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Cyber Seminars Presenter Biographies

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Health Economics Resource Center (HERC) Presenters

Paul Barnett, PhD focuses on the cost-effectiveness of healthcare inventions, determination of the cost of healthcare in the absence of billing data, and economic modeling in support of healthcare policy decisions. He is a health economist at the VA Center for healthcare Evaluation, the VA Cooperative Studies Program Coordinating Center, and the Treatment Research Center at the University of California, San Francisco.

He is also Consulting Assistant Professor in the Department of Health Research and Policy at Stanford University School of Medicine. His health services research focuses on the cost-effectiveness of treatments for substance abuse disorders. He is applying methods used to evaluate medical care interventions to the substance abuse field. A model of the effect of methadone maintenance on healthcare costs and survival determined the treatment is at least a cost-effective as other healthcare interventions provided to injection drug users. This work is being extended via a dynamic model of the HIV epidemic being developed in collaboration with Stanford Professor Margaret Brandeau. They are also combining the results of a meta-analysis of trials comparing buprenorphine to methadone with the HIV model to determine the potential cost-effectiveness of buprenorphine maintenance. Barnett is assisting investigators in the University of California, San Francisco Treatment Research Center evaluate a medication management intervention for HIV-positive drug abusers, among other interventions. He is assisting a VA trial testing if a matching strategy improves hospital and community- based residential treatment for substance abuse patients with psychiatric disorders.

He has lead a team that completed an economic analysis of data from the VA Non-Q-wave Infarction Strategies in Hospital (VANQWISH) trial, which demonstrated that a conservative, ischemia-guided strategy was safe and effective for management of non-Q-wave myocardial infarction. The conservative strategy was shown to be more cost-effective, a result that is helping to shape clinical opinion on the best treatment for heart attack. He also serves as the VA economist on a trial evaluating PTCA in the context of intensive medical therapy in the treatment of all but the very highest risk patients with coronary heart disease. He is leading a team that is studying whether Positron Emission Tomography is cost-effective enough to justify its adoption for the diagnosis of lung cancer.

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Ciaran Phibbs, PhD is the Assistant Director of HERC. Dr. Phibbs is a health economist at the Center for Health Care Evaluation and the Cooperative Studies Program Coordinating Center, a Consulting Associate Professor in the Department of Health Research and Policy, Stanford University School of Medicine, and a Research Associate, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University. His own VA research projects have focused on the demand for VA healthcare and how travel distance and the availability of non-VA alternatives influence veterans use of VA care. In more general terms, his research focuses on the hospital costs and competition. Much of this work has looked at how travel distance effects hospitals, and methods for defining hospital markets. Dr. Phibbs also has a long standing interest in neonatal care. Since coming to VA he has continued to conduct some neonatal related research with non-VA funding. This work is currently focusing on how the competition-driven expansion of neonatal intensive care units has effected neonatal mortality.

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Mark Smith, PhD performs research in three areas: cost-effectiveness of health interventions, health services research in VA and privately insured populations, and the economic impact of adverse health events. Smith is Associate Director of the VA HSR&D Health Economics Resource Center (HERC), where he leads the development of guidelines for research using micro-costing methods. He is also a member of the VA Cooperative Studies program, serving as health economist for clinical studies. Beyond VA, Smith is an associate of the Center for Primary Care Outcomes and Research (PCOR) and the Center for Healthcare Policy (CHP) at Stanford University.

Much of Dr. Smith's research has concerned health outcomes for people with schizophrenia, bipolar disorder, and posttraumatic stress disorder (PTSD). Before joining VA, Smith studied the differential impact of second-generation (atypical) antipsychotics such as olanzapine, risperidone, and quetiapine. He currently serves as health economist on two VA studies of veterans with PTSD. One focuses on the impact of symptom levels on employment outcomes and health care use inside and outside the VA system. The other, Cooperative Studies Program trial #519, will assess the effectiveness of integrating smoking-cessation therapy with PTSD therapy.

