Effects of Accountable Care Organizations on Patient-Centered - - PowerPoint PPT Presentation

Effects of Accountable Care Organizations on Patient-Centered Outcomes Workgroup Meeting

January 9, 2015

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Steven Clauser, PhD, MPA

Program Director, Improving Healthcare Systems

Welcome and Introductions

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Question for this Working Group

Are there patient-centered comparative clinical effectiveness research questions on the impact of Accountable Care Organizations on patient-centered

• utcomes 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 are the important questions? Mark McClellan, the Brookings 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 PCOR questions N/A 12:30 – 1:30 PM Lunch N/A 1:30 – 3:00 PM Plenary session: Report back and discussion of prioritized PCOR questions Penny Mohr, PCORI 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 Bryan Luce, PCORI

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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

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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.

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Webinar/teleconference and archiving this workshop This workshop is advisory! PCORI’s interest in collaborative funding of research

Reminders

Setting the Stage – Current State of Evidence

Setting the Stage

Steven Clauser, PhD, MPA

Program Director, Improving Healthcare Systems

Robert Kaplan, PhD

Chief Science Officer Agency for Health Care Research and Quality

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“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...”

PCORI’s Mandate

• - from Patient Protection and Affordable

Care Act

Compares two or more options for prevention, diagnosis, or treatment (can include “usual care”) Considers the range of clinical

• utcomes 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

How We Define Comparative Effectiveness

Funding Exclusions: Cost-Effectiveness Analysis (CEA)

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
• f care between two or more alternative

approaches as the primary criterion for choosing the preferred alternative

• Based on PCORI’s authorizing legislation, PCORI is not

permitted to fund studies of CEA.

• NOTE: PCORI does fund studies that explore the burden
• f costs on patients—for example, out-of-pocket costs.

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.

What is PCOR?

PCORI’s National Priorities for Research

Assessment of Prevention, Diagnosis, and Treatment Options Improving Healthcare Systems Communication & Dissemination Research Addressing Disparities Accelerating PCOR and Methodological Research

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IHS Goal Statement

To support studies of the comparative effectiveness

• f 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.

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Distinctive Components of IHS Studies

Adapt PCOR model for CER beyond clinical treatment

• ptions to different levels of the healthcare system;

Require inclusion of well articulated and valid comparators, for both trials and studies using

• bservational data;

Focus on outcomes relevant to patients; Active involvement of patients and other stakeholders throughout the entire research process;

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PCORI Community

Patients/ Consumers Caregivers Family Members Clinicians Patient Advocacy Orgs Hospital/ Health System Training Institution Policy Maker Industry Payer Purchaser

PCORI Relies on Engagement in Setting its Research Agenda, Conducting Research and Disseminating Findings

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

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. AHRQ’s Mission

Priorities

Priority #1

Produce Evidence to Improve Health Care Quality Priority #2 Produce Evidence to Make Health Care Safer Priority #3 Produce Evidence to Increase Access to Health Care Priority #4 Produce Evidence to Improve Health Care Affordability, Efficiency 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 %

APR 2007 NOV 2008 DEC 2010 AUG 2012 JUL 2014

71 Care Centers >19,500 patients >575 physicians >35% of all IBD patients

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

Collaboration with the Robert Wood Johnson Foundation on Implementing the Inclusion of a Linked Medical Organizations Survey (MOS) in AHRQ’s Medical Expenditure Panel Survey (MEPS)-Focus on ACOs

• Starting in 2015, the MEPS MOS will obtain

essential data on the medical organizational characteristics

• The following areas will be addressed in the MEPS-

MOS

► Organizational characteristics, e.g., size, specialties

covered, practice rules and procedures, patient mix and scope of care provided, membership in an ACO, certification as a primary care medical home

► Use of health information technology ► Policies and practices related to the ACA ► Financial arrangements, e.g., reimbursement methods,

number and types of insurance contracts, compensation arrangements within the practice

MEPS–MOS Can Be Used to Study the Effects of Practice Organization Upon:

• Access to care
• Use of different types
• f services.
• Overall medical

expenditures for care.

• Out-of- pocket costs

for care.

• Health status of the

individuals receiving care

Jason M. Sutherland and Michael Furukawa- AHRQ Intramural

• Identify integrated

health systems using commercial datasets.

• Derive performance

indicators of integrated health systems (cost, quality, etc).

