Issue Spotlights

Issue Spotlights provide a brief overview of many Duke-Margolis current research and policy analysis topics. This work is often foundational to Duke-Margolis Emerging Initiatives—health policy topics that could benefit from more in-depth research and our proposed projects to address them.

Health Care Transformation

North Carolina Integrated Care for Kids (NC InCK): A federally funded, child-focused health care delivery and payment pilot aims to advance better long-term health outcomes for children and families through care models and payment mechanisms that identify children who are at risk of poor health outcomes earlier, and making these models an integral part of Medicaid reform.

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More Information:

Emerging Initiative - Expanding and Spreading State-Based Transformation in and Beyond North Carolina to Improve Health in the South

NC INcK webpage

Healthy Opportunities Pilots: In one of the first U.S. programs of its kind, North Carolina’s $650 million Healthy Opportunities Pilots program is the nation’s most expansive Medicaid program to address health-related social needs related to food, housing, transportation, and interpersonal safety and toxic stress.

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Emerging Initiative - Expanding and Spreading State-Based Transformation in and Beyond North Carolina to Improve Health in the South

Project Page - Practical, Timely Lessons for Advancing and Aligning North Carolina's Health Care Transformation Leadership to Address Social Needs

Project Report - Addressing Social Needs through Medicaid: Lessons from Planning and Early Implementation of North Carolina’s Healthy Opportunities Pilots

Journal Article - Addressing Housing-Related Social Needs Through Medicaid: Lessons From North Carolina’s Healthy Opportunities Pilots Program

North Carolina State Transformation Collaborative: Duke-Margolis, in partnership with the NC Department of Health and Human Services, the Health Care Payment Learning & Action Network, and the Centers for Medicare & Medicaid Services, convenes North Carolina’s State Transformation Collaborative, which is focused on multistakeholder alignment for value-based care, including performance measurement, data sharing, and health equity in an effort to strengthen coordinated and accountable primary care that improves well-being.

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More Information:

Emerging Initiative - Expanding and Spreading State-Based Transformation in and Beyond North Carolina to Improve Health in the South

Project Page - North Carolina State Transformation Collaborative

Press Release - North Carolina Launches State Transformation Collaborative

Press Release - North Carolina’s Efforts to Advance the State’s Health Care Transformation Pick Up Speed

Advancing Biomedical Innovation

Clinical Trial Innovation: The clinical research enterprise has evolved greatly over the past several decades, with a clear need for evidence-based policy analyses and solutions to better marry clinical care and research, and to address longstanding access barriers that continue to limit representative access to trials for hardly reached populations. Duke-Margolis is expanding our clinical trials focus in several key areas.

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More Information:

Emerging Initiatives - Duke-Margolis Cell and Gene Policy Initiative and Enabling the Digital Health Revolution

Project Page - Clinical Trial Modernization

Project Report - Advancing Clinical Trials at the Point of Care (ACT@POC)

Clarifying the Pathway for Novel Alzheimer's Disease Drugs: Duke-Margolis developed a framework that incorporates two potentially complementary options for a path forward to pursue needed post-market evidence development for Alzheimer's disease monoclonal antibodies treatments. This framework aims to address crucial evidence questions related to Medicare populations by refining and enhancing the adequacy of current and upcoming evidence systems. This forward-looking strategy will not only streamline evidence generation for AD therapies but also contribute to a more robust foundation for informed decision-making in AD health care.

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More information:

Emerging Initiatives - Duke-Margolis Cell and Gene Policy Initiative and Enabling the Digital Health Revolution

Project Page - Alzheimer's

Supply Chain and Advanced Manufacturing Technologies: Manufacturing quality issues, public health emergencies, natural disasters, bioterrorism, geopolitical issues, and other supply and demand shocks all pose threats to patients in need of uninterrupted access to life-saving essential drugs. Duke-Margolis developed the ReVAMP Drug Supply Chain Consortium to generate effective policy solutions that promote a reliable drug supply chain.

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More information:

Emerging Initiatives - Duke-Margolis Cell and Gene Policy Initiative and Enabling the Digital Health Revolution

Project Page - Duke-Margolis ReVAMP Drug Supply Chain Consortium

The State of Real-World Evidence: Health care stakeholders are enthusiastic to explore whether real-world data sources (RWD), and the evidence they produce (real-world evidence (RWE), can inform and/or hasten medical product development and labeling. Importantly, RWE informs us about patient and provider choices as well as patient outcomes, which helps us understand whether medical products perform as intended in routine care. Ultimately, RWE may drive learning health systems that benefit patients by enhancing precision, equity, and care impact.

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More information:

Emerging Initiatives - Duke-Margolis Cell and Gene Policy Initiative and Enabling the Digital Health Revolution

Project Page - Real-World Evidence Collaborative

Public Health

Accountable Population Health: The Accountable Population Health model describes a partnership among health care, public health, and social service programs to implement more sustainably funded data, support, and care delivery capabilities within communities to address population health challenges. In this approach, Public Health 3.0 priorities can be addressed by updating the expectations and responsibilities of public health and publicly-supported, largely private health care systems.

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Emerging Initiative - Strengthening Public Health and Health Care Partnerships for the Future

Advancing Hepatitis C Elimination: Duke-Margolis has been instrumental in advancing a national strategy to reduce the burden of hepatitis C in the United States. Over two million Americans suffer from chronic hepatitis C, which remains the leading cause of liver cancer and transplantation despite the notable biomedical progress over the past decade. Duke-Margolis developed a comprehensive, coordinated national approach to hepatitis C elimination with an evidence-based implementation plan, and with an emphasis on leveraging existing health care and public health programs whenever possible.

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Emerging Initiative - Strengthening Public Health and Health Care Partnerships for the Future

Supporting Traditionally Underserved Populations through Better Safety Net and Home-based Care: Duke-Margolis works to advance health policy for these underserved communities and provides practical, evidence-based guidance for designing value-based payment models that can inform federal and state initiatives to better support safety net institutions and improve care for historically underserved and under-resourced communities—initiatives that exist at the intersection of health care, public health, and social services.

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More information:

Emerging Initiative - Strengthening Public Health and Health Care Partnerships for the Future