• Position: Associate Professor of Health Services, Policy and Practice, Associate Professor of Medicine
• Organisation: Providence VA Medical Center, Brown University School of Public Health
• Research Interests:quality of care and health care disparities, with particular emphasis on the impact of patient and provider incentives on quality and equity of care
We spoke with Amal Trivedi who won the Best Abstract prize at our 2015 conference. His presentation is available here: “Effect of drug co-payment reductions on preventable hospitalizations among Indigenous Australians: Australia’s Closing the Gap PBS Co-payment Incentive”
How did you get started in HSR? During my medical training, I got interested in studying health policy and the US health care system. My patients often struggled to access affordable health care. Many lacked insurance coverage. Or they were underinsured which left them exposed to large out-of-pocket costs. Even when patients accessed health care, there were widespread quality gaps. All of these problems were magnified for the most vulnerable, including racial and ethnic minorities and those with low incomes. So I decided to do an HSR and health policy fellowship after residency.
My goal was to learn how to evaluate policies and system-level strategies to improve quality and access for disadvantaged patients, particularly those with complex health care needs.
What was the first project you worked on and where? In my first project, I worked on developing a report card to evaluate states' efforts to address racial and ethnic health disparities. Like Australia, the US has an interesting and sometimes complex interplay between federal and state governments. Many efforts to address health disparities have originated at the Federal level, but state governments often serve as laboratories of innovation and implement health policy efforts on their own. We put together a list of measures and collected data on each state's performance in addressing health disparities. Not surprisingly, we found widespread state variation in the level of resources and scope of efforts to improve health for minority populations. This led to a paper in Health Affairs in a special theme issue related to health disparities.
What are some of the key projects you are currently working on? My research evaluates the consequences (intended and unintended) of policies and incentives in the Medicare and Medicaid programs. One set of projects examines changes in health insurance benefit design (ie. deductibles, copayments) on the use of services and health outcomes. I also have a grant that examines the role of private managed care plans in Medicaid program. Finally, I am a clinician in the Veterans Affairs health care system and have been funded to examine the quality of care in the VA and the impact of dual use of VA and non-VA care.
Career highlights so far? Mentoring students, post-docs and early-stage investigators is at the top of the list.
I direct a PhD program at Brown and have had the chance to work with an incredibly talented and passionate group of researchers in training. There is nothing that compares to seeing a student or post-doc get their first grant, publish an important paper, or get recruited to their first faculty position.
Another career highlight was coming to Australia in 2014 as a Commonwealth Fund Australian American Health Policy fellow. The fellowship gave me a chance to spend 8 months at the University of Melbourne. I worked with outstanding colleagues and got a chance to learn about strategies to improve access to prescription drugs among Indigenous Australians with chronic disease. This was one of the most meaningful experiences of my career.
What’s next for you in your career? What are you looking forward to? The Affordable Care Act created a number of opportunities to answer fundamental questions about the impacts of expanding insurance coverage, reforming payments to providers, and integrating care. As the implementation of the ACA proceeds, I look forward to examining the effects of this landmark legislation.
I also look forward to continue collaborating with researchers in Australia and other countries outside the US. There are incredible avenues for cross-national learning since many countries are testing innovative solutions to the common challenges of expanding access, improving value, and promoting health equity. That was part of the motivation for my coming to Australia as a Commonwealth Health Policy Fellow and becoming involved with the HSRAANZ.
What do you think is the best way of having an influence on policy? Relationships matter. Probably the best way to have an impact on policy is to engage early and often with policymakers. Find out what questions and issues they are grappling with. And then orient projects to respond to those needs. If policymakers and operational leaders are involved from the start and contribute to the design and execution of a study, that increases the chance that the research findings will ultimately have an impact.
What advice would you give to someone just starting out in the HSR?
Work on projects that you care deeply about. Identify a mentor who supports your work. And situate yourself in a environment that values your contributions.
Finally, relentlessly seek out meaningful collaborations with researchers, providers, and policymakers and patients. You can have more impact by working with others. Also, it's a lot more fun.