Genevra Murray

Assistant Professor of Public Health Policy and Management

Professional overview

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.

Education

PhD Anthropology, University of Pennsylvania

BA Anthropology, University of Pennsylvania

Honors and awards

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)

Publications

Publications

Upstream with a small paddle : How acos are working against the current to meet patients’ social needs

Murray, G., Rodriguez, H. P., & Lewis, V. A. (n.d.).

Publication year

2020

Journal title

Health Affairs

Volume

39

Issue

2

Page(s)

199-206

10.1377/hlthaff.2019.01266

Abstract

Abstract

Despite 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.

Care Transformation Strategies and Approaches of Accountable Care Organizations

Lewis, V. A., Tierney, K. I., Fraze, T., & Murray, G. (n.d.).

Publication year

2019

Journal title

Medical Care Research and Review

Volume

76

Issue

3

Page(s)

291-314

10.1177/1077558717737841

Abstract

Abstract

Although accountable care organizations (ACOs) proliferate, little is known about the activities and strategies ACOs are pursuing to meet goals of reducing costs and improving quality. We use semistructured interviews with executives at 16 ACOs to understand ACO approaches. We identified two overarching ACO approaches to changing clinical care: a practice-based transformation approach, working to overhaul care processes and teams from the inside out; and an overlay approach, where ACO activities were centralized and delivered external to physician practices. We additionally identified four methods ACOs were using to achieve their aims: using patient support roles; targeted clinics, events, programs, and interventions; clinical process standardization; and tracking and identifying patients on which to focus resources. We expect that ACOs using either of the major approaches can succeed under current ACO programs, but that as value-based payment programs mature, ACOs will need to undertake practice-based approaches to be successful in the long term.

Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals

Fraze, T. K., Brewster, A. L., Lewis, V. A., Beidler, L. B., Murray, G., & Colla, C. H. (n.d.).

Publication year

2019

Journal title

JAMA network open

Volume

2

Issue

9

10.1001/jamanetworkopen.2019.11514

Abstract

Abstract

Importance: Social needs, including food, housing, utilities, transportation, and experience with interpersonal violence, are linked to health outcomes. Identifying patients with unmet social needs is a necessary first step to addressing these needs, yet little is known about the prevalence of screening. Objective: To characterize screening for social needs by physician practices and hospitals. Design, Setting, and Participants: Cross-sectional survey analyses of responses by physician practices and hospitals to the 2017-2018 National Survey of Healthcare Organizations and Systems. Responses were collected from survey participants from June 16, 2017, to August 17, 2018. Exposures: Organizational characteristics, including participation in delivery and payment reform. Main Outcomes and Measures: Self-report of screening patients for food insecurity, housing instability, utility needs, transportation needs, and experience with interpersonal violence. Results: Among 4976 physician practices, 2333 responded, a response rate of 46.9%. Among hospitals, 757 of 1628 (46.5%) responded. After eliminating responses because of ineligibility, 2190 physician practices and 739 hospitals remained. Screening for all 5 social needs was reported by 24.4% (95% CI, 20.0%-28.7%) of hospitals and 15.6% (95% CI, 13.4%-17.9%) of practices, whereas 33.3% (95% CI, 30.5%-36.2%) of practices and 8.0% (95% CI, 5.8%-11.0%) of hospitals reported no screening. Screening for interpersonal violence was most common (practices: 56.4%; 95% CI, 53.3%-2 59.4%; hospitals: 75.0%; 95% CI, 70.1%-79.3%), and screening for utility needs was least common (practices: 23.1%; 95% CI, 20.6%-26.0%; hospitals: 35.5%; 95% CI, 30.0%-41.0%) among both hospitals and practices. Among practices, federally qualified health centers (yes: 29.7%; 95% CI, 21.5%-37.8% vs no: 9.4%; 95% CI, 7.2%-11.6%; P

Trust, Money, and Power : Life Cycle Dynamics in Alliances Between Management Partners and Accountable Care Organizations

Murray, G., D'aunno, T., D'aunno, T., & Lewis, V. A. (n.d.).

Publication year

2018

Journal title

Milbank Quarterly

Volume

96

Issue

4

Page(s)

755-781

10.1111/1468-0009.12356

Abstract

Abstract

Policy 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.

Mask use, hand hygiene, and seasonal influenza-like illness among young adults : A randomized intervention trial

Aiello, A. E., Murray, G., Perez, V., Coulborn, R. M., Davis, B. M., Uddin, M., Shay, D. K., Waterman, S. H., & Monto, A. S. (n.d.).

