During the fall 2021 semester, students in the Schroeder Center’s Health Policy Research Lab focused their attention on improving the value of healthcare in the Commonwealth of Virginia.
As is true for the U.S. as a whole, some “high value” or highly effective healthcare – think cancer screening for example – is underprovided in Virginia. At the same time, some “low value” or less effective healthcare is overprovided; an example of low value care is a chest x-ray for a healthy patient undergoing low-risk surgery. If policy makers and the private sector could reduce low value care and promote high value care, the thinking goes, then healthcare in the Commonwealth and across the U.S. would both cost less and be more effective at improving health. The challenge is: how do you bring these changes about?
Promoting high value healthcare is the mission of one Virginia organization, the Virginia Center for Health Innovation, or VCHI. Founded in 2012, VCHI is a nonprofit, non-partisan public-private partnership. Working closely with key stakeholders, VCHI has helped turn “competition into collaboration” while improving the healthcare system in the state. As part of those efforts, VCHI led the development of the Virginia Health Value Dashboard, which reports a wealth of data on Virginia’s performance in more than 20 different dimensions of healthcare value.
On the eve of its 10th anniversary, VCHI asked teams of W&M students participating in Health Policy Research Lab to identify strategies that could increase the value of healthcare in Virginia. Students worked as part of three teams to assist VCHI: each team chose a specific dashboard metric and conducted research to identify what programs or policies have been proven to improve performance, and what obstacles need to be considered in implementing the program. Students in the lab carried out these three projects:
Project 1. Promoting breast and cervical cancer screenings. Julia Grabo ’22, Kiran Rachamallu ‘23 and Davis Little ’22 chose cancer screenings for the focus of their research. As Kiran Rachamallu noted, this topic is very timely: “because of the pandemic, cancer screening rates have dropped dramatically, especially among low income and minority women.” The team examined several potential solutions to improve cancer screening rates and factored in things like financing, cost effectiveness, and the ability to scale-up the approach, and ultimately focused their recommendations on the role of patient navigators.
Project 2. Reducing the overuse of antibiotic prescriptions. Catherine Brady ‘23, Nicole Larsen ‘23, Kavi Shah ‘24, and Martina Tvrdik ‘23 studied the growing problem of antibiotic resistance, which the U.S. Centers for Disease Control and Prevention (CDC) calls "one of the world's most pressing public health problems. “We chose to examine antibiotic overprescription because we felt that the level of concern over the issue didn’t match the potential disastrous consequences,” said Kavi Shah. “We strove to both educate ourselves on the topic and illuminate possible solutions” to this pressing problem. The team recommended clinical decision support tools and peer comparison approaches to “nudge” physicians toward reducing antibiotic prescriptions.
Project 3: Increasing childhood immunization rates. Ashanti Jones ‘23, Ella Schotz ‘23, and David Smith ‘22 chose dashboard measures that seem more relevant than ever in our pandemic era – immunizations against diseases. “I learned about the intricacies in solving healthcare issues,” said Ella Schotz. “We had to address complexities such as physician fatigue, technological constraints in care facilities, and the ways different interventions improved or hurt one another.” Ultimately, the team recommended different ways that physician practices could make use of electronic health records to promote immunizations.
To prepare for their research, students spent the first few weeks of the fall semester taking a class with their lab instructor, where they reviewed healthcare expenditures in the U.S. and the nature of high value and low value care, and brushed up on some research tools. After the initial preparation, Professor Jennifer Mellor, instructor of the lab and director of the Schroeder Center, then met weekly with each team to guide their research. “The lab is a great example of experiential learning,” Mellor said. “By taking the initiative and making decisions about how to proceed, students learn how to think independently and deal with the unpredictable nature of research. And working in teams helps students build their communication skills - both speaking and listening.”
The culminating experience for the students was a presentation to VCHI staff and members of VCHI’s Board and advisory Leadership Council, which currently includes leaders from organizations such as Anthem Virginia, Pfizer, 3M Health Information, Community Health Solutions, Sentara Healthcare, among others.
“It was a really valuable experience to speak to leaders in the field,” said David Smith. “Usually, as students, our work and presentations are directed internally at classmates and faculty, which is great for learning and refining skills. But, after graduation, we will be interacting with others on a less familiar basis, often talking to leadership within an organization, and our work with the Schroeder Center presenting to an important audience will help us thrive in the workforce once we leave William & Mary.” Martina Tvrdik added, “sometimes as students we can get caught up in the grades we receive in our classes and forget that we are working towards more than just a good GPA. Preparing to speak to such an accomplished audience allowed us to think beyond the classroom and experience a taste of what the professional field looks like.”
The presentations were well-received. Margie Fitzgerald, Vaccines Account manager at Pfizer, was in the audience and was impressed by the presentation content and the communication skills. “The students did an incredible job and you can tell so much work went into their presentations,” Fitzgerald said. “Being with Pfizer in the Vaccines Division, I absolutely loved their topics and they focused on so many of the areas that we focus on.” Beth Bortz (‘91 BA; ‘93 MPP), President and CEO of VCHI, was especially grateful. “The students made me proud to be an alum,” Bortz said.
The Schroeder Center is also grateful to Ms. Bortz, who gave so freely of her time and talents to work with the students. As Mellor said, “We couldn’t do this type of authentic learning experience without dedicated partners like Beth. Knowing that their findings have implications for a real organization made the work all the more important to the teams.”
If you are part of an organization that would like to partner with the Schroeder Center’s Health Policy Research Lab, please contact Jen Mellor at email@example.com.