Another focus of research has been the impact of health-promotion programs. In two studies with MEDSTAT colleagues Ron Goetzel and Ronald Ozminkowski, educational programs were shown to reduce health risks in an employed population and to reduce hospitalization for patients with congestive heart failure. He currently serves as health economist on an NIH-funded study at the Stanford Prevention Research Center. Its goal is to determine the clinical effectiveness and cost-effectiveness of education and case management on coronary artery disease risk factors in a low-income population.

A third area of research interest is the economic impacts of violence. In one study, Dr. Smith quantified the impact of violent abuse on the earnings of poor women in Washington State. A second study considers the impact of abuse on poor women's use of public assistance programs. Future research will focus on developing a realistic economic theory of violence among intimate partners.

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Todd Wagner, PhD is a health economist with the Palo Alto VA. His primary position is with the Health Economics Resource Center, but he is also affiliated with the Center for Healthcare Evaluation and the Cooperative Studies Coordinating Center. The Palo Alto VA has a close relationship with Stanford University. In particular, he is affiliated with the Center for Health Policy (CHP) and the Center for Primary Care and Outcomes Research (PCOR).

In addition to his VA work, he is interested in the evaluation of consumer health information and the cost of research administration (including IRBs). Other areas of interest include cost-effectiveness analysis, quality of life measurement, and access to care for multicultural populations.

Dr. Wagner has a Ph.D. in Health Economics from the Health Services and Policy Analysis Program at the University of California, Berkeley in 1999.

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Wei Yu, PhD is a health economist at the VA Health Economics Resource Center, VA Center for Healthcare Evaluation, and the VA Cooperative Studies Program Coordinating Center. He is also a fellow at the Center for Health Policy and Center for Primary Care Outcomes and Research at Stanford University.

Dr. Yu's research interests include determination of healthcare costs, cost-effective analysis, risk adjustment method, healthcare financing policy and healthcare delivery structure under different institutional structures, cultural backgrounds, and economic capacities.

In determining healthcare costs, he investigated costs of nursing homes in South Carolina as well as use of hospital service and intensive care for the elderly. As Research Faculty of the Health Care Financing Administration (HCFA) Research Data Assistance Center, he taught Medicare reimbursement methods, and prepared training databases for health services researchers on how to identify Medicare expenses and hospital costs in HCFA files.

He is currently leading the product line at the VA Health Economics Resource Center to evaluate the Decision Support System, a cost accounting system developed to identify costs of healthcare services provided by the VA. He recently analyzed effects of age and chronic diseases on healthcare costs. He is currently evaluating cost-effectiveness of treatment strategies for HIV/AIDs patients who have failed second runs of anti-retrovirals.

Dr. Yu has analyzed healthcare costs and utilization during the last year of life, including differences in hospice use, place of death, and cause of death between decedents enrolled in a managed care plan and a fee-for-service plan. He also compared Medicare expenses between decedents who used hospice services during the last year of life with those who did not. Dr. Yu is expanding this research to the VA Health Care System. He has studied long-term care use near the end of life among VA patients.

In international studies, Dr. Yu has provided consultation on healthcare financing policy, structure of the community healthcare system, and reimbursement methods for hospital services in China in separate projects funded by the United Nations Development Programme and the Ford Foundation. He is currently coordinating a China-US post- doctoral training program funded by the National Institutes of Health at Stanford. His recent research is comparing risk diversification of the employer-based health insurance systems between US and China.

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Other Presenters

As Director of HSR&D's Center for Practice Management and Outcomes Research in Ann Arbor, Michigan, Rodney Hayward, MD has been instrumental in making it one of the elite health services research centers in the country. Further, his work in quality measurement and improvement, especially in regard to patient safety, and in diabetes health care delivery has been innovative and influential. He and colleagues of the Diabetes Mellitus Quality Enhancement and Research Initiative (DM-QUERI) have worked to decrease visual loss due to diabetic retinopathy, decrease high amputation rates among those with diabetes, and reduce rates of morbidity and mortality by facilitating the aggressive treatment of hypertension. In addition, Dr. Hayward has a long and accomplished academic career at the University of Michigan, where he is currently a professor in the Division of General Medicine.

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