I hope that funds otherwise allocated for punitive institutions can be re-allocated towards non-punitive, restorative and transformative justice initiatives. I also hope that legislative appropriations can be focused toward technological innovation,

Degree: MPH-45


R&D and implementation for treatment of substance use. Finally, I hope that society can adopt abolitionist and transformative justice approaches to substance use treatment rather than solely reform.

Massachusetts Commission on LGBTQ Youth

LGBTQ Health Policy Fellow at MA Commission on LGBTQ Youth Founded in 1992, The Massachusetts Commission on LGBTQ Youth is an independent state agency that is annually mandated to draft recommendations to the state and its agencies in efforts to better support LGBTQ youth in the Commonwealth. In the aftermath of the Criminal Justice Reform Act passed April 2018, the Commission intended to more closely follow the state's initiatives with regards to juvenile justice reform and particularly, because of the disproportionate contact LGBTQ+ youth have with the justice system, expand its Fiscal Year 2020 recommendations on this issue. As an LGBTQ Health Policy Fellow, I was tasked with conducting literature review, keeping in touch with the work of community-based organizations working more closely on the ground, and following state policy and programming updates -- all in efforts of updating the commission's recommendations on juvenile justice.

Wellframe, Inc. Machine Learning and Health Systems Innovation Wellframe, Inc. is a healthcare software company that focuses on mobilizing health insurance plans and digitally connecting patients with their care team to enhance patient engagement and deliver more effective care management. My practicum project this past year was focused on machine learning, particularly as it relates to the healthcare space. Part of Wellframe’s future goal is to be a leader in investigating, describing, and creating innovation laboratories. As such, my focus was working within this model to understand what innovation laboratories mean for companies in 2019, as well as contribute towards Wellframe’s beginning development of an innovation laboratory by building several chatbots aimed at addressing patient pain points in the healthcare system.

Commonwealth Care Alliance/Commonwealth Community Care

Capturing Primary Care Value for the Dual-Eligible Population The objective of this project was to characterize the unique value of primary care provided by the Commonwealth Care Alliance, a non-profit health plan and provider group that serves patients who are dually eligible for Medicare and Medicaid in Massachusetts.

Office of the Assistant Secretary for Planning and Evaluation

How to SUPPORT the Medicare Population in the Opioid Epidemic The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the US Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis. An average of 130 people die in the United States every day from an opioid overdose – a six fold increase since 1999. I interned in the Healthcare Quality and Outcomes department at ASPE to: 1) identify risk factors and demographics of Medicare beneficiaries at-risk for or with opioid use disorder (OUD), and 2) describe major changes enabled by the Substance Use-Disorder Prevention that -Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, and the implications and opportunities for healthcare providers and hospital systems. Medicare beneficiaries have among the highest and most rapidly growing prevalence of OUD. Lower household income, lower-education area, comorbid drug abuse, and chronic medical conditions are associated with prolonged opioid use and higher morphine milligram equivalent of opioids prescribed. The SUPPORT Act includes treatment coverage and

Degree: MPH-45


expansion, payment review, electronic health accessibility increase, drug and therapy management, treatment demonstration programs, outlier provider identification, and program integrity and transparency guidelines. Key findings include supporting medication assisted treatment initiation for OUD in the emergency department, physicians with therapeutic alliances as well-situated to initiate treatment, and using the Medicare data set as a model of individually linked data to report detailed OUD prevalence, patient level use, and subgroup analyses.

Initium Health Targeting Behavioral Health Gaps among Latinos in Los Angeles County Latino communities show similar susceptibility to mental illness as the general population. However, they experience inequities in access to care and in the quality of treatment received. Some of the documented challenges to receiving adequate behavioral health care include cultural and linguistic barriers, lack of insurance, medical mistrust, and stigma. These challenges place Latino communities at a higher risk for more severe and persistent forms of behavioral health conditions. The Los Angeles County Department of Mental Health (LAC-DMH) is committed to treating vulnerable populations, including Latino communities. Although DMH is committed to serving the behavioral health needs of their patient populations, there is no centralized database reflecting their patient populations. As such, there is a lack of knowledge regarding patient demographic information, and it is unclear what the behavioral health needs are at the population-level. The practicum project sought to identify behavioral health inequities among Latino adult patient populations served by DMH to design and implement informed behavioral health initiatives to improve patient outcomes. It consisted of three objectives: 1) To provide patient demographic information and behavioral health inequities among Latino adult populations served by DMH; 2) To gather qualitative information from DMH-affiliated representatives to identify key barriers to serving Latino adult patients; and 3) To highlight behavioral health initiatives that could be implemented at the county level using the patient information and identified challenges to serving Latinos.

