Faculty Spotlight: Kathleen Carey.

Collaborative work is key to developing sustainable public health solutions and improving population health outcomes. This weekly series spotlights one SPH faculty member who advances public health through collaborations within the field and across sectors.

How are collaborative partnerships integral to your research as a health economist, and can you describe a few collaborations that have been most meaningful to you?  

My first real job was an experiment in collaboration. The face of our Cambridge alternative public school was a small business cooperative run by four grant-supported teachers and a group of high school kids in danger of dropping out. I taught the math skills they needed to make their small business successful. This was not my ultimate calling but it showed me for the first time how collaboration can leverage innovation to improve lives.

Economics later lured me in a different direction. There math could meet policy to address problems with our healthcare system. My first position as a health economist was at the former VA Management Science Group, a 10-person think tank that advised VA agency officials. We were tasked with evaluating the cost of VA hospital care compared to the same services provided in the private sector. In collaboration with the Group, I learned how to design a large research project to address an important policy issue and that complementary skills are essential to good research collaboration.

Early research on hospitals steered me to a number of questions around the cost implications of various market and regulatory changes for US hospitals. For example, does reducing length of stay by cutting the marginal days really save hospitals much money? And in collaboration with PhD student and mentee Meng-Yun Lin, might some episodes of care cost more if premature discharge results in the patient being readmitted?

Movement of many services out of the traditional hospital setting opened interesting new research questions. I received grants from AHRQ and from the Robert Wood Johnson Foundation to study cost and other economic issues around single specialty hospitals (SSHs). In the decade of the 2000’s, these facilities became controversial as physician-owners were taking profitable cardiac and orthopedic surgery patients out of general hospitals into their own boutique facilities. Among the series of papers that followed, none concluded that these facilities created value. Seeing the ACA prohibit federal reimbursement to new physician-owned SSHs made these efforts meaningful. Collaborating with the late Jim Burgess and former Department Chair Gary Young made them fun.

Ambulatory surgery centers (ASCs) are freestanding facilities that now outnumber acute care hospitals. Like SSHs, ASCs largely are specialized and physician-owned, but unlike SSHs don’t offer overnight stays. Collaborating with Jean Mitchell of Georgetown University and supported by grants from NIH and AHRQ, our work has found that specialization in ASCs does have a cost advantage, supporting the “focused factory” model of production.

In current AHRQ-funded work, long-standing colleague Avi Dor and others at George Washington University and I are examining several policy issues around the cost of care in Community Health Centers (CHCs). Early on, we are finding that care can be delivered in CHCs at lower cost without compromising quality, a critically important result since CHCs serve the most medically vulnerable yet rely on uncertain public funding streams.

In health services and policy research, economics almost always matters. So I’ve had the opportunity to participate and learn from many meaningful collaborations with non-economists. One stands out because of rapid translation into policy. Working with Lewis Kazis and others at SPH, and funded by OptumLabs, United Health Care, and the American Physical Therapy Association, we studied the association of conservative therapy for new onset low back pain with early and later use of opioids. The economic angle was patient cost sharing. Are patients more likely to see a physical therapist if they face lower out of pocket costs? Our study published in early 2019 in The American Journal of Managed Care indicated that they are. Last July, in a number of markets, United Health Care dropped all low back pain patient cost sharing for the first few visits to physical therapy. More rollouts of this benefit redesign are in progress.

Recently, I was seated on the 14-member Massachusetts Public Health Council where I represent the Massachusetts Coalition for the Prevention of Medical Errors. I now have the opportunity to apply economic logic and all I’ve learned from these and many other collaborators to real-time public health issues here in Massachusetts. I am excited about this newest collaboration and look forward to serving.

“Dr. Carey’s Health Economics course has been one of the backbones of the health policy certificate at SPH for years. She brings to her teaching a wonderfully full career of studying costs across a variety of medical delivery models. Dr. Carey was using big data before anyone thought to call it ‘big data.’”

Michael Stein, chair and professor in the Department of Health Law, Policy & Management