Center for Integrative Social Medicine and Population Health (CISMPH)

Research Areas

Core Research Areas

1. Mental Health and Substance Use Disorders

We study the ongoing “fourth wave” of the overdose crisis, characterized by the widespread proliferation of illicitly manufactured fentanyl (IMF) increasingly mixed with novel adulterants. This rapidly evolving drug supply poses substantial challenges for health systems treating patients with substance use disorders (SUD) and for public health agencies striving to monitor epidemiologic trends and distribute harm reduction resources such as naloxone and drug-checking tools (e.g., test strips).

We are particularly interested in four key areas:

  1. Temporal and geographic trends in the spread of emerging adulterants, including α₂-adrenergic receptor agonists (xylazine, medetomidine), nitazenes, BTMPS, and synthetic cathinones.
  2. Disparities in drug overdose mortality across social determinants of health, including race and ethnicity, socioeconomic status, and rurality.
  3. Access to medications for opioid use disorder (MOUD), particularly methadone and buprenorphine, as essential components of evidence-based treatment and harm reduction.
  4. Access to mental health services and psychotropic medications, particularly among low-income populations

2. Health Systems and Clinical Care Delivery

We study how financing structures, insurance design, and ownership models influence access to and quality of care within the U.S. healthcare system. Fragmented payer arrangements and increasing corporate consolidation have transformed the contemporary healthcare infrastructure, with growing implications for cost, competition, and patient outcomes. Our work examines how these structural forces influence both the efficiency and effectiveness of clinical care delivery.

Specifically:

  1. Comparative performance of insurance models, including Medicare Advantage, Traditional Medicare, Medigap, and dual beneficiaries. We examine how differences in benefit design, provider networks, and payment structures influence patient outcomes and access to care across populations.
  2. Private equity (PE) ownership in healthcare, analyzing how leveraged acquisitions and financially-motivated management strategies affect care quality, staffing, and financial stability across hospitals, physician practices, home health agencies, and behavioral health facilities.

3. Prescription Drug Affordability

Approximately 1 in 5 Americans experience financial barriers to accessing prescription medications due to high out-of-pocket costs, restrictive insurance formularies that limit coverage for brand-name or specialty drugs, and opaque pricing mechanisms shaped by manufacturer rebates and pharmacy benefit manager negotiations. These barriers often result in delayed treatment initiation, medication nonadherence, and worsened health outcomes, particularly among low-income individuals and those living with chronic diseases.

We are interested in studying policies that target prescription drug pricing and utilization, with a focus on how reforms shape affordability, access, and value. Specifically:

  1. Trends in Medicare Part D spending and utilization following the Inflation Reduction Act (IRA), which implemented an annual out-of-pocket spending cap ($3,300 in 2024, $2,000 in 2025). We focus on how this policy affects utilization patterns and adherence for high-cost brand-name oncology drugs.
  2. Alignment between therapeutic value and drug spending, evaluating whether U.S. prescription drug spending reflects clinical benefit. Unlike countries such as the U.K., Germany, and France (where health technology assessment agencies negotiate prices based on therapeutic value), the U.S. historically lacked centralized price negotiation, leading to high expenditures on drugs with modest or uncertain benefit.
  3. Utilization and affordability of high-cost therapies, including out-of-pocket costs for glucagon-like peptide-1 (GLP-1) receptor agonists.