Since its establishment in 2009, the Schaeffer Center has been awarded more than $65 million in grants to support work that aims to measurably improve value in health nationwide and around the world. These grants contribute to the support that allows researchers to pursue innovative solutions to today’s pressing healthcare challenges and to provide evidence for policies with impact far into the future. Below is a sample of Center federal grants showing the breadth and depth of our work:
National Institute on Aging: Minority Aging Health Economics Research Center
In 2012, the National Institutes of Health awarded the Schaeffer Center a $2.7 million grant over five years to establish a Resource Center for Minority Aging Research (RCMAR). USC RCMAR is named the Minority Aging Health Economics Research Center and is led by Dana Goldman and Julie Zissimopoulos. The project mission is to provide infrastructure and resources to increase the number, diversity and academic success of researchers focusing on the health and economic wellbeing of minority elderly populations.
RCMAR work examines the differences across racial and ethnic groups of elderly in healthcare decision-making, including medical care utilization and Medicare Part D plan choice; health behaviors and outcomes; and financial behavior including savings and work, and economic wellbeing. The project aims are to support research careers in the health and economic challenges of minority elderly; to solicit pilot studies; to mentor junior faculty (RCMAR scholars) in multidisciplinary training; to begin new lines of research; and to track and evaluate success of pilot RCMAR scholar investigators.
National Institute on Aging: Medical MalPractice, Healthcare Costs and Technology Adoption
Darius Lakdawalla leads this study on the welfare effects of medical malpractice liability using variation in the generosity of local juries to identify the causal impact of malpractice liability on social welfare. Growth in malpractice payments over the last decade and a half contributed at most 5 percentage points to the 33 percent total real growth in medical expenditures. On the other hand, malpractice leads to modest mortality reductions; the value of these more than likely exceeds the costs of malpractice liability. Therefore, reducing malpractice cost is unlikely to have a major impact on healthcare spending, and unlikely to be cost-effective over conventionally accepted values of a statistical life.
National Institute on Aging: Improving Pharmacy Benefit Design
Dana P. Goldman leads a multidisciplinary team spanning four research institutions to study specific applications of comparative effectiveness research in Medicare. The study examines consumer plan choice in the Medicare Part D marketplace; investigates how formulary and benefit design affects competition, utilization, health and spending; and applies comparative effectiveness analysis to identify clinical areas for potential savings.
National Institute on Aging: Roybal Center for Health Policy Simulation
Dana Goldman leads the Roybal Center for Health Policy Simulation, a collaborative effort between USC and the RAND Corporation. The mission of the Roybal Center is to develop better models to understand the consequences of biomedical developments and social forces for health, health spending and healthcare delivery. In 2010, the Roybal Center moved to the USC Schaeffer Center. Funded by the National Institute on Aging since 2004, the Roybal Center features work using the Future Elderly Model (FEM), a multi-year effort to identify and forecast the consequences of medical breakthroughs over the next 30 years, and the role that regulation plays in promoting or hindering global innovation.
A demographic and economic simulation model designed to predict future costs and health status of the elderly and explore what current trends or future shifts imply for policy, FEM has already shaped the national discussion about the role that medical technology will play in explaining health and healthcare spending. FEM provided the first quantifiable model of the long-run population health consequences of pharmaceutical regulation. Developed by Dana Goldman and colleagues at USC and RAND, the model uses a representative sample of approximately 100,000 Medicare beneficiaries age 65 and overdrawn from the Medicare Current Beneficiary Surveys, national surveys that ask Medicare beneficiaries about chronic conditions, use of healthcare services, medical care spending and health insurance coverage. Each beneficiary in the sample is linked to Medicare claims records to track actual medical care use and costs over time.
National Institute on Aging: Obesity in Older Americans
The last few decades have witnessed a particularly rapid rise in weight and obesity for individuals of all ages. While weight growth in children and working-aged adults has received the most attention, the public health consequences of excess weight for the near-elderly and elderly are considerable. This research identifies the determinants of weight gain in these older populations, and the consequences for health. Under the direction of principal investigator Dana Goldman and co-principal investigator Darius Lakdawalla, the project developed a dynamic economic model of weight gain that illustrates the relationships between food prices, exercise availability, income, retirement status and weight. Further, we studied several clinical solutions to the obesity problem among the elderly and found evidence suggesting the considerable value that could be generated by the use of bariatric surgery on the obese, but found less evidence to support pharmacologic therapy. In sum, we have explored causes, consequences and solutions to the growing problem of elderly obesity.
