The Duke-Margolis Center for Health Policy recently celebrated its public launch Feb 9., announcing a new external board of advisors and highlighting its vision to improving healthcare. The Chronicle's Vir Patel spoke with Dr. Mark McClellan, the Center's director, about the group's general aims and collaboration with the Duke community.
The Chronicle: The Margolis Center is comprised of a diverse group of policy researchers, many of whom have different backgrounds and areas of expertise. How would you describe the organization of the center? Do you and your researchers focus on particular projects or broader aims?
Mark McClellan: The group members work on specific projects within the mission of the Center, and that broad mission is to develop better evidence and analysis to support policies to advance health and healthcare. Our major areas, given the current priorities and opportunities within health policy, include steps to promote the transformation of healthcare delivery, so we have a number of projects that aim to test out and learn about new models of care, for example, based on digital health technologies or team-based approaches to care. Many of these models are not well-supported under our traditional healthcare payment system, which tend to pay for visits or complications, not for keeping people well or for augmenting the work of a physician with other health professionals, social workers or other people who, for particular patients, may be able to make a bigger difference.
Our faculty work on specific projects that match their particular interests. For example, there are a number of faculty at Duke that work on issues related to consumers and how people make decisions about their care. That's obviously very relevant for new models of financing and new models of delivering care that new health policy can support. Other faculty are engaged in areas of biomedical innovation. New strategies and treatments in cardiovascular care and other fields like cancer care may turn out to be very expensive, so we're looking for better ways to pay for drugs and new medical devices that can potentially improve lives but still raise real questions about affordability.
TC: Duke is undergoing a major period of transition, with a new president and medical school dean among others. How do you see the Margolis Center’s general position and collaborative roles in the Duke community changing during this transition and in the future?
MM: Duke is a university that has a great tradition of working together across boundaries and silos especially when the work has practical consequences for making a difference in the world. The Margolis Center is a university-wide center for health policy. It's certainly not the first university-wide effort at Duke. Duke has other notable and very impactful programs in other areas such as global health. We're trying to take a page out of the same playbook and use some of the tools that have worked in the past.
[We aim to] bring faculty from different academic backgrounds together and also bring students from different backgrounds together. Some of the students participating in our early education programs include undergraduates in a Bass Connections cohort that are drawn from throughout the University, medical students who have an interest in the business of health care and how health policy influences it, nursing students and other allied health students like physicians assistants as well as students in business and public policy schools. So we're trying to pool together resources that these students and the University can use to have an impact on health policy, and it really does need a range of disciplines from expertise in health and health care to business to economics, other liberal arts and really all the kinds of disciplines that are represented at Duke.
TC: During your public launch last week, the Center announced a new external board of advisors. How will this new advisory structure contribute to the Margolis Center’s general aims?
MM: The board consists of leaders in just about every area of health and healthcare including experts in new and emerging big data methods from Silicon Valley, consumer advocates, people with experience running large health systems–especially health systems that are committed to improving population health–people from the [biotechnology] industry and also political leaders. People like Peter Orszag, who was the previous director of the Office of Management and Budget under the Obama administration, and Secretary Mike Leavitt, who was secretary of health and human services under President George W. Bush. They've come together to support this program because they think we have some unique opportunities to make a practical difference in the nation's healthcare policies, health care issues globally, and they believe, like we do, that they best way to accomplish these goals is to bring the relevant practical perspectives together.
TC: Health policy has been gaining considerable attention at the federal level with recent legislative discussion, which highlights the role of Duke in D.C. as a partner to the Margolis Center’s base in Durham. Where do you see the Margolis Center’s position in D.C. heading in the coming years?
MM: Even though there's a lot of interest on shifting health policy and other decisions to the state level, there's still a lot in health policy [that] occurs in Washington DC, and it's also a good place for national convening on issues like what are the best state-based approaches to reforming care. We have very experienced staff in D.C. that have a combination of technical expertise in areas like policy analysis, statistical design, biomedical technology, combined with practical experience in working with federal agencies, members of congress and their staff, the administration, as well as being neutral conveners on important policy issues where people would like to make progress. It's often technically difficult [to do so], so it's very helpful to have a trusted group that can bring different perspectives together.
We have about 25 full time Duke Margolis employees leading that work in Washington. Many of them spend time at the Durham campus as well, participating in teaching since there's a lot of student interest in what's going on in Washington and these other policy issues. And they also participate in some of our joint research projects with faculty base in Durham. We're lucky that D.C. is as close as a 30-minute flight from Durham, it makes collaboration relatively easy.
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