Alumna Jia Pu’s research puts patients first and impacts national healthcare policy
By Katie Ginder-Vogel
For initiatives ranging from drug pricing transparency to interventions to improve cardiovascular disease outcomes, healthcare policies require rigorous research that supports their efficacy or provides ways to improve it.
Jia Pu (PhD ’13), a graduate of the University of Wisconsin–Madison School of Pharmacy’s Social and Administrative Sciences in Pharmacy PhD program (now Health Services Research in Pharmacy), is one of the researchers behind this important work, providing evidence to validate strategies and make suggestions for improving programs.
“We want to provide actionable information to guide decisions, especially in policy areas,” explains Pu, health policy researcher at Mathematica Policy Research. “I feel we have a big impact.”
Mathematica Policy Research works mainly for federal, state, and local governments but also does work with private sector organizations. At Mathematica, Pu focuses on health policy and program evaluation, using rigorous methods, like data science and analytics, to help government sectors evaluate their policies.
“In response to their questions, I design studies, lead analysis, draft reports, present findings to policy and professional audiences, and publish in professional journals,” says Pu. “We work closely with our government audience and make recommendations when we uncover challenges.”
Pu calls her work at Mathematica the best job, where she gets to address big-picture questions with real-world impact.
“I’m proud that my research has the potential to change health policy and improve the healthcare system, patient quality of life, and health outcomes,” she says.
Fusing pharmaceutical science with health education
Pu first developed an interest in patient-centered health outcomes working as a clinical trial assistant at Numico Pharmaceutical Company in China. After relocating to the U.S. to earn a master’s degree in health education from the University of Nebraska–Lincoln in 2009, she wanted to combine her interests and skills in pharmaceutical sciences and health education. She was familiar with the UW–Madison School of Pharmacy’s program in Social and Administrative Sciences (SAS) and felt it was the logical next step for her education.
“I knew I wanted to be in the SAS program at UW–Madison and that the program was highly selective,” Pu says. “I had the pharmacy side and the patient care/health education side, and I wanted to go to graduate school and combine those. The SAS program looked like the perfect match, and it was.”
When Professor Betty Chewning in the School’s Social and Administrative Sciences Division, called to congratulate her on being admitted, Pu couldn’t contain her enthusiasm.
“I was so excited when Dr. Chewning called to tell me I was admitted that I was screaming,” Pu says, laughing. “She’s great, the best mentor.”
During her time at the School, she received the Joseph Wiederholt Wisconsin Distinguished Graduate Fellowship as a PhD student at the School and was the valedictorian of her class.
“I developed a deep understanding of the U.S. healthcare system, especially the pharmacy system — including policy, pricing, insurance, and the economic side — that allowed me to pursue a minor in population health,” she says.
After earning her PhD, Pu joined the Palo Alto Medical Foundation Research Institute in Palo Alto, Calif., as a AcademyHealth DSSF postdoctoral fellow and health outcomes researcher, to gain experience working within a healthcare organization.
“I had the opportunity to work with patients and providers, and it helped me appreciate the challenges they face,” Pu says. “I learned that we have gaps between research and practice, and we have to keep that in mind when we develop research questions and think about how to best present our findings to be actionable in practice.”
Pu became interested in bigger-picture questions and wanted to take her analysis to the next level to leverage her quantitative skills and knowledge of pharmacy policy to answer questions about the healthcare system as a whole in order to impact population health.
That’s what led her to Mathematica, where she landed her “dream job.”
Finding real-world answers
“I observe gaps between research findings and daily practice and policy, but my work at Mathematica focuses on real-world questions — real questions from policymakers and healthcare organizations, big questions that have to be answered using rigorous methods and evidence,” Pu says.
Pu’s research has uncovered new information and contributed to the implementation of changes across the care spectrum.
For example, she led a research effort for an environmental scan of insurers throughout the nation who were implementing innovative strategies to address opioid prescription misuse and abuse. Her team was able to identify the most promising programs.
“Professor Chewning taught me the most important thing: to truly care about patient-centered outcomes and understand patients’ perspectives. In large clinical studies, patients can become numbers, so we have to keep in mind that the ultimate goal of our research is to serve the patients.” —Jia Pu
Pu’s team began by conducting an environmental scan, in which they searched peer-reviewed literature, news reports, and insurer websites to identify programs addressing the opioid crisis. They also used a snowball sampling approach, in which they looked at references in relevant articles to find additional programs they might have missed in their environmental scan.
The team ranked programs in order of priority for interviews, based on specific inclusion criteria, and interviewed representatives from these programs over the phone using an in-depth protocol.
“We grouped promising programs by category and synthesized information on these innovations to provide an overview of the types of interventions and the outcomes documented by insurers,” says Pu. “We were able to identify a number of innovative approaches these programs used to address opioid prescription misuse and abuse, such as setting up prescribing limits and integrating physical and behavioral healthcare.”
Pu also evaluated the effectiveness of the CDC’s Million Hearts Program, an initiative to improve cardiovascular disease outcomes by incorporating intervention strategies with participating healthcare organizations.
“I used Medicare Part D insurance claims data to understand whether the initiative helped participants improve their cardiovascular health by initiating or intensifying statins or antihypertensive medications,” Pu says. “Was better care achieved after joining the Million Hearts program?”
Pu’s work at Mathematica has also impacted the planning and implementation of state drug transparency laws as they relate to pricing. The National Academy for State Health Policy (NASHP) recently partnered with Mathematica on an initiative to help states address rising prescription drug prices: the Supporting Effective State Transparency Laws initiative, funded by the Laura and John Arnold Foundation. The NASHP selected Mathematica to collect and analyze data on rising drug prices, with the goal of helping states understand price increases and find ways to control them.
“We worked with the NASHP transparency implementation network to define a set of minimum data elements — basic definitions they could use to address detailed questions about drug pricing and trends,” Pu says. “We helped NASHP to revise legislation and to develop data reporting protocols and templates.”
The project was recently completed, and Pu’s team created a toolkit that all states can use to develop drug transparency legislation. The toolkit includes a common prescription drug pricing data set that all states agree should be collected; optional data elements that states may collect, based on specific legislative goals; a roadmap for implementing drug transparency legislation; a template for a searchable database; and updated model state transparency legislation.
“I’m proud that my research has the potential to change health policy and improve the healthcare system, patient quality of life, and health outcomes.” —Jia Pu
Pu is currently the project director of the Landmark Health Evaluation, a mixed-methods evaluation of an innovative care delivery model initiated by the California Health Care Foundation. Pu has developed research and analytics plans to examine beneficiary satisfaction, cost, utilization, and quality outcomes, using surveys, encounter data, and electronic medical records (EMR).
“This model is designed to deliver coordinated services to a cohort of high-risk and high-cost Medi-Cal managed care members, through a partnership between the Inland Empire Health Plan and Landmark Health,” says Pu. “I love that we can combine qualitative and quantitative information, using mixed methods to understand intervention and program impacts.”
Pu has conducted two types of evaluations, an implementation evaluation and an impact evaluation.
“We interviewed stakeholders and providers to understand their perspectives and learn how the program has been doing from a stakeholder’s perspective,” says Pu. “A few months after the program started, we helped them understand the challenges in the daily program work. The program can use the feedback to improve care.”
Later, Pu and her team analyzed insurance claims data and patient outcomes data to study whether the program really worked to help patients reach their health goals and prevent 30-day hospital readmissions. The effort is still ongoing.
Pu credits her time at the UW–Madison School of Pharmacy with helping her find her way as a researcher.
“Professor Chewning taught me the most important thing: to truly care about patient-centered outcomes and understand patients’ perspectives,” says Pu. “In large clinical studies, patients can become numbers, so we have to keep in mind that the ultimate goal of our research is to serve the patients.”