National Institutes of Health: An Economic and Behavioral Evaluation of Medicare Part D
This program project grant examines the economic underpinnings of Medicare Part D and its consequences. Part D represents one of the most important reforms to the U.S. Medicare system in its history, and a policy experiment with weighty consequences. Researchers will study the economics of consumer choice, the economics of aging, insurance design, pharmaceutical innovation, and health policy from an array of perspectives including beneficiaries, insurers, drug manufacturers, policy makers, and elderly households. In particular, researchers will examine the effects of the Part D coverage gap — known as the “doughnut hole” — on prescription medication adherence, how drug plan formulary and benefit design (FBD) affects competition and adverse selection, and the effects of Part D on the behavior of pharmaceutical firms (through investment in advertising and R&D). This program project will provide an integrated economic evaluation of the welfare effects of Part D, and promote Medicare-related research of policy and scientific interest.
National Institutes of Health: The Science of Medicare Reform
The National Institutes of Health (NIH) awarded more than $5 million to Dana Goldman to lead a multidisciplinary team spanning four research institutions — Stanford University, USC, RAND Corporation and the University of California, Berkeley — to study specific applications of comparative effectiveness research (CER) to the Medicare program. This study examines consumer plan choice in the Medicare Part D marketplace; investigates how formulary and benefit design affects competition, utilization, health and spending; and applies comparative effectiveness analysis to identify clinical areas for potential savings. Researchers will also examine the long-term spending and enrollment effects of changes to the Medicare program as a result of the Affordable Care Act (ACA). Study findings with respect to policies such as a means-tested Part A premium, increasing the eligibility age and establishing vouchers have revealed a 5 to 22 percent spending reduction between the years 2012 to 2036, suggesting that considering such policies may be necessary for long-run cost containment.
Principal investigators are Dana Goldman, Christine Eibner and Jay Bhattacharya with co-investigators Darius Lakdawalla, Geoffrey Joyce, Jeffrey Sullivan, David Lowsky, Peter Huckfeldt and Daniella Perlroth.
National Institutes of Health: Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections
Principal Investigator Jason N. Doctor received an $11.4 million three-year grant to explore ways to dissuade doctors from prescribing antibiotics unnecessarily. Doctor and his team, including Dana Goldman and Joel Hay, apply behavioral economics — the science of how people make decisions — to help reduce the frequency with which doctors prescribe antibiotics for certain acute respiratory infections. Aggressive antibiotic prescribing is a major public health concern — with approximately 22 million inappropriate prescriptions each year — for its suspected link to the spread of antibiotic-resistant bacteria. Doctor’s project set out to “nudge” physicians toward better prescribing.
To make sure that strategies are tested in a variety of settings, the grant provides for collaboration with clinics in poorer districts of Los Angeles as well as in more affluent areas near clinics run by Harvard University, the University of Chicago and Northwestern University. Other investigators include Annie Wong-Beringer, professor at the USC School of Pharmacy; behavioral scientists Craig Fox and Noah Goldstein at the UCLA Anderson School of Management; Daniella Meeker, assistant professor of preventive medicine at the Keck School of Medicine at USC; and John Adams and Emmett Keeler from RAND Corp.
This grant was awarded in 2009 and Doctor has received additional funding, building on the initial work, from the NIH, the Agency for Healthcare Research and Quality, and the California Healthcare Foundation which has supported application of Doctor’s approach to the opioid epidemic, aiming to instill safe prescribing habits in physicians. The National Institute on Aging has also provided support for Doctor’s work focused on improving opioid prescribing safety.
CMS Innovation Grant (CMMI): Integrating Clinical Pharmacy Services in Safety-Net Clinics
The Centers for Medicare and Medicaid Services (CMS) awarded researchers at the University of Southern California a $12 million award to improve healthcare quality, enhance medication safety and reduce overall healthcare costs for high-risk, underserved populations. The study brought pharmacists into safety-net clinics in Southern California as a way to improve medication adherence and to promote safe and appropriate use of prescription drugs. The intended result of the study was to optimize patient health while reducing avoidable hospitalizations and emergency visits. This optimization aimed to lead to a substantial reduction in overall treatment cost. This highly competitive program administered by the CMS Center for Medicare and Medicaid Innovation (CMMI) fielded more than 8,000 letters of intent and 3,000 full proposals to fund just over a hundred programs.
Geoffrey Joyce was the principal investigator on the project.
National Institutes on Aging: Consumer-Directed Health Plans and Use of Preventive Services
The market share of consumer-directed health plans (CDHP) — plans with high deductibles — and personal health accounts has grown dramatically in recent years. CDHPs change incentives for use of preventive services in complex ways. CDHPs provide first dollar coverage for a few selected primary preventive services such as cancer screenings, but CDHP enrollees pay the full costs for other preventive services such as prescription drugs below the annual deductible. Consumers also face higher costs for other medical expenses such as hospitalizations that might be prevented by efficient use of preventive services. This research project is the first, to our knowledge, to comprehensively estimate the long-term effects of CDHPs on use of primary and secondary preventive services, and whether these health plans lead to greater price-shopping for preventive services.
