Enrollee Support for High Deductible Health Plans Workgroup Meeting January 8, 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 that PCORI should fund in the area of providing enrollee support to positively impact access and utilization of health care services by persons enrolled in high deductible health plans? 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 Leah Binder, the Leapfrog Group and what are the important questions? Lynn Quincy, Consumers Union 10:15 – 10:30 AM Break N/A 10:30 – 12:30 PM Breakout sessions – Discussion and N/A ranking of PCOR questions 12:30 – 1:30 PM Lunch N/A 1:30 – 3:00 PM Plenary session: Report back and Penny Mohr, PCORI discussion of prioritized PCOR questions 3:00 – 3:15 PM Break N/A 3:15 – 4:15 PM Priority Questions for PCORI and Penny Mohr, PCORI Justification 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
What Is Patient-Centered Research? Compares effectiveness of important clinical management options that represent realistic choices faced by patients or other decision- makers Includes the range of clinical outcomes that are of interest to patients and their caregivers, including health, health-related quality of life, function, symptoms, safety from medical harm, survival and satisfaction with care
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 12
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. 13
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; Conduct research in real-life settings. 14
PCORI Relies on Engagement in Setting its Research Agenda, Conducting Research and Disseminating Findings Patients/ Consumers Caregivers Purchaser Family Members Payer Clinicians PCORI Community Patient Industry Advocacy Orgs Policy Hospital/ Maker Health System Training Institution
PCORI also 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 Falls Prevention Trial with the National Institute on Aging Uterine Fibroids Registry with the Agency for Healthcare Research and Quality Contracts/MOUs from PCORI to manage targeted PFAs – PCORI provides funding, funding partner provides in-kind expertise In all cases, PCORI works with collaborators to ensure that its CER work complements, not conflicts, with the research mission of other funding organizations.
Enrollee Support in High-Deductible Health Plans Workgroup Robert M. Kaplan AHRQ Chief Science Officer January 8, 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
AHRQ-PCORI Collaboration: Comparing Treatments for Uterine Fibroids • Uterine fibroids ► The most common noncancerous tumors in women of childbearing age ► Second most common reason these women undergo surgery. ► Cause significant pain, bleeding, and fertility problems • Treatment options watchful waiting ► ► drugs or hormones, ► embolization, ultrasound; ► partial or total hysterectomy. • Little evidence about the effectiveness of these therapies or their outcomes, including fibroid reoccurrence and women's ability to have children.
AHRQ-PCORI Study • Data coordinating center based at Duke Clinical Research Institute and nine clinical centers, • The Observational patient registry records real treatment experiences and measures Patient Centered Outcomes (PCOR)
AHRQ Activities • Dissemination and Implementation Research
“PUBLICATION PATHWAY” Balas & Boren, 2000 Original Research 18% variable Dickersin, 1987 Negative Submission results 46% 0.5 year Koren, 1989 Kumar, 1992 Acceptance 0.6 year Kumar, 1992 Publication Expert 35% Lack of opinion 0.3 year Balas, 1995 Poyer, 1982 numbers Bibliographic databases 50% Inconsistent 6 - 13 years Antman, 1992 Poynard, 1985 indexing Reviews, guidelines, textbook 9.3 years Implementation
“PUBLICATION PATHWAY” Balas & Boren, 2000 Original Research It takes 17 years to turn 14 percent of original research to the benefit of patient care years Implementation
The Pivot- Some New Directions at AHRQ Accelerating Adoption of PCOR: Focusing on ABCS • Accelerating Adoption of PCOR: Focusing on ABCS ► Grants for dissemination of patient-centered outcomes research to small- and medium-size primary care practices ► Focus: Million Hearts™ ABCS ( a spirin use among people with heart disease, b lood pressure control, high blood c holesterol control and s moking cessation advice and support) campaign to prevent heart attacks and strokes
Do Cost Concerns Reduce the Use of Effective Services?
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