Medicaid, opioid abuse, the effects of extreme weather on asthma, child eye exam coverage, and records generated by every Arizona pharmacist, nurse and physician since 2007: The Center for Health Information and Research has access to data on all of it.
And now it has a new director.
The Center for Health Information and Research — called CHiR for short — is Arizona’s first and only comprehensive health care data analytics repository of local health records.
Founded in 1999, CHiR’s analysts have mined big data sets for the past 23 years to help researchers and policymakers better address health issues ranging from vision care for children to the cost of chronic mental illness.
Domino grew up in Tucson, Arizona, and has returned to Arizona by way of the University of North Carolina at Chapel Hill, where she was a professor of health economics and a research fellow at the Cecil G. Sheps Center for Health Services Research. She also served as director of the center’s program on mental health and substance abuse services and systems, and led its mental health systems and services research training program. In addition, she directed UNC’s PhD program in health policy and management.
“Data and information are key to improving any health outcome, and I chose Dr. Domino to be the leader who will broaden our collaborative efforts in this area,” said Deborah Helitzer, dean of the College of Health Solutions. “Her research expertise and ability to work closely with community stakeholders will help us to further embed CHiR in the ASU ecosystem, partner with organizations statewide to address the needs for health information, and advance our mission and the goal of ASU’s charter to improve the health of the communities we serve.”
Throughout her career, Domino has used data to make sense of problems in health care systems with the aim of improving health outcomes. One of her first projects at UNC, for example, was research to understand the sudden spikes in Medicaid spending in North Carolina during the late 1990s and early 2000s. Since then, she has worked frequently on policy issues affecting Medicaid populations and providers, issues especially important in her current role as CHiR’s director because the center has access to the entire Medicaid database for Arizona.
After earning her PhD in health economics at Johns Hopkins University, she was a postdoctoral fellow at Harvard Medical School’s Department of Health Care Policy, where she worked with some of the top minds in mental health policy in the U.S. There she learned the importance of combining high-quality data analytics with innovative thinking to improve mental health and substance use services. Several of her research projects involved the role incentives can play in influencing how health care is delivered.
“I have always been interested in how incentives can be structured to affect behavior,” Domino said. “Investigating the relationship between incentives and changes to health systems and health outcomes requires data to make evidence-based treatment and policy decisions.”
Conversations around the dinner table when she was growing up in Tucson first sparked Domino’s interest in the connection between incentives and behavior. Her father was a professor of psychology at the University of Arizona and often talked about his work studying human behavior. Later, the influence of those informal discussions was evident in her dissertation topic, which examined whether prescribers make different treatment choices for their patients with major depression if the patients are on a managed care contract or have paid fee-for-service insurance.
That kind of research isn’t possible without access to a rich trove of health data, and CHiR has that kind of access through its yearslong collaboration with the Department of Health to analyze those records and work closely with Arizona’s health community.
“CHiR has decades of history and stakeholder relationships in the state of Arizona due to the early investments and insights by the founding director, Dr. Bill JohnsonProfessor Emeritus William G. Johnson, who retired from ASU in 2019 as a professor of biomedical informatics and CHiR’s director.,” Domino said. “We have the ability to assist in evidence-based decisions on a wide variety of topics, from helping identify homeless individuals who could benefit from essential preventive care, to examining the quality of services and locations of providers who provide treatment for substance use disorders.”
Domino spoke to ASU News about her new leadership position, CHiR’s role in improving health care and outcomes in Arizona, and the direction of the American health care system.
Question: What impact has CHiR had on improving health outcomes in Arizona, and what do you want to do in your new role as director?
A: There are many examples from CHiR’s work that show how it has improved health care in Arizona. I’ll give just one. CHiR conducted an analysis that showed individuals with chronic, severe mental illness who lived in supportive housing were less costly to the health care system than those who were in unstable and unsupported housing situations. In my role, I hope to further enhance connections to health care stakeholders in Arizona and expand ASU researchers’ access to health care data and expertise to drive evidence-informed decision-making to improve health and the delivery of services.
Q: With the focus on health economics and using incentives to affect behavior, is saving money one of the main goals for the people who use CHiR’s data to investigate health questions?
A: Economists look at so much more than money! Incentives can be very broad and very often include non-financial incentives. I just did a study (with UNC colleagues Sean Sylvia and Sherri Green) looking at how providers respond to incentives such as information on local conditions for opioid use disorders versus financial incentives. We found that local information has a much stronger impact in bringing providers in for additional training than did financial incentives.
Q: We keep hearing that the American health care system is “broken.” Is it? What does that mean to you, and what do you think CHiR’s role is in trying to fix it?
A: It is certainly not optimal. "Broken" generally means far from anyone’s ideal system, but I am not sure our country would agree on what an ideal system looks like. In many ways, our health care system is one of the best in the world, for people who can afford it. The data and expertise in CHiR and the College of Health Solutions can certainly be very helpful in pointing to ways to improve outcomes with scarce resources.
Q: In your health research, is there a consistent result you see repeated that leads you to some general conclusions about health care — about how it is delivered, or how it can be changed to improve overall population health?
A: There are a few common themes. “Incentives matter” is certainly one of them. Also, the balloon-squeezing analogy has been pretty overused in health care but remains true — many times, efforts to trim health care budgets in one place result in increases in spending and utilization in another place. Also, health care intersects with so many other sectors, such as education, social services and criminal justice, that taking a larger system perspective when looking at incentives and disincentives to improve health is critical.
Q: The work you do addresses serious issues about our state and our nation’s health care system. What do you do in your spare time to clear your head and decompress?
A: I love the work I do and am energized by it, so am often reading journal articles or running statistical models after hours. But I also love hanging out with my family and our two dogs, playing the piano — I started college as a piano performance major — cooking, reading, hiking, exercising and traveling.
For an opportunity to learn more about the role health data plays in improving health outcomes, join the College of Health Solutions on April 21 at noon for its monthly Health Talks webinar series. Marisa Domino and fellow panelist Valentin Dinu, an associate professor of biomedical informatics at the College of Health Solutions, will discuss “Using Big Data to Improve Population Health.” Anita Murcko, a clinical associate professor at the College of Health Solutions, will moderate the discussion. Learn more and register.
Story by Kelly Krause
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