Vermont Medicine Magazine

On the fourth floor of the Given Building at the Larner College of Medicine, Adam Atherly, Ph.D., surveys the space outside of his newly-painted office. Two adjacent doors open into rooms with empty desks. A common area includes space for a few more cubicles with top-notch views of the Green Mountains. In one corner, a coat rack hangs on otherwise empty walls. Outside the glass door, a sign reads: UVM Center for Health Services Research. Although the offices may be a work-in-progress, the mission for the new center is clear: Foster cutting-edge research that improves the delivery of healthcare, leading to better population health in Vermont and across the country.

As the first director of the Center for Health Services Research just a few months into the job, Atherly sees the space as brimming with possibility. Soon enough, the cubicles and offices will be filled with analysts and researchers. Faculty from across the university will be stopping in for statistics support and consultation on their work. Brown bag lunches hosted by the center will allow faculty from across disciplines to get to know each other and find new collaborators from across the university

“We want to help researchers who’ve got clinically and policy-relevant questions build good research design, work with data in appropriate ways, and publish their research in leading scientific journals,” says Atherly, who was hired in February of 2018 after a national search.

The time is right to focus on health services research, as Vermont is embarking on a bold experiment in healthcare reform. The state is one of two that has received a waiver from the federal government to create an all-payer system, shifting from fee-for-service to a value-based model over time. As the state’s sole medical school, the Larner College of Medicine has the opportunity to become a national leader in evaluating how the delivery of care affects health outcomes. What happens in Vermont could inform the country’s trajectory. This shift in state policy, combined with Vermont’s relatively small population, proximity to other rural populations in neighboring states, and unique access to data, make it a prime location for studies focused on health services.

Senior Associate Dean for Research Gordon Jensen, M.D., Ph.D., sees the Center for Health Services Research as a catalyst for collaboration among investigators affiliated with the center, making the College even more competitive for large extramural grants.

“By bringing interdisciplinary skills together, we have greater strength,” he says. “I’m very optimistic about where we’re going. I think we’ll be able to compete for major funding opportunities that ultimately will pay big dividends for the health of Vermonters.”

Jensen’s vision extends to northern New England. With New Hampshire, Maine, Vermont and northern New York all delivering healthcare to rural populations in different ways, the region “allows a beautiful model for looking at the impact of new, innovative health services and programs on outcomes.”

UVM Medical Group President and CEO Claude Deschamps, M.D., points to the new center as a “solution shop” to help researchers access data and develop rigorous research projects. The UVM Health Network — which now extends through much of northern Vermont and into the upper reaches of New York State — offers boundless opportunities to ask good questions that lead to innovation in the ways health care is delivered.

“I think we have something to teach the rest of the world,” he says. “Through publishing research we can educate others.” This living laboratory is in part what prompted Atherly to take on the leadership role at the College; as the director of the new center, he’s in a prime position to drive the national conversation on population health, which focuses on improving outcomes across a group and addressing disparities between groups.

“There’s the opportunity here, given the uniqueness of the state, to build a data system that will allow us to do population health research that would be hard to match anywhere else in the country,” he says.

Building a Center from the Ground Up

Atherly comes to Vermont with a track record of success. Considered a national expert on the Medicare system and its effect on health outcomes, he’s been consistently funded since 2002 by agencies including the Centers for Disease Control and Prevention, the NIH, the Centers for Medicare and Medicaid Services, and the Robert Wood Johnson Foundation. His research spans numerous methodological and topical areas, including healthcare spending and expenditure modeling, scale development and psychometric analysis, evaluation of efforts to improve quality of care and patient safety, and cost-effectiveness analysis.

At the Colorado School of Public Health, Atherly was the founding chair of the Department of Health Systems, Management and Policy. His work recruiting leading investigators and building the infrastructure for a successful research program helped to propel the department onto the national stage, even as he continued his own research into the economics of aging and consumer decisions regarding health plan choice. This research has made him a soughtafter speaker: He’s presented his work at more than 75 national and international professional meetings.

In his first months at UVM, he’s met with as many researchers as possible from across the University, sharing the broad goals for the center and getting input on its mission and vision. Atherly points out that the vision statement that has emerged — “to use secondary data to make causal inferences about how to change the healthcare system to improve the health of the population” — is very much focused on action. The inclusion of “causation” was intentional: The goal is to show how an action leads to an outcome, providing clear evidence for intervention or policy change.

“There’s a perspective that you can never do causation without randomization,” he says. “Health services research says you can if you do a good quasi-experimental design.”

Key to crafting that design is the availability of data, and Vermont has it in droves. Atherly points to the Vermont allpayer claims database, or VHCURES — which is housed at the Larner College of Medicine and includes almost the entire population of the state — as one potentially rich source of data. The fact that the UVM Medical Center provides care for a very large percentage of the region’s population is also a benefit, as electronic health records provide another key resource for researchers.

With the volume of data, and the broad scope of inquiry that health services research encourages, investigators have a wealth of opportunities to collaborate and ask questions of the medical system and beyond.

“There’s a lot of talk around the medical center about the effect of housing on health outcomes. That’s a health services research kind of question,” says Atherly. “We might look at costs. We might look at quality of life. We might look at satisfaction. There’s a whole range of life outcomes that we can explore.”