Soumitra Bhuyan, associate professor of health administration and policy at the Edward J. Bloustein School of Planning and Public Policy at Rutgers University, discovered the complexities of the U.S. health care system when a family medical emergency challenged his perspective on health care in the United States. Quite suddenly, he was navigating hospitals, rehabilitation facilities, costly therapies, and health insurance – and viewing the American health care system through an entirely different lens.
In this Spotlight, Bhuyan explains how the experience strengthened his devotion to science and influenced his research and career focus. Furthermore, he discusses his recent visit to Princeton’s Center for Health and Wellbeing, highlighting his work on chronic disease management and health information systems and his overarching goal of improving population health.
Q. In terms of context, were there any early influences, mentors, or events that shaped the trajectory of your career?
A. There are two things, actually. First, both of my parents were educators in my home country of India. My father was a college professor, and my mother was a schoolteacher, now retired. Although they never pushed me toward anything, I always wanted to be a professor – to work with young people, share ideas, and address the burning needs of the world.
The next part is unfortunate, and ironic. About eight or nine years back, my wife had a rare type of stroke. At the time, she had just earned her Ph.D. in neurophysiology and was doing her postdoc on how the brain regulates blood pressure. Even though I was teaching health care administration, I found that I had no clue what was actually happening to the health care system. She is doing well now, but that experience opened my eyes to how difficult it is, as a patient and as a caregiver, to engage with the health care processes in this country. Now, I put myself in the patient’s shoes while teaching health care management or conducting research.
Q. Was this an overall observation, or were you struck by any specific challenges within the system?
A. During the initial and follow-up treatments, my wife and I had the same issues as millions of Americans, including concerns about access to care, quality, and unexpected medical bills.
I still remember, when my wife and I were waiting in the Emergency Department (ED), on a Sunday, noticing that the room was full of people, and that some of them were eating hamburgers. I realized that these were not patients in need of emergency care. They were there because they didn’t have access to a primary care provider and EDs are their only source of care.
In one of my research studies, we found that people who don’t receive paid sick leave wind up using the ED for primary care, especially on the weekends. The United States is the only industrialized country in the world that doesn’t mandate paid sick leave, so workers may only have time to seek medical care on Saturday or Sunday, and they often don’t have a regular primary care provider. Even though they have access to insurance through the Affordable Care Act, they may still have issues with access to care.
Q. Can you elaborate on why you wanted to have a career in teaching health care management?
A. My educational background encompasses many sides of health care: clinical care, public health, and health management. Together, they have given me a broader perspective on how to see a health care issue, or health care problem. When I was pursuing my doctorate, I studied the health care workforce and tried to understand retention, provider satisfaction, and things like that. But I’m evolving. Now I’m mainly focused on how we can leverage health information technology, such as mobile health apps, to manage chronic illnesses.
My goal is to drill down on how we can create healthy communities outside the four walls of the hospital. And how we can help hospitals develop strategies to meet that goal. As I mentioned, the American hospital system is based on a model that emphasizes revenue by increasing patient volume. But that is changing because the insurance industry now adjusts reimbursements based on patient outcomes rather than patient volume. They’ve said that the model of more volume, more revenue isn’t working, and that hospitals must be accountable for the care they provide. All of a sudden, hospitals are reaching into their communities and looking for new ways of improving public health.
Q. Why have you homed in on chronic illness?
A. There’s no other country in the world, other than the United States, in which you want to be if your life needs to be saved. The U.S. has the technology, the advancements, the trained professionals for any type of medical emergency; everything is absolutely unmatched. However, if you are someone with a chronic illness (or have no health insurance), this is the last place that you want to live. Providers can save your life, but after that, access to health care is difficult at every point. The U.S. health system model is built to treat sickness; it’s not built to keep people healthy.
Let’s take cardiovascular disease, for example. Data suggests that more U.S. women die of cardiovascular health issues than men. So I did a study looking at medication adherence. What we found, across cardiovascular disease and diabetes illness, is that women are more likely to skip medication (such as blood pressure or cholesterol medicines) to save money as compared to men. Taking the proper medication is beneficial to the patient in terms of morbidity and mortality, reducing the risk of a cardiac event. This research suggests that we have a significant opportunity to make a difference in the health and lives of millions of women. If we understand the behavioral economics side – how differences in gender, race, ethnicity, and other factors may impact behaviors and ultimately health outcomes – maybe we can design an effective intervention at the hospital level or the outpatient level, such as a financial benefit. It’s an easy fix! If you want to reduce the gap in mortality between men and women when it comes to cardiovascular illness, and keep women well, give them the proper medication if they cannot afford it. But, in spite of spending billions and billions of dollars on health care, the U.S. has not made this a standard practice.