Cambridge Health Alliance Health and Wellness Education and Self- Management Support Development In my role as Health and Wellness Education and Self- Management Support Development staff, I participated and helped lead the redesign of the Cambridge Health Alliance patient-facing website to improve access to health and wellness education and self-management support. More specifically, I helped increase the health literacy of the population served by Cambridge Health Alliance through easy to use and accessible materials in the redesigned website.

Partners Healthcare: North Shore Medical Center

Strategic Implementation of a Community Needs Assessment in the North Shore Area My practicum project was with Partners Healthcare working at their North Shore Medical Center. The hospital had recently completed their Community Needs Assessment (CNA) and this practicum project involved working with the Community Benefits Manager to develop their implementation strategy to address the priority areas identified on the CNA to present to the hospital board. To develop the strategy, a number of meetings with community and hospital representatives to identify possible options to address the priority areas identified in the CAN were arranged.

Degree: MPH-45


Here, ideas for strategies, timelines, outcome data and responsible professional were discussed. This information was collated and the strategic plan drafted. After completion of the strategic document, I was involved with implementation some of the strategies addressing behavioral health. I arranged for ‘In Our Own Voice’ presentations from the National Alliance on Mental Illness to be integrated into hospital and community services and a possible collaboration between other local hospitals for the launch of an anti-stigma campaign. Additionally, work on a community-wide service directory is being created so community and hospital professionals can be up to date with services available in the local area.

Urban Institute Neighborhood Segregation and Access to Buprenorphine Treatment for Opioid Use Disorder in Pregnant Women in Camden County, New Jersey The opioid crisis has been declared a public health emergency by the US Department of Health and Human Services (HHS). A crucial component of the HHS proposed 5-point strategy is access to treatment. Hence, the need for the exploration of the therapeutic barriers and possible solutions to the opioid crisis in systems that have racial disparities. Increasing evidence suggests that racial, ethnic, and economic residential clustering patterns determine access to novel opioid therapies for opiate use disorder. Residential locations with high minority and low-income dwellers are less likely to have access to buprenorphine therapy for opioid use disorder compared to predominantly white, more affluent residential locations. Since the passage of New Jersey Senate Bill 3, signed on February 15, 2017 by Governor Chris Christie, New Jersey has aimed to examine minority and/or pregnant patients’ access to opioid agonist therapy. The bill outlines the state initiative to address the opioid epidemic by increasing restriction on opioid prescribing and requiring state-regulated health plans to cover benefits for both inpatient and outpatient treatment for persons diagnosed with a substance use disorder. New Jersey has contemporaneously invested in a comprehensive approach to confront the opioid crisis through - increasing access to medication-assisted treatment in low income residential areas, increasing access to pregnant women, and expanding the number of waivered providers. The purpose of this project is to evaluate the impact of these policies on pregnant women, given residential clustering patterns.

Health Care For All Education for Providers Regarding Proposed Public Charge Rule and Related Legislation I worked at Health Care For All (HCFA) as an Immigrant Health Fellow, with three main goals: first, to educate providers and different constituencies regarding the proposed “public charge” federal rule change; second, to maintain and update HCFA’s online Immigrant Health Toolkit (IHT) which is meant to serve as a go-to resource for medical and other providers working with immigrant communities; and third, to work in support of HCFA’s annual Democracy School event which empowers advocates and providers in the Greater Boston area to tackle some of the challenges to health care access facing immigrant communities.

