Report Back from Breakout Sessions Moderated by Penny Mohr, MA Senior Program Officer Improving Healthcare Systems 1
Breakout Group 1: Communications and Education for Enrollee Support 2
Of the questions being considered, which patient-centered comparative effectiveness questions PCORI might fund? (Consider: populations/subpopulations that should be target; interventions and comparators; relevant patient-centered outcomes.) • What are the most effective mechanisms to inform consumers regarding coverage of preventive services (and those that are exempt from the deductible) under their plan? • What are the most effective mechanisms to inform consumers regarding services without first- dollar coverage, or which require out-of-pocket payment, under their plan? • Which modalities or models provide consumers with greatest confidence in their health care decision making for themselves and other covered dependents? 3
Which CER question is most compelling and why? • We think they are all important and interconnected. • What are the most effective mechanisms to inform consumers regarding coverage of preventive services (and those that are exempt from the deductible) under their plan? • What are the most effective mechanisms to inform consumers regarding services without first-dollar coverage, or which require out-of-pocket payment, under their plan? • Which modalities or models provide consumers with greatest confidence in their health care decision making for themselves and other covered dependents? 4
Why or why not are these questions particularly well suited for PCORI to fund? • Lack of clarity around models • Who is using which modalities, in which combination(s), for which population(s) • Poor availability of health care services metrics • Lack of evaluation of models • Incentives vs mandatory • E-assistance vs. Personal Outreach vs. Community Partners • Is good data available? • “Soft” metrics to evaluate models (neither patient-centered nor clinical outcomes) 5
What are the challenges raised in conducting research on these questions, and how might those challenges be addressed? • Identifying outcomes • Identifying modalities • Meaningful measurements with multiple variables • Age, language, low income 6
Breakout Group 2: Incentives 7
Of the questions being considered, which patient-centered comparative effectiveness questions PCORI might fund? (Consider: populations/subpopulations that should be target; interventions and comparators; relevant patient-centered outcomes.) Compare the PCO effect of social and financial incentive structures on the understanding of and engagement with high deductible health plans. Target populations: low income, low health literacy, chronic diseases, newly insured Potential comparators : Incentives for educational programs, HSA funding, premium reduction, gift cards Outcomes: Leave patient-centered outcomes up to investigators 8
Of the questions being considered, which patient-centered comparative effectiveness questions PCORI might fund? (Consider: populations/subpopulations that should be target; interventions and comparators; relevant patient-centered outcomes.) Compare the PCO effect of social and financial incentive structures on the understanding of and engagement with high deductible health plans. Target populations: low income, low health literacy, chronic diseases, newly insured Potential comparators : Incentives for educational programs, HSA funding, premium reduction, gift cards Outcomes: Leave patient-centered outcomes up to investigators Comparison of PCO basic HDHP vs. enhanced HDHP Enhancements may include: funding of HSA account, patient engagement initiatives, broader inclusion of deductible-exempt services, network configuration, decision support, and/or ties to provider-facing initiatives Target populations: Same vulnerable populations that are listed above Outcomes: Leave patient-centered outcomes up to investigators 9
Breakout Group 3: Clinical Programs and Care Management 10
Of the questions being considered, which patient-centered comparative effectiveness questions PCORI might fund? (Consider: populations/subpopulations that should be target; interventions and comparators; relevant patient-centered outcomes.) What is the difference in outcomes between having a primary care visits in-house for free/low-cost vs. out-of-house covered by the employer vs. telemedicine vs. standard (out of house)? Outcomes: patient satisfaction/experience, immunizations, quality of life, work absenteeism due to illness, avoidable admissions, alteration of health status, ER visits. What is the impact of clinical outcomes and utilization for employees that have an HRA vs. HSA account (controlling for the level of funding) and vs. no account associated with the high deductible health plan? For patients that are enrolled in high deductible health plans, what is the difference in health outcomes for those that have ‘better pharmacy benefits’ (exempt medications) vs. (non exempt medications) paired with chronic disease management offered by employer vs. standard care? 11
Which CER question is most compelling and why? What is the difference in outcomes between having a primary care visits in-house for free/low- cost vs. out-of-house covered by the employer vs. telemedicine vs. standard (out of house)? Outcomes: patient satisfaction/experience, immunizations, quality of life, work absenteeism due to illness, avoidable admissions, alteration of health status, ER visits. 12
Why or why not are these questions particularly well suited for PCORI to fund? 13
What are the challenges raised in conducting research on these questions, and how might those challenges be addressed? 14
BREAK 3:00 – 3:15 p.m. 15
Priority Research Questions for PCORI and Justification Moderated by Penny Mohr, MA Senior Program Officer Improving Healthcare Systems 16
Priority Questions 17
Criteria to Keep in Mind Patient-Centeredness: is the comparison relevant to patients, their caregivers, clinicians or other key stakeholders and are the outcomes relevant to patients? Impact of the Condition on the Health of Individuals and Populations: Is the condition or disease associated with a significant burden in the US population, in terms of disease prevalence, costs to society, loss of productivity or individual suffering? Assessment of Current Options: Does the topic reflect an important evidence gap related to current options that is not being addressed by ongoing research. Likelihood of Implementation in Practice: Would new information generated by research be likely to have an impact in practice? (e.g. do one or more major stakeholder groups endorse the question?) Durability of Information: Would new information on this topic remain current for several years, or would it be rendered obsolete quickly by new technologies or subsequent studies? 18
Voting Sheet What are the most effective mechanisms to provide ongoing care/disease management support to the chronically ill population within high deductible plans and who should do it to most effectively improve patient outcomes? Score this topic from (1 – low / does not or barely meets the criterion) to (5 – High scoring / fully addresses the criteria). Please reference the scoring criteria guide as reference. The total score will measure how highly this topic is prioritized. 1 (low) 2 3 (modest) 4 5 (high) Patient- Centeredness Impact on Health and Populations Assessment of Current Options Likelihood of Implementation Durability of Information Overall Importance Given your consideration of all CER questions, which one would you recommend that PCORI should pursue and why? 19
Closing Remarks Bryan Luce, PhD, MS, MBA Chief Science Officer, Office of the Chief Science Officer Steven Clauser, PhD , MPA Program Director, Improving Healthcare Systems 20
We Still Want to Hear from You We welcome your input on today’s discussions. We are accepting comments and questions for consideration on this topic through January 23 rd , 2015 via email (info@pcori.org) We will take all feedback into consideration. 21
Thank You for Your Participation 22
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