Q. What’s behind your interest in information technology?
A. AI, or artificial intelligence, and machine learning are buzzwords that you might hear. My global team and I use these tools in our research. For example, we’re building models to understand pregnancy outcomes in low-income settings. We feed data to this kind of machine to predict the factors that result in better pregnancy outcomes, specifically in low-income settings. Although the majority of my work is focused on the U.S., this research is going on in Tanzania.
I’m working on another international project to improve access to breast and cervical cancer screenings in Chennai, India. The key is finding out how to get these things done in a low-resource environment. Some of the solutions are not expensive. We need to think differently, using AI and machine learning to identify trends, best practices, and frugal innovations in global health.
Q. You alluded to this earlier, but could you explain how equity issues, or social determinants of health, play into your research?
A. If we look at morbidity and mortality rates (morbidity meaning how well you are living with illness and mortality meaning death), 20 percent of outcomes are attributed to the health care system or the quality of care it provides. The rest, or 80 percent of outcomes, are related to social determinants of health – where people live and how they live. So there is tremendous opportunity for us to address housing, transportation, availability of places to exercise, and other factors that drive disparities and impact health.
I am doing a lot of interesting work in this area. Right now, for example, I’m tackling food insecurity, a social determinant of health that is linked to chronic diseases such as cancer and high blood pressure. I’m collaborating with the Jersey City Mayor’s office on an urban farming project, through which we’re growing fruits and vegetables and distributing the crops to low-income populations in public housing. We’re in the process of expanding this initiative to include hospitals, delivering these healthy foods to low-income patients.
Q. What was the focus of your work at Princeton’s Center for Health and Wellbeing?
A. I was mainly working on telehealth and the effectiveness of telehealth policies in the State of New Jersey. During and after the Covid-19 pandemic, an increasing number of health care providers introduced telehealth as an alternative to in-person care. However, we are not really sure about how well it’s working. Our research looks at three things: access, effectiveness, and satisfaction (from both the provider side and the patient side). For example, we’re studying whether or not people who use telehealth are less likely to go to the Emergency Department. We’re also evaluating its effectiveness within vulnerable communities, such those with mental and behavioral health issues and people in the LGBTQ community, because these groups sometimes face barriers when it comes to seeing a provider. We hope this research will lead to discussions about reimbursement and other important policy issues.
I’ve also been studying cybersecurity. We live in a society where we do a lot of things online, including registering for doctors’ appointments and providing health information. With so much data available online, cyberattacks have become a real threat, especially for health care organizations, as bad actors try to get access to that data. Approximately 94 percent of health care organizations in the U.S. have experienced at least one type of cyberattack, and the number of data breaches is climbing. Patient records and even medical research data are particularly vulnerable.
There’s a lot of work to be done when it comes to data security and privacy. We need to learn more about how to protect this data and reduce the risk of cyberattacks, thinking proactively rather than reactively. Technology alone will not solve the problem. We also need to look at behaviors. For example, frontline workers often work with health care data. How motivated are they to protect it?
Q. Among many distinctions, you and your colleagues received a Charles E. Gibbs Leadership Prize for research on women’s health issues. Is this another special area of interest?
A. Yes, chronic disease in women’s health is an interest that is close to my heart. I was raised by my mother and my sister, who took care of me after my father passed away when I was not even one year old. Even though I cannot take care of them directly, I can do something that increases our understanding of women’s health issues and promotes evidence-informed policies. That’s absolutely a big motivating factor for me when I’m engaging in women’s health research.
The prize recognized my work on gender differences in cost-related medication nonadherence among patients with cardiovascular disease. As I mentioned earlier, we found lower adherence among women, which puts them at risk of poor health.
Q. What are your plans for future research and hopes regarding your contributions to the field of global health?
A. I just want to be impactful and make a difference – in the lives of the patients for which I do research and also my students.
I hope that my research expands knowledge related to chronic illness management and population health. At the same time, I hope to advance the work of other scientists, as I do in my role as an associate editor for BMJ Global Health, a British medical journal focused on global health.
As for my students, I want them to know they can knock on my door. I want them to feel that I’m kind and empathetic – that I will sit with them, and give my time, and help them do better and be better. That’s the reason I got into academics in the first place. Nothing else. It wasn’t for an honor or a title. It was to help young people maximize their potential. At the end of the day, that’s all that matters.
I’m very optimistic about our current generation. In every generation there are people who want to change the world. But today’s students are true activists and stand for social justice. They want to be participants in the process, which is actually fantastic, because that’s how we build an equitable society.