Degree: MPH-45


Somerville Department of Health and Human Services

Addressing Electronic and Menthol Cigarette Use Among Adolescents Through Local Regulation The practicum project involved my help in creating and implementing new policies/ and regulation to restrict where electronic and menthol cigarettes can be sold in Somerville to reduce their sale to teenagers and adolescents. I analyzed results from Somerville’s recent Youth Risk Behavior Survey and researched e-cigarette regulations in other communities. I also did a significant review of the literature of the health effects of electronic cigarettes and the historical context and advertising methods for these devices as well as menthols. I presented to community stakeholders and Somerville Board of Health, and later worked to create educational materials on electronic cigarettes for high school students. The Board of Health ultimately approved our proposed regulations to require that all electronic and menthol cigarettes be sold in 21+ adult-only stores like other flavored tobacco products. Somerville thus became the first city in Massachusetts to restrict electronic cigarette sales, and Needham followed suit with similar regulations in January. Expectedly, three convenience stores (likely with the legal and financial support of the tobacco industry) filed a civil suit against the City of Somerville that the new regulations are “capricious and arbitrary” and significantly impacting their revenue. Their case is weak, however, and the regulations began to be implemented April 1st. This project is a significant achievement for the Somerville Department of Health and Human Services because reducing teen use of e-cigarettes and flavored tobacco products has important consequences for the long-term health of the community’s youth. We’re hopeful it will serve as a model and exemplar for other communities in Massachusetts or the state as a whole.

Brigham and Women’s Hospital

A Review of BWH’s Substance Use Disorder Transitional Clinic Design The Bridge Clinic is a transitional substance use disorder (SUD) clinic at Brigham and Women’s Hospital (BWH) which began in April 2018 and is ongoing. BWH is a Harvard-affiliated, Level 1 trauma academic medical center. The clinic was started to provide intensive, low-threshold, multidisciplinary treatment for patients with SUDs, including rapid access for patients being discharged from the hospital or the Emergency Department. These patients are then “bridged” to a more longitudinal recovery program. The clinic was created because wait times from referral to SUD treatment program entry can be very long, at which point patients often lose motivation to engage in treatment. The Bridge Clinic provides same day or next business day appointments for individuals to address this barrier to care. This practicum project was created to evaluate clinic functions and write-up a white paper to aide other organizations in establishing their own transitional SUD clinic. Literature and policy reviews were utilized to examine what information is currently published on such clinics, and stakeholder interviews were completed to learn the inside functioning of the clinic.

MGH Global Health and Desmond Tutu HIV Centre, University of Cape Town

Oral health literacy among health care providers and health care delivery impacting access to dental care in Gugulethu, South Africa Objectives The World Health Organization recognizes the need to address the growing epidemic of poor oral health, acknowledging poverty, inequity, and systemic disease as contributors. Most oral

Degree: MPH-45


diseases remain common and are easily preventable early in the disease process; however, current healthcare delivery models often prevent early diagnosis and treatment due to limited available providers and treatment options and/or a lack of understanding of available services. Patients with oral health complaints thus often present late in disease progression to the medical health centers, even though they lack oral health services. Here, we examine medical provider perceptions of interventions to improve access to oral health services. Methods This qualitative study was conducted at Gugulethu Community Health Center (GCHC)— a community hospital located outside of Cape Town, South Africa, where no dental services are available. Local public-sector health services provided free of charge are the main source of all primary healthcare for local residents. In depth qualitative interviews were conducted with physicians, nurses, and health promoters caring for patients at GCHC. Data were analyzed using an inductive content analytical approach. Results Participants stressed the difficulties their patients face accessing dental services due to the separation of medical and dental services, lack available dental services overall, and their own lack of knowledge oral disease. All participants stated that colocation of dental services would improve both access to dental care and efficiency in care delivery. Participants suggested that increasing their own knowledge of oral health would improve the care they provide for patients. Conclusion Our findings suggest medical providers are interested in integration of oral healthcare into medical care and feel these changes may increase patient knowledge about oral health and improve access to care. This exploratory data supports investment in interventions to improve healthcare delivery and efficiency.

