Dissertation
My three-paper dissertation examines Type II diabetes through advanced causal inference, statistical, and geospatial methods. Each paper is connected by a focus on how regulatory and market structures shape patients' ability to obtain care, informed by Penchansky & Thomas's 5 A's of Access framework. The work utilizes longitudinal study designs, causal inference frameworks, and geospatial analytics with large-scale administrative claims datasets.
Quasi-Experimental Evaluation of the Inflation Reduction Act's Capped Insulin Copay Provision
The Question
The Inflation Reduction Act capped insulin copayments for Medicare beneficiaries. Does this provision actually improve medication adherence and healthcare outcomes in Medicare Advantage populations?
Why It Matters
Insulin affordability is a high-profile policy issue with direct consequences for patients managing diabetes. Payers, legislators, and pharmacy benefit managers need evidence on whether federal copay caps achieve their intended goals — and what the downstream effects are on utilization and outcomes.
Methods
Design: Difference-in-differences, exploiting the IRA's implementation timeline to identify causal effects on adherence and healthcare utilization.
Data: IQVIA Pharmetrics Plus — a large-scale administrative claims dataset covering Medicare Advantage populations, capturing pharmacy fills, cost-sharing, and utilization patterns.
So What?
Findings inform ongoing federal debates about pharmaceutical pricing regulation and help payers anticipate the downstream effects of copay cap mandates on adherence, switching behavior, and total cost of care. Presented at ASHEcon 2025.
Multi-Level Modeling Analysis of APRN Full Practice Authority Impact on Diabetes Treatment Outcomes
The Question
When states grant Advanced Practice Registered Nurses (APRNs) full practice authority — removing physician oversight requirements — does it measurably improve diabetes treatment outcomes?
Why It Matters
Provider workforce shortages, particularly in rural and underserved areas, drive the push to expand APRN scope of practice. Payers and health systems need evidence on whether these regulatory changes translate into real gains in care quality and access for patients managing chronic conditions.
Methods
Design: Multi-level modeling to account for nested structures (patients within providers within states) and estimate the causal impact of full practice authority adoption while controlling for clustering effects.
Framework: Penchansky & Thomas 5 A's of Access (Availability, Accessibility, Accommodation, Affordability, Acceptability) to structure outcome measurement.
So What?
Results speak directly to state legislatures weighing scope-of-practice reform, payers evaluating network adequacy strategies, and health systems making workforce planning decisions.
Emerging Hotspot Analysis of Diabetic Foot Ulcer Prevalence in Arkansas
The Question
Where are diabetic foot ulcers concentrated in Arkansas, what spatial patterns are emerging over time, and what risk factors explain the geographic distribution?
Why It Matters
DFUs are among the most costly and morbid complications of diabetes, often leading to amputation. Understanding the spatial distribution and temporal trends of DFUs helps health systems, payers, and public health agencies target prevention and treatment resources to where they're needed most.
Methods
Design: Emerging hotspot analysis to identify spatiotemporal trends, combined with explanatory modeling to identify risk factors driving geographic patterns.
Data: Large-scale administrative claims data combined with geocoded provider/facility and demographic data.
So What?
The combination of emerging hotspot analysis with explanatory modeling is a novel approach in DFU research. Findings can guide resource allocation, network design, and targeted intervention programs for payers and public health agencies.
Publications
Bugolski, C., Watson, W.P., Young, S. G. "Privy by the Bay: Emerging Hotspot Analysis of 311 Reports of Human/Animal Waste Near San Francisco Pit Stop Locations." PLOS One, August 14, 2025.
In Press: Young, S. G., Truong, V., Watson, W.P., & Bogulski, C. A. "Geospatial evaluation of San Francisco, California's homeless encampment sweeps injunction." Frontiers in Public Health.
Selected Presentations
Watson, W.P., Lovell, R.L., and Bhai, M. "Impact of State Insulin Copayment Caps on Healthcare Utilization and Medication Adherence: A Study of Commercially Insured Diabetic Patients, 2020–2021." American Society of Health Economists Conference (ASHEcon), Nashville, TN, June 2025.
Watson, W.P., Owsley, K.O. "Deductible Type and the Impact on Family Utilization of Select Healthcare Services." Emerging Scholars Session, ASHEcon, San Diego, CA, June 2024.
Young, S.G., Bogulski, C.A, Watson, W.P., Truong, V. "Where can you go in San Francisco? Evaluating 311 reports of human/animal waste and the Pit Stop program." American Association of Geographers Annual Meeting, Honolulu, HI, April 2024.
Other Research Projects
Beyond the dissertation, selected research includes a family-level cost-sharing analysis examining aggregated vs. embedded deductible structures and their impact on healthcare utilization (presented at ASHEcon 2024 Emerging Scholars Session), predictive modeling using deep learning to classify family deductible types from administrative claims, and ongoing geospatial health analytics published in peer-reviewed journals.
My broader research interests include health insurance benefit design and its behavioral effects, the economics of provider workforce regulation, geographic disparities in healthcare access, and methodological applications of causal inference to administrative claims data.