Publication year

2010

Journal title

Journal of Infectious Diseases

Volume

201

Issue

4

Page(s)

491-498

10.1086/650396

Abstract

Abstract

Background. During the influenza A(HlNl) pandemic, antiviral prescribing was limited, vaccines were not available early, and the effectiveness of nonpharmaceutical interventions (NPIs) was uncertain. Our study examined whether use of face masks and hand hygiene reduced the incidence of influenza-like illness (ILI). Methods. A randomized intervention trial involving 1437 young adults living in university residence halls during the 2006 2007 influenza season was designed. Residence halls were randomly assigned to 1 of 3 groups face mask use, face masks with hand hygiene, or control for 6 weeks. Generalized models estimated rate ratios for clinically diagnosed or survey-reported ILl weekly and cumulatively. Results. We observed significant reductions in ILl during weeks 4 6 in the mask and hand hygiene group, compared with the control group, ranging from 35% (confidence interval [CI], 9% 53%) to 51% (CI, 13% 73%), after adjusting for vaccination and other covariates. Face mask use alone showed a similar reduction in ILl compared with the control group, but adjusted estimates were not statistically significant. Neither face mask use and hand hygiene nor face mask use alone was associated with a significant reduction in the rate of ILl cumulatively. Conclusions. These findings suggest that face masks and hand hygiene may reduce respiratory illnesses in shared living settings and mitigate the impact of the influenza A(H1N1) pandemic.

More than just a communication medium : What older adults say about television and depression

Nguyen, G. T., Wittink, M. N., Murray, G., & Barg, F. K. (n.d.).

Publication year

2008

Journal title

Gerontologist

Volume

48

Issue

3

Page(s)

300-310

10.1093/geront/48.3.300

Abstract

Abstract

Purpose: Older adults watch more television than younger people do. Television's role in mental health has been described in the general population, but less is known about how older adults think of television in the context of depression. Design and Methods: Using a semistructured interview created to help clinicians understand how older adults conceptualize depression diagnosis and treatment, we conducted a qualitative study of 102 patients aged 65 years or older. We recruited them from primary care offices and interviewed them in their homes. During our analysis, we found that many respondents offered spontaneous thoughts about the relationship between television and depression. We extracted all television-related content from the interview transcripts and identified themes by using grounded theory. Results: Participants cited television as a way to identify depression in themselves or others (either through overuse or lack of interest) or as a way to cope with depressive symptoms. Some felt that television could be harmful, particularly when content was high in negativity. A substantial number of participants discussed more than one of these themes, and a few mentioned all three. Married people were more likely to discuss television's role in identifying depression. Participants with low education more often mentioned that television could be helpful, whereas those with a history of depression treatment were more likely to discuss television's potential harm. Implications: Researchers should conduct further studies to help them better understand the relationship among depression, television viewing, and individual viewpoints concerning television's role in geriatric depression. An exploration of these issues may yield new approaches to help clinicians address depression in late life.

A mixed-methods approach to understanding loneliness and depression in older adults

Barg, F. K., Huss-Ashmore, R., Wittink, M. N., Murray, G., Bogner, H. R., & Gallo, J. J. (n.d.).

Publication year

2006

Journal title

Journals of Gerontology - Series B Psychological Sciences and Social Sciences

Volume

61

Issue

6

Page(s)

S329-S339

10.1093/geronb/61.6.S329

Abstract

Abstract

Objectives. Depression in late life may be difficult to identify, and older adults often do not accept depression treatment offered. This article describes the methods by which we combined an investigator-defined definition of depression with a person-derived definition of depression in order to understand how older adults and their primary care providers overlapped and diverged in their ideas about depression. Methods. We recruited a purposive sample of 102 persons aged 65 years and older with and without significant depressive symptoms on a standardized assessment scale (Center for Epidemiologic Studies-Depression scale) from primary care practices and interviewed them in their homes. We applied methods derived from anthropology and epidemiology (consensus analysis, semi-structured interviews, and standardized assessments) in order to understand the experience and expression of late-life depression. Results. Loneliness was highly salient to older adults whom we asked to describe a depressed person or themselves when depressed. Older adults viewed loneliness as a precursor to depression, as self-imposed withdrawal, or as an expectation of aging. In structured interviews, loneliness in the week prior to interview was highly associated with depressive symptoms, anxiety, and hopelessness. Discussion. An improved understanding of how older adults view loneliness in relation to depression, derived from multiple methods, may inform clinical practice.

Working title: A Review of ACOs and Equity

Murray, G., Holm, J., & Lappen, H. (n.d.).

Abstract

Abstract

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