• Can be done similarly

for ACOs.

New Directions at AHRQ: Comparative Health System Performance in Accelerating PCOR Dissemination

• Up to $10.5 million per year for 5 years to support up

to three Centers of Excellence on Comparative Health System Performance in dissemination of PCOR

• Develop and implement methods of measuring health

system performance on cost and quality domains, with an emphasis on performance in disseminating PCOR

• Work will seek to understand the characteristics of

high performing systems.

• Currently in peer review. Awards expected Spring

2015

http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-14-011.html

1% 21.4% 5% 49.9% 10% 65.6% 86.4% 25% 97.2% 50%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% U.S. Population Health expenditures Mean expenditures Percentage

$87,570 Top 1% $26,851 Top 10%

$40,876 Top 5% $14,155 Top 25% $7,960 Top 50%

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2010.

Total = 1.263 Trillion

Figure 1. Distribution of health expenditures for the U.S. population by magnitude of expenditure and mean expenditures, 2010

Conclusion

• AHRQ is a federal

research agency

• AHRQ has a center

focused on Delivery Organization, and Markets (recruiting for a new director)

• Look for opportunities

relevant to ACOs at AHRQ

Setting the Stage – Current State of Evidence

Background and Objective of Workgroup

Penny Mohr, MA Workgroup Moderator

Senior Program Officer Improving Healthcare Systems

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‘‘(A) IDENTIFYING RESEARCH PRIORITIES.—The Institute shall identify national priorities for research, taking into account factors of disease incidence, prevalence, and burden in the United States (with emphasis on chronic conditions), gaps in evidence in terms of clinical outcomes, practice variations and health disparities in terms of delivery and

• utcomes of care,……”

Identifying Research Priorities

• - from Patient Protection and Affordable

Care Act

PCORI’s Research Prioritization Process

Prioritized Research Topics Topics Come from multiple sources Gap Confirmation Research Prioritization

(Multi-stakeholder Advisory Panels)

PCORI Website Workshops, Roundtables

• Eliminating non-

comparative questions

• Aggregating

similar questions

• Assessing

Research Gaps

• Preparing Topic

Briefs

1:1 interaction w Stakeholders Guideline Efforts, Evidence Syntheses

IOM 100 AHRQ Future Research Needs

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Post-Prioritization Process: Board Review and Final Disposition of Topic

• From Advisory

Panel Process

• From Staff or

Board with Advisory Panel Input

Prioritized Research Topics Further Topic Assessment and Refinement Landscape Reviews

Topic-specific Workshop Science Oversight Comm & Board Review

Board Approval Final Disposition

Place Topic in a Broad PFA Approve for Targeted PFA Place on PCS* List None of the above

“Fast track”

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*Pragmatic Clinical Study

Evolution of the Topic

1,000+ research topics collected 841 accepted 308 assigned to IHS program

• Program Director screened, consolidated, and rated topics

89 resulted from Program Director screening, and were scored 15 scored highest and selected for Advisory Panel consideration

• Topic briefs commissioned for all 15 topics
• Reviewed and ranked by IHS Advisory Panel – April 19-20, 2013

Link to PCORI Website - Full Description

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PCORI Advisory Panel on IHS

Topic was prioritized by IHS Patient and Stakeholder Advisory Panel in April 2013: Features of Health Insurance Coverage IHS staff worked with panelists and other stakeholders; two subtopics

• f interest arose: Enrollee Support for HDHPs (workgroup yesterday)

and Effects of Accountable Care Organizations IHS staff commissioned updated topic briefs and conducted numerous key informant interviews to produce an initial set of PCOR questions Workgroup participants submitted additional questions, which we used to develop the final list

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Workgroup Objectives: Narrowing the Broad Topic

How do different models of ACOs (e.g., ownership, structural, risk) compare in their ability to improve patient- centered care, e.g., access to appropriate care, improved care coordination, improved care experiences, and health

• utcomes?

Are there patient-centered comparative effectiveness research questions that PCORI should pursue? If so, how would this multi-stakeholder group prioritize these questions in terms of importance?

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Taxonomy of ACOs

Degree of integration Outpatient Inpatient Full spectrum Centralization of ownership Multiple owners Single ownership

Full spectrum integrated Independent Physician Group Physician Group Alliance Independent Hospital Hospital Alliance Full spectrum integrated Adapted from Muhlstein et

• al. A Taxonomy of ACOs.

