Designing policies to incentivize high-quality health care for vulnerable Americans: Evidence from the 340B Drug Pricing Program

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ABSTRACT Dr. Sunita Desai’s long-term goal is to inform policies that support and incentivize providers to invest in high- quality care and access for vulnerable populations. This proposal, which is the first step in achieving Dr. Desai’s long-term goal, will study the impacts of one such policy, the 340B Drug Pricing Program, which directs financial resources to eligible hospitals and their outpatient practices serving disproportionate shares of low-income populations. The proposed research will generate novel evidence on whether the Program has achieved its intended goals of improving clinical quality and drug outcomes for vulnerable patients and/or has caused unintended spillover effects on drug provision and spending to the privately insured. Dr. Desai is an assistant professor in the Department of Population Health at NYU School of Medicine. She has a PhD in Health Care Management and Economics from The Wharton School of the University of Pennsylvania and was previously a Seidman Fellow in the Department of Health Care Policy at Harvard Medical School. She is trained in health care economics, quasi-experimental research methods, and secondary data analysis using large administrative datasets. Dr. Desai seeks to complement her background in health care economics and quantitative methods with training in clinical quality and drug outcomes measurement, the unmet health care needs of vulnerable populations, and qualitative methods. This training will give Dr. Desai the skills to study clinically-nuanced and population-specific measures and to leverage qualitative methods to inform quantitative inquiry. The aims of this proposal are (1) to estimate the impact of 340B Program participation on hospital quality of care for uninsured and Medicaid patients, (2) to assess the impact of hospital 340B participation on medication use and adherence among low-income and privately insured populations, and (3) to identify barriers and facilitators to effective hospital participation in the 340B Program consistent with the policy’s goals. This proposal explicitly addresses AHRQ’s emphasis on the role of incentives in health care system performance (NOT-HS-14-005), with a focus on AHRQ priority populations including low-income and uninsured patients. It will generate novel and policy-relevant evidence on the 340B Program’s effects on patient care across all major payer groups and the uninsured. Results will also yield insights for safety net health care policymaking more broadly. The award will support Dr. Desai’s transition to independence and her long-term research agenda to inform policies that promote a reliable and high-quality health care system for the most vulnerable Americans.