Center for Surgery and Public Health

Implementing a Cultural Dexterity Surgical Education Curriculum: Conducting a Qualitative Analysis of Surgical Resident Perceptions of Potential Barriers Objective: Focus groups (FGs) were conducted to obtain surgical resident perceptions and potential barriers to implementing the cultural dexterity curriculum. The curriculum is a part of the Provider Awareness and Cultural Dexterity Toolkit for Surgeons (PACTS) Trial that aims to mitigate disparities in surgical outcomes by enhancing patient-clinician communication through a cultural dexterity framework. Methods and Materials: Participants constituted a convenience sample of general surgery residents at the 2019 Academic Surgical Congress. Residents were provided curriculum

Degree: MPH-45


materials to review for the FGs. The 4 one-hour FGs were transcribed and thematic analysis performed using an inductive coding method. Results: 12 codes were ascribed to excerpts extracted from the transcriptions. Of the 12 codes, the top 5 codes applied to all transcripts were interest, delivery method, resident/team buy-in, content, and institutional buy-in. Conclusion: 3 major themes emerged from the qualitative analysis: (1) curriculum content and delivery, (2) institutional support, (3) integration of cultural dexterity framework into practice. Impact and Significance: The barriers to implementation that were identified in the focus groups will be addressed prior to the curriculum roll-out in July 2019.

Health Law Advocates Legislative Lobbying for the Mental Health Advocacy Program for Kids The objectives of my practicum were to develop ongoing relationships with lawmakers and staff, secure support for MHAP for Kids from individual legislators, and to ultimately secure state funding for MHAP by getting it passed as a line item in the state legislative budget. In order to prioritize which legislators to meet with, I conducted background research to see what causes, legislation, and programs representatives had supported in the past. To enhance my communication skills and knowledge about the legislative process, I attended Boston Children’s Hospital's Children Health Advocacy Bootcamp presented by their office of Government Relations. Additionally, I analyzed and documented the changes in the Massachusetts House of Representatives leadership to ascertain who was able to champion budget items and other priorities.

Brigham and Women's Center for Surgery and Public Health

Does the implementation of Medicare Accountable Care Organizations (ACOs) reduce healthcare disparities among patients treated for spinal fractures? Background: Healthcare disparities associated with orthopedic surgical interventions are widely reported for racial and ethnic minorities. Documented disparities include reduced access to surgical services and higher rates of peri-operative complications. Recent healthcare reform efforts have been proposed as initiatives that would not only reduce costs and improve quality, but also lead to reductions in healthcare disparities. National changes in healthcare disparities within the setting of trauma care have not been examined within ACOs or non-ACOs. In this context, we examined the impact of Medicare ACO formation on post-treatment outcomes and surgical rates for White and non-white beneficiaries treated for spinal fractures. Objective: Examine the impact of Accountable Care Organizations (ACO) on post-treatment outcomes (in-hospital mortality, 90-day complications and readmissions), as well as surgical intervention among Whites and non-Whites treated for spinal fractures. Methods: We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day

Degree: MPH-45


complications and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Non-Whites were compared to Whites treated in non-ACOs between 2009-2011 as the referent. Results: We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, while 7% were non-White. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (OR 0.75; 95% CI 0.44, 1.28). A disparity in the development of complications existed for non-Whites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among non-Whites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for non-Whites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09). Conclusions: Our work reinforces the idea that ACOs could improve healthcare disparities among non-Whites. There is also the potential that, as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.

Center for Research and Teaching in Economics (CIDE), Central Region (Mexico)

Health impact estimation of a colorectal cancer screening strategy implementation in Mexico City The main objective of my practicum was to assist in the estimation of the impact of a city-wide CRC screening program in CRC cases, CRC deaths prevented, and life-years gained using a microsimulation model. The methodology that we planned to followed to achieve this objective was the following: 1) search for epidemiologic data of colorectal cancer (CRC) disease in Mexico City; 2) adapt an existing CISNET microsimulation model3 of CRC screening (SimCRC) using this information; 3) estimate the number of individuals screened, CRC cases prevented, CRC deaths prevented, and life-years gained from alternative fecal immunochemical test-based screening programs in Mexico City that vary by positivity cutoff and interval; 4) develop a health policy recommendation for the Ministry of Health of Mexico City. During my practicum, I identified and contacted several researchers or physicians who had epidemiological data for CRC in Mexico City and worked in hospitals part of the National Institutes of Health. I described to them the aim of the project, invited them to be part of our research team, and asked for epidemiological data of CRC in their medical facilities. Later, I

Degree: MPH-45


gathered and analyzed the data they sent us, and I sent this information to the researchers in charge of the SimCRC microsimulation model so they could adapt the model.

