Dr. William Schpero is an assistant professor of healthcare policy and research in the Division of Health Policy and Economics. Dr. Schpero received his Ph.D. in health policy and economics from Yale University, during which he was a pre-doctoral fellow in aging and health economics at the National Bureau of Economic Research. Dr. Schpero also completed a master’s degree and fellowship at The Dartmouth Institute for Health Policy & Clinical Practice.
What got you interested in healthcare policy and economics?
I think my interest in health policy dates back to college. I’ve always been interested in public policy more broadly, and I became captivated by two particular realizations: first, the extent to which health, as a domestic spending program, has the potential to crowd out our ability to invest in other policy priorities like education…and second, how access to healthcare is such a major determinant of life outcomes, particularly for kids. At this point, there is a lot of good causal evidence that improving access in childhood has huge effects on later-life health, educational outcomes, labor market participation, and income.
After graduating from college, I spent two years in a research fellowship at The Dartmouth Institute for Health Policy & Clinical Practice. It was just after the passage of the Affordable Care Act (ACA), and I got to see how research by Dartmouth faculty became incorporated into the law. It was an inspiring moment that really convinced me of the potential for good research to effect positive change.
Tell us about your research
My research is focused on informing the evolution of Medicaid policy and the design of the healthcare safety net. I’m particularly interested in how provider incentives affect their participation in the safety net, the overall composition of the delivery system, and outcomes for low-income populations. I think there are now a number of important questions on how Medicaid policy can be used as a tool to drive value in the program, whether by incentivizing quality improvements or by supporting non-medical interventions (like housing) that we know have strong effects on health. I’m also interested in identifying and testing policy levers that can be used to address racial, ethnic, and socioeconomic disparities in health and health care.
Historically, we’ve been somewhat constrained in terms of what questions we can answer about the Medicaid program, in large part because of limitations in data availability. That has really begun to change in recent years.
Any trends and issues you are following?
I think my research in Medicaid is responsive to three trends. One is that now, following the ACA and implementation of partial Medicaid expansion across the states, we have a huge new population in Medicaid. How do we optimize the design of the delivery system to provide high-quality care for an entirely new group of people with potentially a whole different set of needs? Another trend is consolidation and integration among physician practices and hospitals. While there has a been a fair amount of work looking at how this type of consolidation affects healthcare spending and outcomes for the privately insured and in Medicare, we don’t know much about how this changes the incentives for providers to treat Medicaid beneficiaries. The third trend is privatization. We think of Medicaid as a government program that’s a function of a federal-state partnership, but most Medicaid benefits are now provided by private plans. There are a lot of important questions about how to appropriately structure and regulate Medicaid markets to ensure that we have high-quality outcomes and manageable spending over time.
What brings you to Weill Cornell Medicine?
First, healthcare policy research at Weill Cornell has a great record of interdisciplinary inquiry, bringing together expertise in medicine, biostatistics, health informatics, economics, and other social sciences. That, combined with the department’s strong data infrastructure, makes it possible to bring a whole new set of methods to bear on big, important policy questions. Second, I think my research fits nicely at the nexus of two large research programs in the department. One is around how physician practice structure affects spending and outcomes – that’s led by Dr. Larry Casalino and funded by The Physicians Foundation. The other is on improving care for high-need, high-cost patient populations, led by Dr. Rainu Kaushal and funded by PCORI. Third, I’m really excited about being in New York. The city and state governments are at the forefront of designing policy interventions to improve health outcomes for low-income populations. I’m looking forward to collaborating with policymakers to evaluate new approaches for delivering care in Medicaid and for the uninsured.