Leavitt and Partners. June 2014.

ACO Risk Sharing Models

Shared Savings Shared risk and savings, pay for performance for selected performance metrics Bundled payments, case management fee Partial capitation, targeting high-risk chronic disease population Full capitation, population

• based

risk

Adapted from Delbanco et al. Promising Payment Reform: Risk Sharing with ACOs. The Commonwealth Fund. 2011

Advisory Panel Advice

Focus on comparing across different types of ACOs Shared Savings Plan are early in trajectory of risk and not where the market is going

• focus more on shared risk arrangements

Better define what is important about an ACO from the patient’s perspective, and which patient-important outcomes to include Examine the impact of ACOs on managing the high-risk population Look at Medicaid and private ACO market, not Medicare

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PCORI-Funded Studies on ACOs

Relative Patient Benefits of a Hospital-PCMH Collaboration within an ACO to Improve Care Transitions

• Principal Investigator: Jeffrey Schnipper, MD, MPH

Improving Care Coordination for Children with Disabilities Through an Accountable Care Organization

• Principal Investigator: Paula Song, PhD

The Comparative Impact of Patient Activation and Engagement on Improving Patient-Centered Outcomes of Care in Accountable Care Organizations

• Principal Investigator: Stephen Shortell, PhD, MPH, MBA

Caring for the Whole Person: A Patient-Centered Assessment of Integrated Care Models in Vulnerable Populations

• Principal Investigator: Bill Wright, PhD

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Compares two or more options for prevention, diagnosis, or treatment (can include “usual care”) Considers the range of clinical

• utcomes 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

How We Define Comparative Effectiveness

What Research Questions are Within PCORI’s Mandate?

PCORI funds studies that compare the benefits and harms

• f two or more approaches to care.

Cost-effectiveness: PCORI will consider the measurement

• f factors that may differentially affect patients’ adherence to

the alternatives such as out-of-pocket costs, but it cannot fund studies related to cost-effectiveness or the costs of treatments or interventions. Disease processes and causes: PCORI cannot fund studies that focus on risk factors, origins, or mechanisms of disease.

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Examples of Out of Scope Questions

How does local market context influence the formation, structure, and activities of ACOs? How effective have we been in having patients believe that they have an investment in high quality low cost care? How do ACOs perform relative to traditional FFS in terms of encouraging the use of preventive services? If so, what are Medicare ACOs doing to encourage or enable this utilization? What is the impact on patient- centered outcomes?

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How to make a PCOR question

Can the ACO/system accommodate patients using evidence based care? Are ACOs that have adopted a fully integrated medical record across providers better than those that have not at facilitating the uptake of evidence-based care and reducing avoidable hospitalizations, improving patient quality of life, and satisfaction with care?

Comparators Patient-centered Outcomes

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Discussion of Research Gaps

Mark McClellan, MD, PhD

Director of Healthcare Innovation and Value Initiative Brookings Institution

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Commercial ACO Discussion Questions

How do different models of ACOs (e.g., ownership, structural, risk) compare in their ability to improve patient-centered care, e.g., access to appropriate care, improved care coordination, improved care experiences, and health outcomes? Are different models of patient engagement in ACOs better at improving patient-centered

• utcomes than others? Are different models of

patient engagement more effective for different subpopulations (e.g., children versus adults, socioeconomic status)?

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Commercial ACO Discussion Questions

How do different models of distributing risk and shared savings among providers within an ACO (e.g., primary care, secondary care, hospitals) affect practice changes and patient-centered

• utcomes?

What are the most effective mechanisms to communicate CER findings, promote evidence- based care, and affect practice change within an ACO model? What is the impact of this on patient experience with care and patient-centered

• utcomes?

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Commercial ACO Discussion Questions

Which components of ACOs are driving the biggest changes/have the largest impact on improving patient- centered outcomes for high-risk, beneficiaries with chronic disease? Which arrangements for care coordination and care management within ACOs have the largest benefit for long- term (5-year) beneficiary health on high-risk, beneficiaries with chronic disease? What is the comparative effectiveness research of different ACO models in terms of encouraging activation and use of preventive services? What is the impact on patient-centered

• utcomes?

