Effects of Accountable Care Organizations on Patient-Centered Outcomes Workgroup Meeting January 9, 2015 1
Welcome and Introductions Steven Clauser, PhD, MPA Program Director, Improving Healthcare Systems 2
Question for this Working Group Are there patient-centered comparative clinical effectiveness research questions on the impact of Accountable Care Organizations on patient-centered outcomes that PCORI should support? 3
Agenda Time Agenda Item Speaker(s) 8:30 – 8:45 AM Welcome and Introductions Steve Clauser, PCORI 8:45 – 9:05 AM Setting the Stage Steve Clauser, PCORI Robert Kaplan, AHRQ 9:05 – 9:15 AM Background and Objectives of Work Group Penny Mohr, PCORI 9:15 – 10:15 AM Discussion of Research Gaps: Why now and what Mark McClellan, the Brookings are the important questions? Institution Tricia McGinnis, Center for Healthcare Strategies 10:15 – 10:30 AM Break N/A 10:30 – 12:30 PM Breakout sessions – Discussion and ranking of N/A PCOR questions 12:30 – 1:30 PM Lunch N/A 1:30 – 3:00 PM Plenary session: Report back and discussion of Penny Mohr, PCORI prioritized PCOR questions 3:00 – 3:15 PM Break N/A 3:15 – 4:15 PM Priority Questions for PCORI and Justification Penny Mohr, PCORI 4:15 – 4:30 Closing Remarks Steve Clauser, PCORI 4 Bryan Luce, PCORI
Housekeeping Session is being webcast live and recorded; please use microphones when speaking and turn off your microphone when you are done Webinar participants can provide input via e-mail (info@pcori.org); via Twitter (#PCORI); or the webinar “chat” feature. Please submit questions as they occur to you. We will collect and synthesize these for inclusion in the meeting summary. We welcome additional input through January 23, 2015 at 5:00 pm ET via e-mail info@pcori.org 5
How PCORI Manages the Potential for Conflict of Interest The researchers, patients, and other stakeholders who have been invited to this workgroup will be involved in the process of determining the specific subject areas that we should address in the PFA. The broader community of researchers, patients, and other stakeholders who are participating by web, twitter and chat can be involved as well. Participants in this workgroup are eligible to apply for funding if PCORI decides to produce a funding announcement. Input received during the workgroup deliberations will be broadcast via webinar, and the webinar will be archived and made available to other researchers, patients, and stakeholders via the PCORI website. 6
Reminders Webinar/teleconference and archiving this workshop This workshop is advisory! PCORI’s interest in collaborative funding of research
Setting the Stage Setting the Stage – Current State of Evidence Steven Clauser, PhD, MPA Program Director, Improving Healthcare Systems Robert Kaplan, PhD Chief Science Officer Agency for Health Care Research and Quality 8
PCORI’s Mandate “The purpose of the Institute is to assist patients, clinicians, purchasers, and policy- makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis...and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services...” -- from Patient Protection and Affordable Care Act
How We Define Comparative Effectiveness Compares two or more options for prevention, diagnosis, or treatment (can include “usual care”) Considers the range of clinical outcomes relevant to patients Conducted in real-world populations and real-world settings Attends to differences in effectiveness and preferences across patient subgroups Often requires randomized trial design
Funding Exclusions: Cost-Effectiveness Analysis (CEA) Based on PCORI’s authorizing legislation, PCORI is not permitted to fund studies of CEA. NOTE: PCORI does fund studies that explore the burden of costs on patients—for example, out-of-pocket costs. Examples of CEA Research that conducts a formal CEA in the form of dollar-cost per quality-adjusted life-year (including non-adjusted life-years) to compare two or more alternatives Research that compares the relative costs of care between two or more alternative approaches as the primary criterion for choosing the preferred alternative
What is PCOR? Patient-Centered Outcomes Research (PCOR) helps people and their caregivers communicate and make better-informed healthcare decisions. PCOR: Actively engages patients and key stakeholders throughout the research process Compares important clinical management options. Evaluates the outcomes that are the most important to patients. Addresses implementation of findings in clinical care environments .
PCORI’s National Priorities for Research Assessment of Communication & Prevention, Improving Dissemination Diagnosis, and Healthcare Systems Research Treatment Options Accelerating PCOR Addressing and Methodological Disparities Research 13
IHS Goal Statement To support studies of the comparative effectiveness of alternate features of healthcare systems that will provide information of value to patients, their caregivers and clinicians, as well as to healthcare leaders , regarding which features of systems lead to better patient-centered outcomes. 14
Distinctive Components of IHS Studies Adapt PCOR model for CER beyond clinical treatment options to different levels of the healthcare system; Require inclusion of well articulated and valid comparators, for both trials and studies using observational data; Focus on outcomes relevant to patients; Active involvement of patients and other stakeholders throughout the entire research process; 15
PCORI Relies on Engagement in Setting its Research Agenda, Conducting Research and Disseminating Findings Patients/ Consumers Caregivers Purchaser Family Members Payer Clinicians PCORI Community Industry Patient Advocacy Orgs Policy Hospital/ Maker Health System Training Institution
PCORI Collaborates with Other Funders PCORI’s Board and its Strategic Plan express great interest in co-sponsoring and collaborative management of research with other funding agencies are Research and Quality Falls Prevention Trial with the National Institute on Aging Uterine Fibroids Registry with the Agency for Healthcare Research and Quality In all cases, PCORI works with collaborators to ensure that its PCOR principles are reflected in the funding announcement, peer review process, and project award Anticipate we will collaborate with AHRQ on any funding initiative arising from this workgroup
Impact of Accountable Care Organizations on Patient-Centered Outcomes Workgroup Robert M. Kaplan AHRQ Chief Science Officer January 9, 2015
AHRQ’s Mission To produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.
Priorities Priority #1 Priority #2 Produce Evidence to Produce Evidence to Make Health Care Safer Improve Health Care Quality Priority #4 Priority #3 Produce Evidence to Produce Evidence to Improve Health Care Increase Access to Affordability, Efficiency Health Care and Cost Transparency
A Few Activities • Evidence Based Practice Centers (EPCs) • United States Preventive Services Task Force (USPSTF) • Medical Expenditures Panel Survey (MEPS) • Healthcare Associated Infections Program
New Directions at AHRQ: Evidence, Data, & Methods to Build Learning Health Systems of the Future (EDM) • EDM Forum is an avenue to share innovations and lessons learned by those working at the interface of clinical informatics, quality improvement, research and clinical care. • There are several freely-accessible resources: ► eGEMs papers (over 70 papers and over 30,000 downloads), ► Webinars, toolkits, issue briefs, and summaries of previous symposia and workshops.
New Directions at AHRQ: PA Margolis and Colleagues- The Learning Healthcare System Remission rate (PGA, Centers >75% registered) 79 % 71 Care Centers >19,500 patients >575 physicians >35% of all IBD patients APR 2007 NOV 2008 DEC 2010 AUG 2012 JUL 2014 Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease. Pediatrics. 2012;129:1030- 41
AHRQ Activities • Provide data for researchers and policy makers
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