July 2020 was a challenging time for all of us as the COVID-19 pandemic was causing devastating loss of life, vaccines were yet to be developed, and many Americans found themselves in limbo. For Salama Freed, PhD, it also marked the beginning of her path to learn the inner workings of health policy – who shapes it, what drives it, and how it gets done through the National Pharmaceutical Council (NPC)/Duke-Margolis Postdoctoral Health Policy Fellowship. This month we celebrate Dr. Freed's next step on her career journey as she completes her fellowship and begins as an Assistant Professor at the Milken Institute School of Public Health at George Washington University.
In the last two years, Dr. Freed has accomplished much, including two peer-reviewed publications,,  a manuscript currently under review, several works in progress, including research on telehealth disparities and medication use patterns due to COVID for people with chronic conditions. Even during a time of disruption for industry and academic conferences, Salama gave ten research presentations, including her most recent presentation this week at the American Society of Health Economists 2022 Annual Conference in Austin, Texas, and taught an undergraduate econometrics course at Duke University in Spring 2022.
As we prepared to say farewell to Dr. Freed, we asked her a few questions.
What advice would you give incoming research fellows to help them become successful?
Be curious. Do not be afraid to ask for help, ask questions, and get involved in projects beyond your own work, even if it is just sitting in on meetings. You learn a lot just by sitting in on those projects.
Why did you want to be a fellow at NPC?
There were three primary reasons. I wanted the experience of learning about the pharmaceutical industry and having the opportunity to understand health policy and policymakers. I also wanted to understand their perspective of others. Through exposure to NPC member companies, I heard firsthand different perspectives of how policy impacts patient access, which is extremely important to me. I tend to think about organizations, how they work, their structure, and how they affect patient access. The fellowship was an excellent way to do that.
Did your experience as a fellow meet your expectations?
For the most part, yes. I learned a lot about policies ranging from Medicaid Best Price to 340B and how they are intertwined. More importantly, my thinking on health policy-related research was enhanced. For example, on my first day at NPC, we were talking about value, and the question was asked of me, “Well, how do you measure what value is?” Considering these types of questions in practical terms changed the way I think about a lot of things. I had read a lot of economics papers that talk about low-value care, but at NPC, I had to really think about how you measured concepts like value.
The diversity of projects I had the opportunity to work on was amazing. In two years, I have developed research papers on Accountable Care Organizations, Medicare-Medicaid dual eligibility, measuring changes in pharmaceutical pricing and innovation, disparities in telehealth, and medication use patterns during the COVID-19 pandemic. The opportunity to learn from both NPC and Duke University at the same time helped me expand my research reach and see how different organizations can be different but have very similar goals. Perhaps more importantly, I learned a lot about relationships, how to lead a project and keep work progressing on schedule working as part of a team, and how to look at different research approaches.
What skills have you gained in these two years that will help you be successful in your role as a professor?
Being able to develop an entire research portfolio from a project instead of thinking about one or two papers or one question or two questions. I am currently working on what started as one project that has developed into multiple papers and more questions to answer later. Learning to take a big idea and break it into manageable pieces that are connected has been incredibly valuable.
My confidence has grown in my ability to do research, write and publish papers, and speak publicly. This is the first time I’m publishing work where I’m the first author beyond my dissertation, and I will be the first author on possibly four papers developed during my NPC fellowship. Other than your dissertation, you don’t get that opportunity in graduate school.
Why the focus on aging in your new role as an Assistant Professor at George Washington University?
My interest in aging began in graduate school through my interest in Medicare and long-term care. My interest was amplified by helping my father navigate our complicated health care system after he had a serious health crisis and seeing firsthand what older Americans have to deal with. I always have cared about plugging the holes in the system where vulnerable people can fall through the cracks. In my new role, I will focus on health policy issues related to aging and how to enhance the appreciation of the talents brought to the table by older Americans.
What excites you about your future?
Tackling issues that matter. The department I am going to at George Washington is very hands-on and service-oriented. Nearly everyone I interviewed with has experience with nonprofit organizations that advocate for vulnerable and underserved populations. I am excited to learn from them and build upon the valuable connections already made at NPC. Each new connection brings a different perspective and new ways to think about things.
If you had one wish for policy, health policymakers, what would that be?
I wish policymakers could see the connection between healthy people and economic growth. How the right mix of coverage and care, not letting people fall through the cracks, funding for essential coverage like dental benefits, providing adequate funding for long-term care, and other issues can increase productivity and improve GDP. If you are sick or caring for someone sick, you are less productive. If you are less productive, you are not helping this nation grow.
Dr. Freed is no stranger to blazing new paths, as we highlighted at the beginning of her fellowship. We are proud of the work she has done, her personal and professional growth, and know she will continue to build upon the body of research that supports health policies that put patients first.
 Freed, S.S.; Kaufman, B.G.; Van Houtven, C. H.; Saunders, R.S. (2022) Using a Home Time Measure to Differentiate ACO Performance for Seriously Ill Populations. J Am Ger Soc. doi:10.1111/jgs.17882
 Ritter, A. Z.; Freed, S. S.; Coe, N. B. (2021). Younger Individuals Increased Their Use of Nursing Homes Following ACA Medicaid Expansion. J Am Med Dir Assoc. doi: 10.1016/j.jamda.2021.08.020
 Freed, S.S.; Franscino, N.; Jones, K.; Giri, A.; Stewart, L.; Hendel, K.; Clark, A.; Van Houtven, C.; Higgins, A.; Kaufman, B. Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis.