Genevra Murray
Genevra Murray
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Assistant Professor of Public Health Policy and Management
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Professional overview
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Genevra F. Murray, PhD is an Assistant Professor in the Department of Public Health Policy and Management. Her research and teaching focus is on the organization and management of health care services, examining the organizational dimensions of payment and delivery system reform and its impact on racial, ethnic and socioeconomic disparities.
Dr. Murray’s current projects are focused on primary care delivery, with an emphasis on the health care safety net; the social determinants of health, particularly the integration of social services and medical care; advance care planning and palliative care integration; and global health systems and governance, particularly related to sexual and reproductive health care. She uses a mix of research methods with expertise in longitudinal qualitative methods.
Prior to joining the faculty at GPH, Dr. Murray was a fellow at Boston Medical Center and a research scientist at The Dartmouth Institute for Health Policy and Clinical Practice. She has published in leading journals such as Health Affairs, Milbank Quarterly and Health Care Management Review.
Dr. Murray received her PhD in medical anthropology from the University of Pennsylvania, having graduated from there summa cum laude with a BA in anthropology.
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Education
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PhD Anthropology, University of PennsylvaniaBA Anthropology, University of Pennsylvania
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Honors and awards
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Ruth L. Kirschstein National Research Service Award Recipient (202020212022)Fulbright Scholar (20052006)William Penn Fellowship (2002200320042005)Summa Cum Laude, University of Pennsylvania (2001)Phi Beta Kappa, University of Pennsylvania (2001)Valedictorian, Department of Anthropology, University of Pennsylvania (2001)
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Publications
Publications
Survey of Information Exchange and Advanced Use of Other Health Information Technology in Primary Care Settings Capabilities In and Outside of the Safety Net
AbstractCross, D. A., Stevens, M. A., Spivack, S. B., Murray, G., Rodriguez, H. P., & Lewis, V. A. (n.d.).Publication year
2022Journal title
Medical careVolume
60Issue
2Page(s)
140-148AbstractBackground: Advanced use of health information technology (IT) functionalities can support more comprehensive, coordinated, and patient-centered primary care services. Safety net practices may benefit disproportionately from these investments, but it is unclear whether IT use in these settings has kept pace and what organizational factors are associated with varying use of these features. Objective: The aim was to estimate advanced use of health IT use in safety net versus nonsafety net primary care practices. We explore domains of patient engagement, population health management (decision support and registries), and electronic information exchange. We examine organizational characteristics that may differentially predict advanced use of IT across these settings, with a focus on health system ownership and/or membership in an independent practice network as key factors that may indicate available incentives and resources to support these efforts. Research Design: We conduct cross-sectional analysis of a national survey of physician practices (n= 1776). We use logistic regression to predict advanced IT use in each of our domains based on safety net status and other organizational characteristics. We then use interaction models to assess whether ownership or network membership moderate the relationship between safety net status and advanced use of health IT. Results: Health IT use was common across primary care practices, but advanced use of health IT functionalities ranged only from 30% to 50% use. Safety net settings have kept pace with adoption of features for patient engagement and population management, yet lag in information exchange capabilities compared with nonsafety net practices (odds ratio= 0.52 for federally qualified health centers, P< 0.001; odds ratio =0.66 for other safety net, P=0.03). However, when safety net practices are members of a health system or practice network, health IT capabilities are comparable to nonsafety net sites. Conclusions: All outpatient settings would benefit from improved electronic health record usability and implementation support that facilitates advanced use of health IT. Safety net practices, particularly those without other sources of centralized support, need targeted resources to maintain equitable access to information exchange capabilities.Systemic Therapy Decision Making in Advanced Cancer : A Qualitative Analysis of Patient-Oncologist Encounters
AbstractWasp, G. T., Knutzen, K. E., Murray, G., Brody-Bizar, O. C., Liu, M. A., Pollak, K. I., Tulsky, J. A., Schenker, Y., & Barnato, A. E. (n.d.).Publication year
2022Journal title
JCO Oncology PracticeVolume
18Issue
8Page(s)
E1357-E1366AbstractPURPOSE:We sought to characterize patient-oncologist communication and decision making about continuing or limiting systemic therapy in encounters after an initial consultation, with a particular focus on whether and how oncologists foster shared decision making (SDM).METHODS:We performed content analysis of outpatient oncology encounters at two US National Cancer Institute-designated cancer centers audio recorded between November 2010 and September 2014. A multidisciplinary team used a hybrid approach of inductive and deductive coding and theme development. We used a combination of random and purposive sampling. We restricted quantitative frequency counts to the coded random sample but included all sampled encounters in qualitative thematic analysis.RESULTS:Among 31 randomly sampled dyads with three encounters each, systemic therapy decision making was discussed in 90% (84 of 93) encounters. Thirty-four (37%) broached limiting therapy, which 27 (79%) framed as temporary, nine (26%) as completion of a standard regimen, and five (15%) as permanent discontinuation. Thematic analysis of these 93 encounters, plus five encounters purposively sampled for permanent discontinuation, found that (1) patients and oncologists framed continuing therapy as the default, (2) deficiencies in the SDM process (facilitating choice awareness, discussing options, and incorporating patient preferences) contributed to this default, and (3) oncologists use persuasion rather than deliberation when broaching discontinuation.CONCLUSION:In this study of outpatient encounters between patients with advanced cancer and their oncologists, when discussing systemic therapy, there exists a default to continue systemic therapy, and deficiencies in SDM contribute to this default.The Role of Value-Based Payment in Promoting Innovation to Address Social Risks : A Cross-Sectional Study of Social Risk Screening by US Physicians
AbstractBrewster, A. L., Fraze, T. K., Gottlieb, L. M., Frehn, J., Murray, G., & Lewis, V. A. (n.d.).Publication year
2020Journal title
Milbank QuarterlyVolume
98Issue
4Page(s)
1114-1133AbstractPolicy Points One of the most important possibilities of value-based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. Screening patients for social risks such as housing instability and food insecurity represents an early step physician practices can take to address social needs. At present, adoption of social risk screening by physician practices is linked with having high innovation capacity and focusing on low-income populations, but not exposure to value-based payment. Expanding social risk screening by physician practices may require standardization and technical assistance for practices that have less innovative capacity. Context: One of the most important possibilities of value-based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. However, there is uncertainty about the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. Methods: We used the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS), a nationally representative survey of physician practices (n = 2,178), to ascertain (1) the number of social risks for which practices systematically screen patients; (2) the extent of practices’ participation in value-based payment models; and (3) measures of practices’ capacity for innovation. We used multivariate regression models to examine predictors of social risk screening. Findings: On average, physician practices systematically screened for 2.4 out of 7 (34%) social risks assessed by the survey. In the fully adjusted model, implementing social risk screening was not associated with the practices’ overall exposure to value-based payment. Being in the top quartile on any of three innovation capacity scales, however, was associated with screening for 0.95 to 1.00 additional social risk (p < 0.001 for all three results) relative to the bottom quartile. In subanalysis examining specific payment models, participating in a Medicaid accountable care organization was associated with screening for 0.37 more social risks (p = 0.015). Expecting more exposure to accountable care in the future was associated with greater social risk screening, but the effect size was small compared with practices’ capacity for innovation. Conclusions: Our results indicate that implementation of social risk screening—an initial step in enhancing awareness of social needs in health care—is not associated with overall exposure to value-based payment for physician practices. Expanding social risk screening by physician practices may require standardized approaches and implementation assistance to reduce the level of innovative capacity required.Trends in Screening for Social Risk in US Physician Practices
AbstractBrewster, A. L., Rodriguez, H. P., Murray, G., Lewis, V. A., Schifferdecker, K. E., & Fisher, E. S. (n.d.).Publication year
2025Journal title
JAMA network openVolume
8Issue
1AbstractImportance: A wealth of research on screening for social risks in health care has emerged, but evidence is lacking on how social risk screening among physician practices has changed over time. Objectives: To evaluate trends in screening for social risks among US physician practices and examine practice characteristics associated with adoption of social risk screening. Design, Setting, and Participants: The main analysis used a repeated cross-sectional design to analyze results from US physician practices that completed the National Survey of Healthcare Organizations and Systems, a nationally representative survey of physician practices, in 2017 and 2022. Sensitivity analysis tested robustness in a cohort of practices that completed surveys in both years. Exposures: Survey year and characteristics of physician practices. Main Outcomes and Measures: Whether physician practices systematically screened patients for 5 common social risks: food, housing, utilities, interpersonal violence, and transportation. Results: In this cross-sectional study, 3442 practice survey responses were studied. Weighted results showed that in 2022, 27% (95% CI, 23%-32%) of practices reported screening for all 5 of the social risks, an increase from 15% (95% CI, 13%-18%) of practices in 2017 (PTrust, Money, and Power : Life Cycle Dynamics in Alliances Between Management Partners and Accountable Care Organizations
AbstractMurray, G., D'aunno, T., & Lewis, V. A. (n.d.).Publication year
2018Journal title
Milbank QuarterlyVolume
96Issue
4Page(s)
755-781AbstractPolicy Points Accountable care organizations (ACOs) form alliances with management partners to access financial, technical, and managerial support. Alliances between ACOs and management partners are subject to destabilizing tension around decision-making authority, distribution of shared savings, and conflicting goals and values. Management partners may serve either as trainers, ultimately breaking off from the ACO, or as central drivers of the ACO. Management partner participation in ACOs is currently unregulated, and management partners may receive a significant portion (in some cases, majority) of shared savings. Context: Accountable care organizations (ACOs) are a prominent payment and delivery model. Though ACOs are often described as groups of health care providers, nearly 4 in 10 ACOs partner with a management company for services such as financial investment, contracting, data analytics, and care management, according to recent research. However, we know little about how and why these partnerships form. This article aims to understand the reasons providers seek partners, the nature of these relationships, and factors critical to the success or failure of these alliances. Methods: We used qualitative data collected longitudinally from 2012 to 2017 at 2 ACOs to understand relationships between management partners and ACO providers. The data include 115 semistructured interviews and observational data from 7 site visits. Two coders applied 48 codes to the data. We reviewed coded data for emergent themes in the context of alliance life cycle theory. Findings: Qualitative data revealed that management partners brought specific skills and services and also gave providers confidence in pursuing an ACO. Over time, tension between providers and management partners arose around decision-making authority, distribution of shared savings, and conflicting goals and values. We observed 2 outcomes of partnerships: cemented partnerships and dissolution. Key factors distinguishing alliance outcome in these 2 cases include degree of trust between organizations in the alliance; approach to conflict resolution; distribution of power in the alliance; skills and confidence acquired by the ACO over the life of the alliance; continuity of management partner delivery on promised resources; and proportion of savings going to the management partner. Conclusions: The diverging paths for ACOs with management partners suggest 2 different roles that management partners may play in ACO development. In some cases, management partners may serve as trainers, with the partnership dissolving once the ACO gains skills and confidence to work alone. In other cases, the management partner is a central driver of the ACO and unlikely to break off.Upstream with a small paddle : How acos are working against the current to meet patients’ social needs
AbstractMurray, G., Rodriguez, H. P., & Lewis, V. A. (n.d.).Publication year
2020Journal title
Health AffairsVolume
39Issue
2Page(s)
199-206AbstractDespite interest in addressing social determinants of health to improve patient outcomes, little progress has been made in integrating social services with medical care. We aimed to understand how health care providers with strong motivation (for example, operating under new payment models) and commitment (for example, early adopters) fared at addressing patients’ social needs. We collected qualitative data from twenty-two accountable care organizations (ACOs). These ACOs were early adopters and were working on initiatives to address social needs, including such common needs as transportation, housing, and food. However, even these ACOs faced significant difficulties in integrating social services with medical care. First, the ACOs were frequently “flying blind,” lacking data on both their patients’ social needs and the capabilities of potential community partners. Additionally, partnerships between ACOs and community-based organizations were critical but were only in the early stages of development. Innovation was constrained by ACOs’ difficulties in determining how best to approach return on investment, given shorter funding cycles and longer time horizons to see returns on social determinants investments. Policies that could facilitate the integration of social determinants include providing sustainable funding, implementing local and regional networking initiatives to facilitate partnership development, and developing standardized data on community-based organizations’ services and quality to aid providers that seek partners.Working title: A Review of ACOs and Equity
AbstractMurray, G., Holm, J., & Lappen, H. (n.d.).Abstract~“I Didn’t Do Into Medicine Just to be on the Phone” : Emotional Expression as Sacrosanct During Serious Illness Patient-Physician Advanced Cancer Care Communication During the COVID-19 Pandemic
AbstractKaur-Gill, S., Drummond, D. K., Zhang, J., Butcher, R., Eggly, S., Schifferdecker, K., Brooks, G. A., Murray, G., Kapadia, N. S., Hanson, L. C., & Barnato, A. E. (n.d.).Publication year
2024Journal title
Health CommunicationAbstractGuided by communication accommodation theory, we studied 27 physician reports of patient-physician advanced cancer communication during the COVID-19 pandemic. Advanced cancer communication requires recognizing patients’ psychosocial states and collaboratively engaging patients empathetically to develop the shared understanding necessary to guide decision-making. However, physicians found their communication underaccommodated, stemming from personal protection equipment, social distancing, and telemedicine. Based on provider perspectives, our study identified that during advanced cancer communication, emotional expression was critical for reflecting care and concern to patients, and discourse management was central to showing interest and engagement to patients by their providers. The failure to convey emotional expression to patients meant rapport-building cues were missing, impeding discourse management when navigating difficult conversations about prognosis and end-of-life care. Despite efforts to adjust emotional expression and discourse management during the pandemic to address the needs of their patients, providers were dissatisfied with their communication outcomes. Physicians struggled to relay verbal and nonverbal emotional expressions effectively, supportively, and compassionately to patients when breaking bad news during advanced cancer communication, resulting in a profound source of moral and emotional distress.