PRL-IHPS Research Focus: Healthcare Value and Health Economics

Perioperative Care Utilization for Cataract Surgery

Catherine Chen, MD, is Assistant Professor in Anesthesia and Perioperative Care and is core faculty at PRL-IHPS. Her research program is focused on identifying and reducing low-value care, especially instances of perioperative healthcare overutilization that may not be of benefit and can cause potential harm to surgical patients. She employs large datasets, such as Medicare claims and the OptumLabs Data Warehouse, as well as interdisciplinary and cross-institutional collaborations to conduct her research. 

Chen’s current work aims to improve our understanding of anesthesia resource utilization during cataract surgery to better allocate anesthesia personnel to those cataract patients who may benefit most from having an anesthesiologist supervising their care intraoperatively. She is looking at the value of anesthesia care for cataract surgery, where the patient risk has decreased over the last 30 years, in comparison to other low-risk outpatient anesthesia care to determine how to risk stratify and identify high-risk patients, discover any potential downside to limiting anesthesia, and working on the implementation of any potential practice changes in the care setting. A recent paper is here.

Precision Medicine

Kathryn A Phillips PhD, Professor of Health Economics and Health Services Research, conducts research that examines the value of healthcare interventions and the associated policy implications. A particular focus of her team is measuring the value of “precision medicine” - the development and delivery of approaches for disease prevention and treatment that take into account people’s individual variations in genes, environment, and lifestyle using computational tools and integrated data. Phillips directs the UCSF Center for Translational and Policy Research on Precision Medicine (TRANSPERS), which is currently conducting research on the economic value of emerging genomic technologies such as “liquid biopsy” tests that can detect over 50 types of cancers using one blood test. We are also examining the economic and health equity impact of genetic biomarker testing for non-small lung cancer and for Alzheimer’s Disease. Additionally, TRANSPERS collaborators conduct global research on how to develop better methods for assessing economic value as part of the Global Economics and Evaluation of Clinical Genomics Sequencing Working Group (GEECS).

Medical Decision-Making and Health Technology Assessment

Grace Lin is Associate Professor of Medicine and Health Policy in the Division of General Internal Medicine and the Philip R. Lee Institute for Health Policy Studies.  In 2021, she became the Medical Director for Health Technology Assessment for the Institute for Clinical and Economic Review (ICER). In this role, she works with the senior management team, research teams, and economic modeling teams to conduct and oversee ICER reviews. Her most recent review on the Alzheimer’s drug aducanumab is here.

Prior to her role at ICER, her research focused on improving medical decision-making to ensure that all patients receive high quality, evidence-based, patient-centered care.  In particular, she focuses on identifying areas where practice is inconsistent with the evidence base and assessing reasons for variation in care, developing and implementing tools to facilitate shared decision-making, and measuring the quality of the decision-making process. Ongoing projects include development of a decision quality measure for patients with coronary artery disease, development and implementation of shared decision-making tools for cancer screening in older adults, and evaluation of genetic test ordering practices in safety net populations.

Reducing Low-Value Use of Medical Devices

PRL-IHPS affiliated faculty Sanket Dhruva, MD, is Assistant Professor, Cardiovascular Medicine and Rita Redberg, MD, MS, Professor, Cardiology, conduct research on use of medical procedures and devices. Dhruva and Redberg study the regulatory process for medical devices and the strength of evidence that supports them, particularly high-risk devices, both before and after they are marketed. Both are strong proponents of high-quality data to support safety and effectiveness for medical devices, in order to provide the best quality and appropriate medical care and advice.  They recently had a perspective in the New England Journal of Medicine on Medicare approval policy regarding the recent Centers for Medicare and Medicaid Services (CMS) decision to end its national noncoverage policy for transvenous (catheter) pulmonary embolectomy.  CMS has delegated the coverage decision to private insurers that process Medicare claims in their jurisdictions and establish local coverage determination policies, despite that there has been no evidence of clinical benefit to the device.  Dhruva and Redberg argue that CMS should include clinical benefit of a device or procedure in the Medicare population as a mandatory condition for coverage. Another recent paper from JAMA Internal Medicine more broadly focused on partnering with payors to reduce low-value medical device use is here.

The Center for Healthcare Value (CHV)

Situated within PRL-IHPS, the Center for Healthcare Value (CHV) brings together expertise in clinical care, research methods, implementation sciences, health policy, health care delivery, law, information technology, entrepreneurship, and business to address the barriers to providing high-quality, efficient, and cost-effective healthcare and innovation. Through the development of proven, replicable interventions, the CHV will develop and test local and national models for improving healthcare value. The leadership team consists of IHPS affiliated faculty George Sawaya, MD (Director), Ralph Gonzales, MD, MSPH, Jahan Fahimi, MD, MPH, Catherine Lau, MD and Joanne Spetz, PhD. The Center focuses on three areas; education, systems improvement and research & policy.

The education initiative hosts the recurring UCSF Educational Skills Workshop: “Teaching to Provide High Value Care’ and a seminar series for medical students that is open to others at UCSF during winter quarter, “The High-Value Care Seminar Series” that provides an opportunity for trainees from all four UCSF schools to interact and learn about the practice and principles of high-value care from leaders throughout the diverse UCSF community.

Caring Wisely™ is an organized process for engaging and supporting frontline staff and clinicians in efforts to remove unnecessary costs from healthcare delivery systems and improve the quality of care delivered. The program was created and launched by the UCSF Center for Healthcare Value in November 2012. The program, which utilizes the “Reducing Out-of-Pocket Expenses for Patients” Contest, a health system-wide open call to all staff, providers, faculty and trainees to bring forward their best ideas for identifying areas that could be targeted to reduce inefficiencies and healthcare costs and provides seed funding and support to three projects annually.

The research & policy initiative aims include 1) improving our ability to measure value, 2) increasing transparency about value and cost, and 3) stimulating market developments, accreditation standards, and government payment or reporting rules that reward value. CHV recently awarded research grants to study the local effects of COVID-19 on healthcare value.  Projects awarded included: 

  • Chuong Tran, MD (Medicine) “Evaluating Patient and Provider Perspectives on Telemedicine Utilization and Barriers in the Outpatient Solid Organ Transplant Clinic Setting”
  • Elaine Khoong, MD, MS (Medicine) and Sarah Nouri, MD, MPH (Medicine) “Changes in primary care utilization and impact on control of type 2 diabetes mellitus after wide-scale telehealth implementation”
  • Armond Esmaili, MD (Medicine) and Sajan Patel, MD (Medicine) “Assessing the Impact of ‘Physically Distanced’ Care in the Hospital on Health Care Value for Hospitalized, Acute Care-Level Patients with COVID-19”
  • Woon Cho Kim, MD (Surgery) and Sandhya Kumar, MD (Surgery) “Surgical Care for Benign Gallbladder Disease During COVID-19: Operational Barriers and Areas for Intervention at a Safety-Net Hospital”
  • Gabriel Devlin, MD (Pediatrics) and Aaron Kornblith, MD (Emergency Medicine) “Determining Emergency Department Utilization on Child Epidemiology During COVID-19 (DEDUCED COVID)