Not many MPH students get to see the results of their internship work covered in the New York Times, but Danielle Raso was one of the lucky few. The payment models Danielle worked on with the Center for Medicare and Medicaid Innovation (CMMI) in Woodlawn, Maryland were rolled out via an executive order from President Trump on July 10, directing reforms to dialysis and kidney disease treatment.
Since 1972, End Stage Renal Disease (ESRD) has remained unique as the only condition that specifically makes patients eligible for Medicare, and in 2016, care for Medicare beneficiaries with Chronic Kidney Disease and ESRD accounted for $114 billion in total Medicare expenditures. The new models that Danielle worked on shifts financial incentives for providers away from receiving dialysis in dialysis centers and towards in-home dialysis, which is both less expensive and offers a better quality of life for patients. Additionally, the models waive certain Medicare requirements to make kidney disease patient education more available and incentivize providers to facilitate kidney transplants, which are preferred by most patients. The mandatory model released through the rule will affect approximately 50 percent of the country, and many more providers will be able to join the voluntary models.
Danielle, a student in the Department of Health Policy and Management was able to work on the policies before they were announced and is working on materials explaining the structure and specifics of the models for participants and the public. She describes seeing language she wrote in a rule as surreal and is grateful to have been placed on such a great team within CMMI. “The great thing about working on a systemic level is that the U.S. health care sector is huge, so something that may sound dry like altering reimbursement rates can actually improve quality of life for millions of people,” says Danielle.
Danielle worked for 6 years in both global and domestic health before starting her master’s degree at the Yale School of Public Health. While international work is exciting, she says, she found it hard to watch the changes her own medical system from afar without being engaged. In addition to exploring new disciplines like economics through her classes, Danielle also works for Yale’s Center for Outcomes Research and Evaluation, which supports quality measurement for the Centers for Medicare and Medicaid Services. Opportunities to affect the system in such a high-profile way as the kidney disease models may not be frequent, but Danielle is confident that her interdisciplinary training will help her craft health policy that is both relevant and high impact in the future.