For the past year, Aaron McKethan, Ph.D., an assistant professor of population health at the Duke School of Medicine, also has been serving as the chief data officer for the North Carolina Department of Health & Human Services. Having one foot each in the two worlds of government and academia has given him some unique insights into how academic researchers can help policymakers with data-driven decision making. For example, he has helped North Carolina partner with the state’s university researchers to create an Opioid Analytics Roadmap.
Speaking to a June 29 Grand Rounds meeting of the NIH Collaboratory, McKethan stressed that state government health agencies need help identifying their analytics priorities.
He said directors of these agencies are so busy with legislative hearings and interactions with federal and county counterparts, they often don’t have clear analytics priorities established.
“There is an opportunity for all of us to partner around analytics priorities,” McKethan said. “There are unique contributions universities can make in helping to set the agenda for the most important questions to ask.”
Typically, the HHS department addresses two types of questions. One might be legislative requests for fact-finding data such as how many skilled nursing facilities are there in the state.
On the other end of the spectrum are studies looking at more complex issues such as the impacts of Medicaid managed care, and the state tends to outsource those efforts. “There is a large opportunity in the middle ground between those to help states craft questions to influence policies,” he said.
McKethan wants researchers to help the state in asking these questions:
• What do we already know and where is policy not aligned with available evidence?
• What do we not know and how valuable would it be to know?
• What are the highest priority questions?
He said answering these questions can help a state create an analytics roadmap. Initially, it can determine what can be answered with the data and methods the state has and that can inform near-term policy issues.
North Carolina is applying this approach to the opioid crisis, because it has been identified as a top priority by state leaders. The state is good at creating dashboards and metrics of things like trends in Medicaid opioid prescription claims broken down by region. “But that is where we run out of gas,” McKethan said. “We need partners to help answer questions that are important but that we can’t answer now.”
To answer more complex questions, such as the adequacy of treatment options, the state enlisted the support of 70 experts, including researchers from Duke, the University of North Carolina, SAS and research firm RTI. “Unlike most conferences where you review evidence you just produced, this meeting set out to identify what we don’t know,” McKethan said. “It requires a posture of humility.”
For instance, he said, examples might be: “What do we know about the quality and options for treatment?” or “What do we know about the interplay between prescription opioids in the medical system and illicit use outside the health system?”
He said the state is finalizing a list of 150 questions that will help define its collective opioid analytics roadmap. Some will be answered internally, while others can be done through outside experts with which the state has data-sharing agreements. He stressed this approach can be applied to other high-priority areas such as early childhood health and development.
A similar approach can work across states as well. McKethan highlighted the work of a State University Partnership Learning Network led by Julie Donahue, PhD, of the University of Pittsburgh. It is working to develop consistent performance measures across the states, even though they have different data systems and policy environments. He said it is an example of Medicaid directors devoting their time to sit with researchers to flesh out analytic plans that are meaningful to researchers and impactful for the policymakers.
Finally, McKethan urged academic researchers to think more about policy implications of their work upfront. “I have worked on articles and then bolted on some kind of statement about policy impact at the end,” he said. Instead, he suggested that researchers should think about the decisions policy officials are facing so their work has the potential to influence a very specific decision.
“My argument is that if we are policy-oriented researchers, it is incumbent on us to think about policy choices state leaders face and how to use evidence to inform those decisions.”
