Peter ("Pete") W. Groeneveld, MD, MS is Professor of Medicine at the University of Pennsylvania’s Perelman School of Medicine and a primary care physician at Philadelphia’s Corporal Michael J. Crescenz VA Medical Center. He is the Founding Director of Penn’s Cardiovascular Outcomes, Quality, and Evaluative Research (CAVOQER) Center, Director of Research at Penn’s Leonard Davis Institute of Health Economics (LDI), Chair of the VA’s Research and Development Committee, Co-Director of Penn’s Master of Science in Health Policy (MSHP) program, and Associate Director of the VA’s Center for Health Equity Research and Promotion. Dr. Groeneveld’s research is focused on the quality, outcomes, costs, and equity of high-technology cardiovascular care, and his methodological expertise is in the analysis of a wide variety of health care data, including administrative claims, clinical registries, electronic medical records, and surveys. His research has been funded by the VA, NIH, AHRQ, and the Commonwealth of Pennsylvania, and he has co-authored over 100 peer-reviewed publications. Dr. Groeneveld is a Fellow of the American Heart Association and of the American College of Physicians, and he is an elected member of the American Society for Clinical Investigation (ASCI).

Title: Cardiology Physician Group Practice Vertical Integration and the Use of Cardiovascular Imaging

Abstract: A substantial proportion of previously independent U.S. cardiology physician practices have become vertically integrated into larger health systems.  It is unclear if vertical integration affected the clinical practice patterns of these cardiologists.  Longitudinal data from cardiology practice surveys from 2008-2013 were combined with Medicare fee-for-service claims for two common cardiology imaging tests: echocardiograms and cardiac nuclear studies. Cardiologists who transitioned from independent to hospital- or health system-owned practices ordered 17% more echocardiograms and 10% more cardiac nuclear imaging studies after their practices had transitioned.  Our findings surprisingly suggest that vertical integration of cardiologists' practices was associated with higher rates of cardiovascular imaging.  Potential explanations include preferential integration of group practices with lower pre-integration imaging rates, increased post-integration clinician incentives for ordering tests, and/or reduced administrative barriers to obtaining testing after integration. 

Pascal Geldsetzer, PhD 
Assistant Professor of Medicine in the Division of Primary Care and Population Health

Title:  Regression Discontinuity in Electronic Health Record Data

Abstract: Regression discontinuity in electronic health record (EHR) data combines the main advantage of randomized controlled trials (causal inference without needing to adjust for confounders) with the large size, low cost, and representativeness of observational studies in routinely collected medical data. Regression discontinuity could be an important tool to help clinical medicine move away from a “one size fits all” approach because, along with the increasing size and availability of EHR data, it would allow for a rigorous examination of how treatment effects vary across highly granular patient subgroups. In addition, given the broad range of health outcomes recorded in EHR data, this design could be used to systematically test for a wide range of unexpected beneficial and adverse health effects of different treatments. I will talk about the broad motivation for this research and discuss examples from some of our ongoing work in this area. If there is time, I will also discuss some of my ongoing research on improving healthcare services for chronic conditions in low- and middle-income country settings. 

Alyce S. Adams, PhD 
Professor of Medicine, Stanford's Center for Health Policy & Center for Primary Care and Outcomes Research
Professor of Epidemiology and Population Health in the Stanford School of Medicine 
Associate Director for Health Equity and Community Engagement in the Stanford Cancer Institute 

Title: Health Policy and the Fight for Equitable Healthcare Outcomes: Why Access Isn’t Enough

Abstract: Using evidence from evaluations of natural experiments, Alyce Adams will discuss the intended and unintended consequences of changes in prescription drug policy at the state and federal level of low income and minority individuals with multiple chronic conditions. We will explore the potential for policy effects to have an immediate and dramatic increase in access to clinically essential treatments. However, she will also discuss where such policies can widen, rather than reduce disparities in treatment. We concluded that increasing access (while critical) is not sufficient to address inequities in treatment use and outcomes among high risk populations. Importantly, new strategies are needed to inform the design of policy interventions that promote access, while simultaneously advancing health equity.