Dr. Franzini is Professor and Chair of the Health Services Administration Department, School of Public Health, University of Maryland, College Park. Her research interests focus on health care costs, health policy innovations in Maryland, and health disparities.
Dr. Franzini’s research has been published in Journal of the American Medical Association, Health Affairs, Health Services Research, American Journal of Managed Care, Social Science and Medicine, and the American Journal of Public Health.
During the last 20 years, a major component of Fr. Franzini’s research and teaching activities has focused on the application of economics and econometrics to investigating the causes and consequences of disparities in health and health care delivery in vulnerable populations. She brings extensive experience in cost and cost-effectiveness analysis and a commitment to improving healthcare access and quality for vulnerable populations, including chronically ill patients and high-risk children on Medicaid. Her research on health disparities addresses the pathways through which socioeconomic disparities affect health, including trust, cultural factors, religion, policies to reduce disparities, healthcare disparities, and disparities in parenting and academic achievement.
Her methods expertise is: Econometrics, multilevel models, claims data, health economics, economic evaluation, cost-effectiveness and cost analysis, evaluation of interventions and policies.
The impact of Maryland’s Global Budget Revenue System (GBRS) on cardiac care delivery systems and cardiac patient outcomes: Maryland is the most innovative state in health care. In 2014, the state launched the Maryland All Payer Model, which stipulated that all payers, private and public, pay the same rate for inpatient and outpatient hospital services to eliminate cost shifting among payers. Maryland also pledged to move away from fee for service reimbursements to a new hospital global budget payment program in which all hospitals are paid a fixed amount per year for inpatient and outpatient hospital services, irrespective of utilization. The goal is to reward hospitals for providing value and focusing on population health. In this project, we partner with University of Maryland School of Medicine, Baltimore, to assess the impact of the GBRS on cardiac patients. Have cardiac procedures shifted from tertiary care centers to community-based settings? What are the changes in mortality, re-admission, in-hospital complications and health care costs for patients with an Acute MI diagnosis?
The efficiency of neonatal intensive care: Neonatal intensive care has been highly successful in reducing death and illness in newborns, particularly in very premature infants. This success has led to tremendous growth in the availability and size of Neonatal Intensive Care Units (NICU), although the number of newborns has remained about the same. This project will use newly available population-based medical claims data to conduct the first study of the medical care of the entire newborn population including both the mildly and severely ill. Using methods developed by the Dartmouth Atlas of Health Care, we will examine regional and provider variation in NICU availability, the use and outcomes of NICU care, and associated costs for all newborns insured by Texas Medicaid. The findings will identify new opportunities for improvement in the quality of care at the same or lower cost.
The role of price and utilization in spending variation for hip and knee replacement in a privately insured population: There is evidence that elective procedures such as hip and knee replacement are over-utilized. Thirty four percent of knee replacements performed over a 20-year period were classified as "inappropriate". Rates of utilization differ markedly across hospital service areas, suggesting uncertainty among physicians regarding indications for replacement surgery. This project describes spending, prices and utilization for hip and knee replacement and investigates the role of price and utilization in spending variation in a privately insured population and in Medicare.
A Hospital-level Analysis of Commercial Prices for Inpatient Stays: Researchers have extensively investigated provider- and market-level variations in Medicare spending and utilization patterns, but patterns of variation among the commercially insured are less well understood. In this project, we assess the hospital, market, provider and population characteristics that may affect variation in prices paid by a commercial health plan for inpatient hospital stays across hospitals. Using Cross Blue Shield of Texas claims data, we use regressions examine the association of hospital prices with hospital and market characteristics, including the socioeconomic characteristics of the resident population, BCBSTX market share, and a measure of hospital competition (the Herfindahl-Hirschman Index).
Vision for the department:
As the second chair of the UMD SPH Department of Health Services Administration, Dr. Franzini seeks to grow the department by recruiting more faculty and students. She has revamped the existing MHA and PhD programs and has expanded degree programs by offering a new MPH in Health Equity and a new MPH in Health Policy Analysis and Evaluation. Her research efforts are focused on making available to departmental faculty and students health care data, such as the Maryland All-Payer Claims Database, and data from Optum Labs and Inovalon, as well strengthening collaborations with the state and the private sector. She also is looking forward to collaborating with other departments and schools on both the College Park and Baltimore campuses whose faculty members are engaged in research focused on improving healthcare policy, access, delivery and costs.
Before joining UMD, Dr. Franzini served as a professor at the University of Texas School of Public Health , where she was Director of the Division of Management, Policy and Community Health and Director of the University of Texas School of Public Health/Blue Cross and Blue Shield of Texas Research Program in Payment Systems and Policies.
She trained as an econometrician and received her B.Sc, M.Sc, and PhD in Economics and Econometrics from the London School of Economics in England.
(selection; * indicates student)
L Franzini, S Taychakhoonavudh*, R Parikh*, C White “Medicare and private spending trends from 2008 to 2012 diverge in Texas” Medical Care Research and Review, vol. 72, 1: pp. 96-112, 2015.
C White, S Taychakhoonavudh*, R Parikh*, L Franzini “Roles of Prices, Poverty, and Health in Medicare and Private Spending in Texas” accepted American Journal of Managed Care, 2015.
IM Abbass*, TM Krause, SS Virani, JM Swint, W Chan, L Franzini “Revisiting the Economics Efficiencies of Observation Units” accepted Managed Care, 2014.