Office of the Assistant Secretary for Preparedness and Response (ASPR), Office of the Secretary of Health and Human Services (OS/HHS

Data Identification Re Successes of the National Health Security Strategy I compared the action points contained in the National Health Security Strategy with those in other federal plans and strategies relating to national security and the health of the nation to identify points of overlap. This analysis will help the Office of the Assistant Secretary for Preparedness and Response identify available data that can be used to determine what progress has been made and what needs remain in national health security efforts.

Children's Health Initiative at Cambridge Health Alliance

Developing a Child Mental Health Policy Curriculum The Children’s Health Initiative (CHI) is a children’s health policy research group located within the Academic Research Programs of the Cambridge Health Alliance (CHA). CHI projects include grant-funded demonstration projects of integrated mental healthcare for youth in primary care settings, and analyses of practice approaches and cost-effectiveness. Dr. Katherine Grimes, the director and founder of CHI, is also a Harvard Medical School Academy member focusing her medical education teaching on collaborative practice methods and improving workforce capacity in Child & Adolescent Psychiatry. Though the need to integrate mental health into the curricula at schools of public health was recognized since the 1950s, it continues to be underrepresented, particularly relative to its burden to society. Children’s mental health is even less present in public health training, and curricula specifically about children’s mental health policy is simply absent. This reflects the severe workforce shortage of child mental health providers and experts, leading to a scarcity of faculty who focus on this topic. The lack of exposure and training in public health education only adds to the paucity of the mental health workforce in the face of increasing need. This practicum project was an effort to design the first children’s mental health policy course at HSPH, to be offered to all public health students. Literature and policy reviews were used to create a seminar-format course that analyzes major policy problems and opportunities related to children’s mental health in the US. Curriculum development included drafting a syllabus, course objectives, course description, and proposal for a new course.

Wellframe Creation of a Chatbot Tool for Oncology Patient Management Objectives: 1. To learn artificial intelligence concepts, how Google Diaglogflow functions, and how to code to create an application. 2. To utilize Google Diaglogflow to build a chatbot that will provide medical decision support for breast cancer patients at home. Background: Given the advances in oncologic treatment, cancer has become a chronic disease. The increased prevalence and life expectancy of cancer patients has led to higher costs to the healthcare system. In 2010, national cancer care costs were estimated to be over $124 billion. The highest proportion of spending is for female breast cancer. Cancer care

Degree: MPH-45


spending is projected to greater than double by 2020. In addition, other factors such as first-time treatment of breast cancer, advanced stage of breast cancer, higher household income, ethnicity, presence of co-morbidities, and/or mental health concerns significantly influence costs of breast cancer care. Also, these factors can lead to inappropriate utilization of acute care services. Optimizing at-home management of cancer patients has the potential to reduce inappropriate utilization of clinical services. Furthermore, patient-facing mobile platforms can help optimize patient management outside of clinical settings and have been shown by healthcare software companies such as Wellframe to decreased care utilization and costs for chronic disease patients. Methods: We developed oncology patient personas based upon actual interactions and identified specific problems that these patients may experience (pain points). We then created algorithms to address these pain points and coded them into Google Diaglogflow to create the chatbot. Results: We were able to successfully create English-speaking chatbots for scheduling, radiation-induced dermatitis and pain management that can be used via Google Assistant. Future Directions: We plan to develop chatbots for the remaining pain points and adapt the code for Spanish-speaking patients. Additional steps will include data collection to determine if the chatbot is improving access to care; decreasing healthcare organization costs by reducing utilization of unnecessary care; and improving patient and physician experiences with the healthcare system.

