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Health systems have struggled to address the long-standing challenges to improve the affordability and quality of health care. Financial incentives and payment structures too often fail to encourage accountable, high-value care and provide limited flexibility for health care organizations to adapt to change.

At Duke-Margolis, our goal is to accelerate the successful implementation of new approaches to pay for and deliver health care—approaches that focus health care on the whole person, improve accountability for people’s health and the value of the care they received, ensure equitable access to high-quality care and build flexibility and resilience to handle future emergencies.

The Duke-Margolis Health Care Transformation effort is unique in our focus on securing pragmatic, evidence-based solutions to the most pressing, relevant health care delivery and payment policy questions. In our work, we:  

• Focus on engaging and partnering with diverse health care stakeholders, including patients, clinicians and health care delivery leaders, payers, employers, life sciences and others, to ensure we focus on the most critical issues facing health care, understand the real-world challenges to delivering better care, and encourage implementation of innovative solutions;
• Leverage the expertise of Duke faculty, researchers, and staff to generate new quantitative and qualitative evidence on pressing health policy challenges and potential solutions;
• Support the transformation of clinical practice by drawing on clinical experiences of those at the front lines; and
• Translate evidence into practical and feasible policy options for the federal government, states, and private sector. 

With increased support, we can:

• Accelerate national systemwide accountable care transformation through evidence-based policies that drive health care payment and care models.
• Accelerate national accountable care transformation through rapid learning that draws on experiences from the front lines of health care and translates that evidence to support better policy.
• Support Medicaid and state health care transformation in North Carolina to improve health and the value of health care for all North Carolinians.
• Develop whole-person models that address people’s medical and non-medical health needs for medically and socially underserved populations.

North Carolina and Duke-Margolis’ public-private partnership is a roadmap for better health for states across the American South, and our extensive and deepening work in North Carolina can be further strengthened and extended to other states in the American South. Learning from our experiences in NC, we can provide a potential pathway for leaders and communities to led to better health for all across the American South.

With increased support, we can:

• Realize the full potential of North Carolina, Duke, Duke-Margolis, and their partners’ efforts to make health care more accessible, equitable, and affordable for North Carolinians
• Expand Duke’s cutting-edge policy and research approach through the American South
• Engage Duke health policy researchers, faculty, and students in building scalable and practical policy solutions to improve health in the American South, prevent disease, and save lives.

Recent decades have seen an influx of biomedical innovation that holds great promise for patients. The biomedical response COVID-19 pandemic demonstrated dramatically the potential—and the reality—of rapid product development, the critical value of national and international collaborations, the essential need for new and better payment and procurement options, and the fundamental need for strategies and infrastructure to ensure access to therapeutics and vaccines for the patients that need them.

Yet, while we have made enormous scientific and medical advances, more work is needed to enable an efficient, affordable, and equitable biomedical pathway. To bring about the substantive changes needed in how research is conducted, Duke-Margolis has prioritized policies and research that:

• Improve the process of medical product development and regulatory review in order to increase the treatment options available to patients,
• Engage a more diverse community of patients in clinical trials,
• Collect and share quality data,
• Enhance the health care value that these products can bring to the health care system, and;
• Enable patient’s access to promising discoveries through new payment models.

The Duke-Margolis biomedical innovation portfolio spans regulatory science, competition and drug pricing policy, payment reform, and use of real world evidence. Our work engages leaders and experts from across healthcare and the biomedical research enterprise, including patient groups, the Administration, federal agencies, private insurers, manufacturing companies and health delivery systems. 

Duke-Margolis is uniquely situated to drive change—and improve—how drugs, devices and medical products are developed, tested, regulated, distributed and monitored in the marketplace. Our core strengths are:

• Proven ability to identify challenges and find solutions by bringing stakeholders together, including researchers, innovators, and policymakers, 
• Deep understanding the life cycle of medical product development, pricing/payment, and use,
• Well-established history of working effectively with the public and private sectors on complex policy challenges, including the Food and Drug Administration and the Centers for Medicare & Medicaid Services, and with leaders and experts from across healthcare and the biomedical research enterprise, and
• Expertise and resources of Duke University, where researchers at the Duke Clinical Research Institute, the Clinical Trials Transformation Initiative, and elsewhere are driving the development of innovations that are transforming biomedical research.

With continued support, we can accomplish the following objectives:

• Bring learnings from the biomedical innovation during COVID and lead discussions to advance and accelerate the transformation of clinical trials, manufacturing, evidence generation, and payment reforms.
• Generate new, practical evidence on ways to pay for innovative technologies, medical device breakthroughs, antimicrobials, cell and gene therapies, and treatments for Alzheimer’s disease so they are accessible to the patients who need them.
• Support the Administration and states as they seek to confront the balance of innovation and affordability by providing research, strategic and technical guidance, and stakeholder engagement.