Principal investigator on this grant is Neeaj Sood, who has garnered additional support to expand his work on consumer-directed health plans from the National Institute of Health Care Management and the California Healthcare Foundation. Learn more about Sood’s work on high-deductible health plans.
National Institute on Aging: Vertical Integration and Care Coordination in Post-Acute Care Markets
Each year millions of Medicare beneficiaries are discharged from acute care hospitals into post-acute care (PAC) facilities. We seek to understand how health outcomes and costs of these beneficiaries are influenced by the level of integration between the acute care hospital and PAC provider. We examine the potential effects of proposed Medicare reforms aimed at improving care coordination between acute care hospitals and PAC providers. We looked at patient health outcomes and healthcare costs for those admitted to skilled nursing facilities (SNFs) and to those admitted to inpatient rehabilitation facilities (IRFs). We also estimate the extent to which the causal effects of receiving vertically integrated care evolve overtime as efforts to coordinate care gain momentum.
Neeraj Sood is the principal investigator on this project.
National Institutes of Health: Effectiveness of Therapeutics and Health Care Service Use in the Reduction of Health Disparities in Alzheimer’s Disease
The origins of racial disparities in Alzheimer’s disease (AD) are multifaceted — ranging from risk of AD and access to care to delivery of care and genetic variance in response to care. In the proposed program of research, we will approach the challenge of racial and ethnic disparities in AD from two perspectives: use of and response to drug therapies for non‐AD conditions that influence risk of AD and; healthcare treatments for AD. Our goals are to identify racial and ethnic differences in both and, once identified, elucidate opportunities for potential AD prevention and treatment regimens across diverse populations. To achieve these goals, we will conduct analyses using longitudinal Medicare claims data on more than 10 million persons per year. Medicare claims data have several advantages over other types of data such as clinical trial data, survey data or data from electronic medical records: 1) Medicare beneficiaries are of the age group at greatest risk for AD, persons ages 65 or older, beneficiaries are of both sexes and all races and come from diverse socioeconomic backgrounds; 2) the magnitude of the Medicare population provides sufficient number of persons by sex and by race to conduct statically powered analyses; 3) data contain details on all prescribed drug therapies and healthcare treatments and services reimbursed by Medicare and they are not limited by error in self‐report measures common in survey data. Aim 1 will identify drug therapies currently used to treat non‐AD conditions that may affect AD risk. Expert panelists will help prioritize the evidence and provide insight into probable variations across sex, race and ethnicity. Aim 2 will analyze the influence of these drug treatments on incidence of AD and differences in the association across sex, race and ethnicity. Aim 3 will evaluate racial disparities in AD diagnoses and treatments over time, including diagnosis methods; the specialties of diagnosing physicians; initiation and use of AD and other psychotropic drugs; timing and regularity of physician visits; and the factors associated with differences across diverse race and ethnic populations. This research will inform drug targets and the design of clinical trials, as well as AD treatment and care interventions to reduce racial disparities in combating the disease.
National Institute of Diabetes and Digestive and Kidney Diseases: The Long-Term Benefits of Interventions to Improve Type 2 Diabetes Outcomes
Diabetes is a mounting public health concern, with millions of new cases each year. Poor control of diabetes is associated with serious health complications, including heart disease, blindness and amputation. Control of diabetes can be achieved through adherence to diet, exercise and treatment guidelines, but compliance with prescribed regimens can be complicated and difficult. The Look AHEAD study randomized an intensive lifestyle intervention focused on weight reduction among more than 5,000 patients with type 2 diabetes in 2001.
Participants in the intervention lost weight and improved their diabetes control over the 11 years of the intervention relative to the control group. Weight reductions and improvements in diabetes outcomes may lead to broader benefits for patients in terms of functional status, ability to work and fewer health complications. We propose research linking Look AHEAD participants with data from Medicare and the Social Security Administration to determine the effect of the intervention on long-term healthcare utilization (e.g. hospital admissions), employment, earnings, retirement and severe disability (as measured by enrollment in disability insurance). In addition, we will simulate the long-term fiscal impacts of a broader, national expansion of the intensive lifestyle intervention. Finally, we will compare health and disability measures collected by the Look AHEAD study to overlapping measures in Medicare and the Social Security Administration data, to evaluate the use of administrative data as a source of health information in clinical trials. The results of this study will provide important evidence on the broader benefits of successful lifestyle interventions for diabetes. In addition, the results will indicate the impact of improved diabetes control on functional status and economic outcomes.
Dana Goldman is principal investigator with Peter Huckfeldt.