Current Work in Access to Care and Insurance
Renee Hsia, MD explores structural racism as part of access to care. Her current research focuses on stroke services and emergency room transfers. Although advances in the treatment of stroke have significantly decreased morbidity and mortality for stroke patients in the United States, there is a growing disparity in the provision of stroke services between disadvantaged populations and others. Hsia’s project examines the role of structural racism and discrimination (SRD) in the expansion of stroke care capacity across communities and its subsequent effects on health disparity patients. She and her team hope to determine the mechanisms through which health disparity patients experience SRD in access to stroke care.
Hsia is also researching how structural racism and discrimination underlie disparities in emergency department transfer and the association of EMTALA on equity. Specifically, analyzing whether hospitals have different admission thresholds before transfer or longer ED lengths of stay for minority patients and whether they differentially transfer minority patients to different hospitals, such as safety-net hospitals or those outside of a hospital network.
Kathryn Phillips is Director of The UCSF Center for Translational and Policy Research on Precision Medicine (TRANSPERS) which focuses on how to achieve equitable, effective, and efficient access to care and payer coverage for precision medicine and other emerging technologies. TRANSPERS collaborators are addressing the ethical, legal, and social implications (ELSI) of genomics, which continue to grow in importance as we grapple with advancing justice and equity for emerging genomic technologies for diseases such as Alzheimer’s. An emerging technology of particular importance are multi-cancer early detection screening tests (MCED), also called “liquid biopsy tests,” which could transform current approaches to cancer screening. The first MCED test is now available in the US, and there are numerous other tests in the development pipeline. Given their intrinsic features and the complexity of payer assessments for screening tests, MCEDs will predictably face coverage challenges. In their policy insight in Health Affairs, Patricia Deverka, MD, Michael Douglas, MS, and Kathryn Phillips, PhD, describe the potential benefits of an MCED test that could detect multiple cancers, and they illustrate how this innovation will complicate payer decision-making. In addition, Kathryn appeared as a special guest on the Health Affairs podcast, talking with editor-in-chief Alan Weil about coverage and access for multi-cancer early detection screening tests. “Will patients understand the limitations and the drawbacks?”
Elena Portacolone's research aims at developing policy recommendations to expand access to healthcare services for older adults with cognitive impairment who are living alone (an estimated 4.3 million people in the United States), with emphasis on communities of color. This research is funded by an R01 grant from the National Institute on Aging. For more information please visit: livingalone.ucsf.edu.
Mary Whooley and her research team have worked to improve access to cardiac rehabilitation (CR) by discovering that patients were unable to participate in traditional (facility-based) CR programs due to travel distance and low SES (paper, paper), developing and implementing a new virtual cardiac rehab program (paper), demonstrating that virtual cardiac rehab quadrupled participation in CR (paper), publishing a scientific statement on benefits of home-based cardiac rehabilitation (paper), and demonstrating that virtual cardiac rehab reduced time from index event to enrollment (paper).
Lena Winestone, MD, MSHP focuses her research on access to care among patients with childhood cancer, starting from access to timely cancer diagnosis and to national clinical trials through to access to highly advanced, personalized cancer therapies such as cellular therapy and stem cell transplant. She has demonstrated that access to care and insurance are central to the survival disparities that exist within pediatric oncology.