Home – Nils Franco

I devote my life to improving the health care systems. I constantly struggle to systematize my understanding in the face of enormous complexity, and use this log to hold myself accountable in that effort. I focus on long-term conditions and providers’ efforts to improve and innovate.

2020 activities

PACE Program Research, Policy

Themes: Capitation and Quality in End-of-Life Care, Long-Term Care

Program Design. JAN 2020–PRESENT, researched PACE expansion and its effects, balancing how CMS can get the greatest reach using the PACE care model (i.e., can meet the most need) while retaining the program’s integrity and purpose.

Provided comment to the DC government on DC’s PACE Establishment Act rulemaking, based on conversations with local health-finance experts and national capitation-economics researchers.

Long-Term Care Financing Legislative Assistance

Themes: Social Insurance, Insurance Markets, Congress

Policy Design. NOV 2019–PRESENT, interviewed researchers, think tank leaders, and policy advocates to generate policy solutions that provide manageable financing options for long-term care.

Learning & balancing the various arguments, I am assisting two researchers tasked with developing palatable, sound federal legislation.

Research Consulting for the D.C. Government

Themes: Criminal Justice, Addiction Treatment, Continuity of Care, Care Utilization
Skills: Deep academic, legal, & “gray” research, key informant interviews, health services data, R, writing

Data Analysis. DEC 2019–MAR 2020, designed and implemented analysis of administrative data — data never before merged from Medicaid, behavioral health, police, corrections, and death. Leading the analytical and data management, I constructed a novel episode-based framework for the study. Project evaluated social services and behavioral health care utilization and continuity by justice-involved D.C. residents.

2019 activities

Research Consulting for the D.C. Government

Themes: Criminal Justice, Addiction Treatment, Continuity of Care, Care Utilization
Skills: Deep academic, legal, & “gray” research, key informant interviews, health services data, R, writing

General Research. NOV 2018 – AUG 2019. Contributing to the literature reviews, key informant interviews, and report drafting for the D.C. Auditor’s forthcoming report on substance use disorder treatment in D.C.’s criminal justice system.

Consulting for the U.S. Government

Themes: Alternative Payment Models, Provider Measures, Process Improvement
Skills: Data management & analysis, project management, R, Microsoft Excel, writing
Learning and Diffusion. NOV 2018–MAY 2019. Linked, for the first time, performance outcomes and Learning and Diffusion Group technical assistance data among providers engaging with the Medicare Innovation Center’s alternative payment schemes. Recommended promising practices drawn from models of technical assistance data, including (1) classification, (2) regression, (3) ANOVA, and (4) statistical process control methods as appropriate. Produced a half-dozen reports and final slide deck for the Learning and Diffusion Group staff.

Eligibility Groups. OCT 2018–MAR 2019. Analyzed, for the Medicare Beneficiary Ombudsman, key patient populations and insurance groups that face added challenges in Medicare eligibility and enrollment (E&E) using R to describe multiple years of Census Current Population Survey data for American individuals.

Operations Tracking. JUN 2018 – MAY 2019. Automated analyses in and Excel of operations data, monitoring errors in beneficiary outreach during a major new initiative overseen by the Office of Hearings and Inquiries. Merged operations and beneficiary data to inform targeting of groups in process control.

Report to Congress. OCT 2018 – MAY 2019. Co-developed the Competitive Acquisition Ombudsman (CAO) Report to Congress for multiple years, working directly with the CAO to craft the report around data analysis considerations, policy changes (e.g. the DMEPOS Competitive Bidding Program Gap Period, starting 2019), and many agency clearance cycles.

Fulbright Proposal on Primary Care, Diabetes, Hospitalizations

Themes: Care Utilization, Provider Measures, Long-Term Conditions
Skills: Deep academic & gray research, proposal writing, international communication

APR 2019 – OCT 2019. Proposed research to the Fulbright Commission to understand how primary care can maximally influence chronic condition outcomes, using diabetes clinical pathways in New Zealand.