A key pillar of the Institute’s mission is to educate and train the next generation of leaders who will advance health, health equity, and the value of health care at local, state, national and global levels through equitable and evidence-based solutions. 

Reflecting this commitment, since Duke-Margolis's inception in 2016, we have developed a range of undergraduate, graduate, postgraduate education programming that heightens and hones students’ understanding of health and health care, health policy making and reform, and the capabilities that health-related organizations need to achieve greater value in care. Our programs seek to ensure that tomorrow’s leaders are equipped with the analytic, communication, and leadership skills needed in a complex health care environment. 

As a University-wide institute, an interdisciplinary lens underpins our distinctive approach to education and workforce transformation, bringing together perspectives in medicine, nursing, law, business, global health and public policy, among other disciplines. With each year, we further deepen and expand the Institute’s footprint as a health policy education leader within and outside of the Duke community.

Duke-Margolis has achieved a broad educational footprint at Duke University. Our core educational initiatives include: 

• Margolis Scholars Program
• Summer Internship Program
• Bass Connections Health Policy and Innovation Theme
• Undergraduate Health Policy Certificate Program
• Postdoctoral Scholars and Affiliated Fellows Program
• Student Collaborative on Health Policy (SCOHP)
• Health Equity Educational Initiatives
• Margolis Seminars

These programs collectively involve extensive partnerships with a number of Duke schools, including Medicine, Nursing, Fuqua (Business), Sanford (Public Policy), Law, and Trinity (Arts & Sciences). Each program is led by a Faculty Director from our Core Faculty network who is partnered with a member of our education team staff.

With more support, we would:

• Be better able to meet the burgeoning demand from Duke students for health policy education
• Design innovative curriculum and training opportunities that combine didactic and applied experiential learning opportunities that link academia, practice, and policy
• Foster more cross-campus collaborations across Duke Schools, Departments, Institutes, units, faculty, and staff to expand interdisciplinary health policy education and training at Duke
• Further Duke’s goals of diversity and inclusiveness by building a student community and workforce that prioritizes health equity, reflects diverse populations, and supports anti-racist, culturally-competent practices

Duke-Margolis is developing a major, cross-cutting initiative to address—and inform—the future of public health in the United States. Importantly, it will also seek to infuse reforms to public health institutions and policies with emerging 21st century medical and health system capabilities—with an emphasis on better public health outcomes and resulting improvements in trust.

Current projects seek to shape:

• the creation of population-level public health partnerships capable of identifying, tracking and responding to population health threats locally, nationally, and internationally;
• deployment of health care and treatment pathways that make comprehensive but
• efficient use of new testing and treatment modalities in a range of disease areas or health conditions; and
• processes of earning and sustaining the trust of citizens to enable collaborative approaches to the improvement of health.

With more support, we can pursue similar research and policy efforts for a range of conditions and public health issues, all aimed at informing a 21st century plan for public health.

Duke-Margolis aims to ensure that its health policy research and leadership contribute significantly to dismantling health inequities and improving health and health care through the following ways:

• Drivers of health: Address the underlying causes of poor health or poor health outcomes through payment flexibilities and other policies. Many areas of the country have limited access to services that address social drivers, including rural areas and areas with concentrated poverty.
   
• Supporting the health care safety net: Safety net organizations, such as community health centers and safety net hospitals, provide health care to people who otherwise would be unable to access health care. Duke-Margolis research has identified payment and care delivery reforms that expand and improve health care provided to medically and socially underserved communities.
   
• Population and community health: In order for health care providers to understand and manage the health of their community and populations of people, they need to identify the different health needs of different populations; measure disparities or differences in health status between populations; engage people to understand their health needs and health care experiences; remove barriers to access; and ensure health care is delivered in a way that meets people’s needs, goals, and context.
   
• Evidence: Therapies and health care care models often work differently for different groups and subgroups of people (e.g., by age groups like pediatric, by region like rural and urban, if people have other concurrent conditions). Therefore, we need good representative evidence to track what therapies are safe and effective for different people under different circumstances. Ideally, evidence should draw broadly from people and communities to understand health care on the front lines. This evidence is important so agencies can make sure that products and care approaches are safe and effective for all people.

With more support, we can:

• expand the Duke-Margolis research portfolio to identify how policy, payment models, and care approaches can reduce disparities in health care, access and outcomes at the local, national, and global levels;
• build on the Institute’s ongoing efforts and research to develop evidence-based solutions to reduce disparities for historically marginalized populations;
• educate the next generation of health care leaders on how to improve health and health care for all people.

The Duke-Margolis global health portfolio focuses on accelerating and supporting health system transformation to achieve better population health—through health policy—while promoting efficiency, equity, and high-quality care. In addition to critical partnerships and collaborations across campus and around the world, this work requires the strategic design and implementation of system-level care delivery, payment, and related policy measures that enable transformative solutions to succeed.