A Path to Policy
Salama Freed, PhD, has always been a numbers person. As a postdoctoral researcher in health economics at the University of Pennsylvania, she analyzed datasets to gain insight into health care disparities among disadvantaged populations in the United States. Her research focused on detailing and quantifying the effectiveness of innovative health care methods in advancing equal access to health. But she also wants to step beyond the world of numbers and learn about the inner-world of health policy – who shapes it, what drives it and how it gets done.
Dr. Freed believes that her path to this experience is through the National Pharmaceutical Council (NPC)/Duke-Margolis Postdoctoral Health Policy Fellowship. The two-year position, based in Washington, D.C., is designed to bridge a persistent gap between health research and policy analysis. She thinks the Fellowship will help her find a deeper understanding of how health policy works and how she can directly contribute to it.
She will be working on research projects for both NPC and Duke during her Fellowship. At NPC, she will be working with Jennifer Graff, PharmD, Vice President Comparative Effectiveness Research at NPC, focusing on topics such as coverage of medications, access to pharmaceuticals through benefit and formulary design and new payment delivery mechanisms. “My agenda aligns closely with NPC’s goals of ensuring that patients have meaningful access to appropriate treatments,” she said. “I am especially interested in the projects ensuring access to appropriate pharmaceutical therapies.”
At Duke, she will be working with Rob Saunders, PhD, Deputy Director, Academics, Duke-Margolis, and Professor of Population Health Sciences, School of Medicine, on research focusing on the evaluation of new payment policies and federal physician payment reforms. “Because of my previous work in these areas and my continued interest in health care spending, my research goals closely align with the Margolis Center’s efforts to investigate, document and implement payment reforms in novel health care delivery areas,” she said.
The policy implications for both of her research tracks may lead to a change in the way stakeholders approach issues such as provider payment rate changes, state Medicaid funding, private insurance premium setting and bundled payment initiatives.
A Path to Research
Dr. Freed’s strong research experience will serve as a foundation for her Fellowship and will allow her to understand how policy drives system change forward and where it can be improved. Looking forward to applying these skills, Dr. Freed will focus on the intersection of payment reform such as provider rate changes, insurance rate setting and bundled payment initiatives and how this can encourage, rather than discourage, equitable health care access.
The Fellowship allows early career researchers to explore the policy implications of health services research and to learn how to design studies to inform U.S. health care policy. As a Fellow, Dr. Freed will have access to researchers and policy experts from Duke and from NPC and will gain hands-on policy research experience, with opportunities to interact with a diverse set of stakeholders and mentors. Dr. Freed is the fourth Fellow to enter the program since the Fellowship was launched by NPC in 2013.
“I want this research to actually turn into something,” she said. “I feel like the only way to do that is to really understand the policy world. Being in the middle of all these policy makers and organizations that are on the ground dealing with policy is a unique opportunity.”
Her research has looked at how innovations in health care delivery systems, like urgent care clinics and assisted living facilities, have affected vulnerable groups such as minorities, the elderly and low-income individuals. She says her work stems from a desire to understand how providers and insurers establish alternatives to care, and whether these innovations improve the efficiency of care delivery, fill gaps in access to care or simply replace current options.
Dr. Freed says we risk gaining new technologies or creating new policies that increase quality of health care for some, while leaving vulnerable populations with antiquated care or no access to care. In the long term, we risk widening the life expectancy gap and increasing disparities between patients with ample access to care compared to those with few options.
“Vulnerable populations can slip through the cracks of the current health care systems,” she said. “Many low-income neighborhoods still can’t get health care. For example, there are many new urgent care clinics with innovative technology, but are they in the places where the most vulnerable people need them?”
She hopes her research will help improve these health disparities and has many questions on how to use health policy as a key to positive change. “How do we shine a light on important issues? How do we use research to see what the next issue is going to be? How do we define what that issue is?”
A Path to PhD
Dr. Freed did not start out as a health economics researcher. After finishing high school in her hometown of Birmingham, Alabama, she went on to complete her undergraduate and graduate degrees in electrical engineering at Vanderbilt University and North Carolina State University, respectively.
The focus of her master’s degree was in engineering computer microchips, so after graduation she accepted a position with Intel at a chip manufacturing facility in Oregon. She worked at Intel for the next eight years in several different roles, including manufacturing process engineer, business analyst and supply chain program manager. In her free time, she started to do a lot of volunteer work in her community.
“I was spending a lot of time volunteering at food banks and other things like that, so I started to care more about these other things that are going on around me,” she said. “I started to ask a lot of questions and began developing a passion for public policy and realized I wanted to pursue it as a career.”
She started from scratch at a community college with Econ 101 and fell in love with it. Then she applied to Duke University’s graduate program in economics and thrived there. With her master’s in economics in hand she won a health policy fellowship from the Robert Wood Johnson Center for Health Policy at Meharry Medical College to study in the PhD program in economics at Vanderbilt University. Six years later, she earned her PhD and started her postdoctoral research at the University of Pennsylvania’s Leonard Davis Institute of Health Economics and Perelman School of Medicine.
She is not entirely sure what she wants to do after her Fellowship at NPC, but knows she’ll still be involved in the academic and health policy spaces. Whatever it is, she still has plenty of time to decide. “I think one thing I've learned over the years is to never set out and say what your path is. You have no idea what it's going to be,” she said. “You know, the path is curvy for some people, and I happen to be one of those people.”