Invest Outside Private Private

Community Catalyst Catholic Hospitals and Convenient Care Clinics I performed a 50-state regulatory analysis of the licensing requirements, regulations, and statutes related to convenient care clinics (for example, pharmacy clinics and urgent care centers), particularly as they relate to Catholic hospital ownership. I analyzed them through a lens of health equity and access to care for women, LGBT folks, the uninsured population, and other underserved communities, and provided policy recommendations in the form of a whitepaper.

Health Care For All MassHealth ACOs and Social Determinants of Health Project The MassHealth ACOs and Social Determinants of Health Project (SDOH) explored the initiatives, systems, and structures utilized by MassHealth (Medicaid) ACOs to address health related social needs (HRSN). The nine Boston MassHealth ACOs were interviewed and asked about HRSN related screening processes, referral systems, as well as partnerships with CBOs. Qualitative data from interviews were then transcribed, coded, and analyzed. Preliminary results demonstrated that all ACOs have implemented some sort of screening process, many

Degree: MPH-45


utilize a mix of formal and informal referral systems, and all are currently collaborating with CBOs in some capacity. Wide variations occur both within and between ACOs on the systems implemented to address HRSN. These include differences in geography, patient population, IT systems, standardization processes, practice types, payer mixes, and more. Barriers to address HRSN include EHR integration, tracking of referrals, patient follow up and ambiguity associated with future changes in funding streams. Results also revealed dilemmas around buying or building systems, as well as the balance between standardization and innovation of HRSN processes.

Massachusetts Health Connector

Reducing Health Care Barriers for Immigrants in Massachusetts The Massachusetts (MA) Health Connector is the state-based health insurance marketplace exchange of MA. In partnership with other state health agencies and community organizations, the Health Connector strives to cover the remaining uninsured population of MA. Immigrants in MA are three times as likely as US-born residents to be uninsured, with Hispanic and non-citizen residents of MA being disproportionately represented among the uninsured. This project aimed to understand what initiatives the Health Connector currently has in place to promote health care access for immigrants in MA, identify areas for growth in these support structures, and create policy recommendations to target these key growth areas. The methods for this project included interviews with internal stakeholders at the Health Connector, a qualitative survey of 54 Navigators, interviews with immigrant health care providers, and development of policy recommendations. It was found that immigrants in MA most often encounter language, health literacy, and financial barriers to health care; immigrants most often raise concerns about consequences of seeking care on their residency application or ability to stay in the country, fears related to the political climate, whether their provider will speak their language, affordability of care, and limited access to health insurance options due to immigration status; Navigators feel adequately prepared to address immigration status-related concerns but are nevertheless interested in further training in certain topics. Based on these findings, policy recommendations were delivered to the Health Connector in the form of a white paper.

Health Care For All MassHealth ACOs and Social Determinants of Health Project (34081115) HCFA’s MassHealth ACOs and Social Determinants of Health Project seeks to assess and promote meaningful collaboration between MassHealth ACOs and CBOs in the Boston area. The brst year of this multi-year project will focus on researching the systems ACOs are putting into place as they implement programs to address the impact of SDOH, including challenges and best practices. Research will also focus on the experience of CBOs in partnering with MassHealth ACOs, including whether CBOs have the capacity to absorb additional referrals generated as a result of ACO SDOH screenings. Research fndings in year 1 will be shared with ACOs, CBOs and MassHealth, and will serve as a basis for longer-term policy recommendations for improving the ACO program. Years 2 and 3 will follow up on this research, documenting the impacts and success stories from ACOs’ collaborations with CBOs, which will also speak to the important role philanthropy, state government and community benefts play in this work.

Independent Landscape Analysis of Blockchain Technologies in Healthcare Blockchain technologies have only recently begun to permeate into the healthcare space, and while there are several theoretical use cases of blockchain in healthcare, little work has been done to assess the feasibility of implementing such technologies in this context. In working

Degree: MPH-45


with Dr. Halamka to identify key players in the healthcare blockchain space, we conducted a series of informational interviews with the leaders of these companies, as well as other thought leaders in the industry, and profiled their pilot blockchain programs. Additionally, in evaluating these programs, we highlighted certain challenges to implementation, and discussed how potential reforms and innovations could influence healthcare stakeholder participation in blockchain technologies for the coming future.

Center for Health Law & Policy Innovation

Expanding Access to Hepatitis C Medication through Litigation Hepatitis C kills more Americans than any other infectious disease. The virus is also responsible for a range of debilitating—if not fatal—symptoms, including liver scarring and cancer, weight loss, fatigue, fluid build-up, and a host of other issues. Fortunately, a breakthrough curative treatment for Hepatitis C was approved by the FDA in 2011. Clinical students on the CHLPI litigation team help develop strategies to improve access to this curative Hepatitis C medication under the federal Medicaid law. In my placement with CHLPI's impact litigation program, I gained practical experience in deploying both legal and policy tools to better the lives of Hepatitis C patients.

Brigham and Women’s Hospital

Does Race Impact Patient-Reported Outcomes (PROs) for bariatric surgery? An assessment with the BODY-Q: Bariatric Module, a novel more rigorous PRO measures tool Introduction: Bariatric surgery is the most effective method of achieving weight loss and alleviating obesity-related comorbidities. While African Americans have a higher prevalence of obesity, they are less likely to undergo bariatric surgery and may not achieve similar outcomes as their Caucasian counterparts. Patient-reported outcome measures (PROMs) have been effectively used to assess meaningful patient outcomes. This study aims to determine if race influences patient-reported outcomes in bariatric surgery patients using BODY-Q: Bariatric Module- a novel, psychometrically rigorous PROMs tool. Methods: We are performing a multicenter, prospective, longitudinal cohort analysis of patients who underwent laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in Boston and in the Netherlands. Endpoints include percent excess weight loss (%EWL), percent weight loss (%WL), change in body mass index (∆BMI), and BODY-Q PROMs domains (e.g., quality of life, self-image, etc.). This study will involve 2,000 patients with a follow-up of 5-years. Preliminary Results: In 564 patients- 453 Caucasian and 111 non-Caucasian, there was no significant difference at 1-year follow-up in %EWL, %WL, and ∆BMI between the two cohorts. However, the non-Caucasian group had a significantly lower mean difference score for BODY-Q domain subscales in body image (-8.525, p = 0.017), satisfaction with body (-20.195, p < 0.001), and psychological function (-6.812, p = 0.022) compared to the Caucasian group from pre-

Degree: MPH-45


operative to 4-month follow-up. Conclusion: Overall, preliminary data suggest that though race does not have an impact on weight loss, non-Caucasians have lower satisfaction in body image, satisfaction with body, and psychological function.

Mayor's Office of New Urban Mechanics in the City of Boston

Play Around the Snowy City My host organization was the Mayor’s Office of New Urban Mechanics (MONUM) in the city of Boston. MONUM is the city’s hub of innovation and experimentation. Play Around the Snowy City was a civic design competition that invited artists, designers, and builders to reimagine Boston’s public spaces to be more welcoming and inviting during the harshest season of the year. Selected artists partnered with MONUM to create playful wintertime interventions throughout the city. The city used this as an opportunity to further its public health goals, including: 1) reducing wintertime stress; (2) increasing physical activity and play; and (3) developing resilient habits. For my practicum project, I implemented and evaluated Play Around the Snowy City along with the rest of the MONUM team.

Health Care For All Education for Providers Regarding Proposed Public Charge Rule and Related Legislation I worked at Health Care For All (HCFA) as an Immigrant Health Fellow, with three main goals: first, to educate providers and different constituencies regarding the proposed “public charge” federal rule change; second, to maintain and update HCFA’s online Immigrant Health Toolkit (IHT) which is meant to serve as a go-to resource for medical and other providers working with immigrant communities; and third, to work in support of HCFA’s annual Democracy School event which empowers advocates and providers in the Greater Boston area to tackle some of the challenges to health care access facing immigrant communities.

Documents

Degree: MPH-45 Field of Study: Health Policy Practicum ... · Field of Study: Health Policy Practicum Project Abstracts 2019 ... we will qualified these opportunities with challenges