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Commercial ACO Discussion Questions

Which components of ACOs are driving the biggest changes/have the largest impact on improving patient- centered outcomes for high-risk, beneficiaries with chronic disease? Which arrangements for care coordination and care management within ACOs have the largest benefit for long- term (5-year) beneficiary health on high-risk, beneficiaries with chronic disease? What is the comparative effectiveness research of different ACO models in terms of encouraging activation and use of preventive services? What is the impact on patient-centered

• utcomes?

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Tricia McGinnis, MPP, MPH

Director of Delivery System Reform Centers for Health Care Strategies, Inc

Discussion of Research Gaps

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www.chcs.org

PCORI Accountable Care Organization Workgroup January 9, 2015

Tricia McGinnis Vice President, CHCS

Overview of ACOs in Medicaid

A non-profit health policy resource center dedicated to improving services for Americans receiving publicly financed care

► Priorities: (1) enhancing access to coverage and services; (2) advancing

quality and delivery system reform; (3) integrating care for people with complex needs; and (4) building Medicaid leadership and capacity.

► Provides: technical assistance for stakeholders of publicly financed care,

including states, health plans, providers, and consumer groups; and informs federal and state policymakers regarding payment and delivery system improvement.

► Funding: philanthropy and the U.S. Department of Health and Human

Services.

► Medicaid ACO Learning Collaborative: Participating states include CO,

MA, ME, MN, NY, OR, WA and VT

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Medicaid ACOs: A National Perspective

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Medicaid ACO Organization Structures Vary

Provider-Driven ACOs

• Providers establish

collaborative networks

• Provider network

assumes some level of financial risk

• Providers oversee patient

stratification and care management

• State or MCO pays

claims

• STATES: Maine,

Minnesota, Vermont MCO-Driven ACOs

• MCOs assume greater

role supporting patient care management

• MCOs retain financial risk

but implement new payment models

• Providers partner with the

MCO to improve patient

• utcomes
• STATES: Oregon

Regional/Community Partnership ACOs

• Community orgs partner

to develop care teams and manage patients

• Regional/community org

receives payment, shares in savings

• Providers partner with

regional/community orgs and form part of the care team

• MCOs/states retain

financial risk

• STATES: Colorado, New

Jersey

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Key Observations from State Approaches

• Most payment arrangements based on MSSP

► Many Medicaid shared savings approaches offer multiple

“tracks” or options

► No state requires downside risk in its shared saving

program’s first year

► Oregon uses global payments for its CCOs

• Quality metrics reflect priorities for Medicaid

populations

• Most states will hold ACOs accountable for

behavioral health services, with other services added in the future

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Medicaid ACO Program Results to Date

• Colorado Accountable Care Collaborative:

► Estimated $29-33 million in net savings over three years,

associated with 600,000 beneficiaries

• Minnesota Integrated Health Partnerships:

► $10.5 million year over year cost savings associated with

100,000 beneficiaries

► Three out of six ACOs eligible for shared savings payments

• Oregon Coordinated Care Organizations:

► ED visits declined 17% in two years ► Decreased hospitalizations: 27% for CHF, 32% for COPD,

and 18% for adult asthma

Sources: Accountable Care Collaborative Annual Report 2014. https://www.colorado.gov/pacific/hcpf/accountable-care-collaborative MN: http://mn.gov/governor/newsroom/pressreleasedetail.jsp?id=102-136054 OR:http://www.oregon.gov/oha/Metrics/Documents/2013%20Performance%20Report%20Executive%2 0Summary.pdf

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Examples of Quality Metrics for Medicaid ACOs

Oregon Minnesota

• Screening for depression and follow-up plan
• Depression remission at six months
• Timeliness of prenatal care
• Pneumonia appropriate care measure
• Elective delivery
• Heart failure appropriate care measure
• Outpatient and ED utilization
• Optimal asthma care composite (kids)
• Colorectal screening
• Optimal asthma care composite (adults)
• PCMH enrollment
• Home management asthma care plan
• Developmental screening for 1st 36 months of

life

• Optimal vascular care composite
• Adolescent well-care visits
• Optimal diabetes composite
• Controlling high blood pressure
• CG-CAHPS
• Diabetes: HBa1c poor control
• HCAHPS
• Alcohol or other substance abuse (SBIRT)
• Follow-up after hospitalization for mental

illness

• CAHPS access to care composite (adults &

kids)

• CAHPS satisfaction with care composite

(adults & kids)

• EHR adoption
• Mental and physical health assessment within

60 days for children in DHS 58

Visit CHCS.org to…

• Download practical resources to improve the quality and

cost-effectiveness of Medicaid services

• Subscribe to CHCS e-mail updates to learn about new

programs and resources

• Learn about cutting-edge efforts to transform the way

Medicaid delivers and pays for care

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www.chcs.org

Setting the Stage

Why this is an important area that needs research (what makes this compelling) Why this is an issue where PCORI can play a unique role- compared with other groups funding research in this area (what makes this a particularly patient centered question?) What are some of the key questions that PCORI research might address?