HV Russell*, MF Okcu, K Kamdar, MD Shah, E Kim, JM Swint, W Chan, XL Du, L Franzini, V Ho “Algorithm for analysis of administrative pediatric cancer hospitalization data according to indication for admission” accepted BMC Medical Informatics and Decision Making, 2014.
IM Abbass*, SS Virani, JM Swint, W Chan, L Franzini “One-Year Outcomes Associated With Using Observation Services in Triaging Patients With Nonspecific Chest Pain” Clinical Cardiology, 2014, DOI: 10.1002/clc.22319.
L Franzini, C White, S Taychakhoonavudh*, R Parikh*, M Zezza, O Mikhail “Variation in inpatient hospital prices and outpatient service quantities drive geographic differences in private spending in Texas” Health Services Research, 2014, doi: 10.1111/1475-6773.12192.
CH Colla, WL Schpero, DJ Gottlieb, AB McClurg, PG Albert, N Baum, K Finison, L Franzini, G Kitching, S Knudson, R Parikh*, R Symes, ES Fisher. “Tracking Spending Among Commercially Insured Beneficiaries Using a Distributed Data Model” accepted American Journal of Managed Care, 2014.
T Richmond, MN Elliott; L Franzini; I Kawachi; MO Caughy; NJ Gilliland, CE Walls, FA Franklin, R Lowry; SW Banspach, MA Schuster “School programs and characteristics and their influence on student BMI: Findings from Healthy Passages” PLOS ONE, 2014, 9(1): e83254, doi:10.1371/journal.pone.0083254.
KM Roche, MO Caughy, MA Schuster, LM Bogart, PJ Dittus, L Franzini “Cultural Orientations, Parental Beliefs and Practices, and Latino Adolescents’ Autonomy and Independence” accepted Journal of Youth and Adolescence, 43:1389-1403, 2014. DOI 10.1007/s10964-013-0077-6.
S Taychakhoonavudh*, L Franzini, LS Lal, EI Chang, CA Meyers, J Wefel, JM Swint “Comparison of time trade-off utility with neurocognitive function, performance status, and quality of life measures in patients with metastatic brain disease” Journal of Radiation Oncology, 3-2: 215-221, 2014, doi:10.1007/s13566-013-0093-8.
L Franzini, OI Mikhail, M Zezza, I Chan, SC Shen, J Smith. “Comparing Variation in Medicare and Private Insurance Spending in Texas” American Journal of Managed Care, Vol. 17 Issue 12, pe488-e495, 2011.
L Franzini, K Sail*, EJ Thomas, L Wueste “Cost and cost-effectiveness of a tele-ICU program at a large healthcare system” Journal of Critical Care. 26(3):329.e1-329.e6, 2011.
RL McConley, S Mrug, MJ Gilliland, R Lowry, MN Elliott, MA Schuster, LM Bogart, L Franzini, SL Escobar-Chaves, FA Franklin. “Mediators of Maternal Depression and Family Structure on Child BMI: Parenting Quality and Risk Factors for Child Overweight” Obesity, 19(2):345-52, 2011.
R Basu*, L Franzini, PM Krueger, DR Lairson “Lifetime medical expenditures among hypertensive men and women in the U.S.”, Women's Health Issues. 20(2):114-25, 2010.
L Franzini, J Skinner, O Mikhail “McAllen And El Paso Revisited: Medicare Variations Not Always Reflected In The Under-Sixty-Five Population” Health Affairs, 29 (12): 2302-2309, 2010.
L Franzini, M Giannoni. “Determinants of health disparities between Italian regions” BMC Public Health, 10:296 (1 June 2010) http://www.biomedcentral.com/1471-2458/10/296, 2010.
JA Boom, LC Shani, CS Nelson, AC Dragsbeak, L Franzini “Immunization information system opt-in consent: At what cost?” Journal of Public Health Management and Practice, 16(5): E18-E25, 2010.
L Franzini, W Taylor, MN Elliott, P Cuccaro, SR Tortolero, MJ Gilliland, JA Grunbaum, MA Schuster “Neighborhood characteristics favorable to outdoor physical activity: Disparities by socioeconomic and racial/ethnic composition” Health and Place, 16(2): 267-274, 2010.
L Franzini, MN Elliott, P Cuccaro, M Schuster, MJ Gilliland, JA Grunbaum, F Franklin, SR Tortolero “Influences of physical and social neighborhood environments on child physical activity and obesity” American Journal of Public Health, 99(2), 271-278, 2009.
L Franzini “Self-rated health, and trust in low income Mexican-origin individuals in Texas” Social Science and Medicine, 67(12): 1959-1969, 2008.
L Franzini “Predictors of trust in low income, minority neighborhoods in Texas” Journal of Health Care for the Poor and Underserved, 19(4):1282-1302, 2008.
L Franzini, E Thomas “Costs and effectiveness of tele-ICU in reducing morbidity and mortality in ICUs” Journal of Medical Economics, 11(1): 165-169, 2008.
L Franzini, CB Dyer “Health care costs and utilization of vulnerable elders reported to adult protective services for self-neglect” Journal of the American Geriatrics Society, 56: 667-676, 2008; published with editorial comment by M. Lachs pages 757.
BC Dyer, Franzini, L, M Watson, L Sanchez, L Prati, S Mitchell, R Wallace, S Pickens “Future research: A prospective longitudinal study of elder self-neglect” Journal of the American Geriatrics Society, 56 (SUPPL. 2): S261-S265, 2008.
L Franzini, MO Caughy, SM Nettles, P O’Campo. “Perceptions of disorder: Contributions of neighborhood characteristics to subjective perceptions of disorder” Journal of Environmental Psychology, 28: 83-93, 2008.