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Medicaid ACO Discussion Questions

How well have Medicaid ACOs performed on patient- centered outcomes relative to Medicaid Managed Care? Are Medicaid ACOs more effective than traditional Medicaid Managed Care in reducing health disparities? What are the best mechanisms to integrate traditional carve-out services into Medicaid ACOs to improve patient-centered outcomes?

• Long-term services and support
• Behavioral and mental health
• Social services

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BREAK

10:15 – 10:30 a.m.

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Penny Mohr, MA

Senior Program Officer Improving Healthcare Systems

Introduction to Breakout Sessions

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Questions Grouped Into Four Topic Areas

ACO Structures and Risk Sharing Arrangements

• Location: Main event room
• Facilitator: Stephen Shortell
• Scribe: Kaitlin Hayes
• Rapporteur: John Martin

Patient and Provider Activation

• Location: Conference Room P

(4th Floor)

• Facilitator: Joel Weissman
• Scribe: Michelle Johnston-

Fleece

• Rapporteur: David Bruhn

Delivery Services

• Location: Conference Room M
• Facilitator: Lewis Sandy
• Scribe: Beth Kosiak
• Rapporteur: Kurt Wrobel

Medicaid

• Location: Conference Room O
• (4th Floor)
• Facilitator: Tricia McGinnis
• Scribe: Lauren Azar
• Rapporteur: Lisa Angus

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Key Questions to Answer

Describe ACO models and/or components to compare Why or why not are the questions particularly well suited for PCORI to fund? What specific questions would you recommend PCORI target? If you have developed more than one question – which

• f these is the most compelling and why?

What are the challenges raised in conducting research

• n these questions, and how might those challenges

be addressed?

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For each question

Clearly describe the comparators What populations should be targeted? Which patient-centered outcomes should be examined?

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Collaborative Workgroup Discussion

Focus: Provide targeted input without scientific jargon Participate: Encourage exchange of ideas among diverse perspectives that are present today:

• Researchers
• Patients
• Other stakeholders

Be respectful: Disagree with ideas, not people

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Webinar participants are invited to submit questions via: Email: info@pcori.org Twitter: #PCORI Website: http://www.pcori.org/events/2015/understanding- impact-accountable-care-organizations-patient- centered-outcomes-workgroup

Additional Questions

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BREAKOUT SESSIONS

10:30 a.m.– 12:30 p.m.

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LUNCH

12:30 – 1:30 p.m.

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Moderated by Penny Mohr, MA

Senior Program Officer Improving Healthcare Systems

Report Back from Breakout Sessions

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Breakout Group 1: ACO Structures and Risk Sharing Arrangements

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Breakout Group 2: Patient and Provider Activation

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Breakout Group 3: Delivery Services

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Breakout Group 4: Medicaid

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BREAK

3:30 – 3:45 p.m.

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Moderated by Penny Mohr, MA

Senior Program Officer Improving Healthcare Systems

Priority Research Questions for PCORI and Justification

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Priority Questions

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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

• ngoing research.

Likelihood of Implementation in Practice: Would new information generated by research be likely to have an impact in practice? (e.g. do

• ne 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?

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Voting Sheet

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

Are different models of patient engagement in ACOs better at improving patient-centered outcomes than others? Are different models of patient engagement more effective for different subpopulations (e.g., children versus adults, socioeconomic status)? 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.

Given your consideration of all CER questions, which one would you recommend that PCORI should pursue and why?

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Steven Clauser, PhD, MPA

Program Director, Improving Healthcare Systems

Closing Remarks

Bryan Luce, PhD, MS, MBA

Chief Science Officer, Office of the Chief Science Officer

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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 23rd, 2015 via email (info@pcori.org) We will take all feedback into consideration.

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Thank You for Your Participation

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