…and how it affects patients and employers?
Two significant drivers of escalating healthcare costs are a lack of knowledge about the cost of medical services and low levels of patient engagement in their healthcare decisions. However, thanks to healthcare consumerism, this is starting to change.
Healthcare consumerism is a movement to improve the quality of healthcare services while making delivery more efficient and cost-effective. It aims to accomplish this by putting purchasing power and decision-making in the hands of consumers. Agencies that provide resources to help patients become more involved in their healthcare decisions support this movement. The Patient-Centered Outcomes Research Institute (PCORI) is one of these organizations.
PCORI is a nonprofit research group that funds studies to help healthcare consumers make better-informed healthcare choices. Its primary goal is to ensure that consumers have the information they need to make decisions that reflect their desired health outcomes. PCORI works to achieve this goal by:
- Funding research guided by patients, caregivers, and the broader healthcare community
- Producing and promoting evidence-based information based on the research PCORI supports
- Working to improve healthcare delivery and outcomes
- Helping people make informed healthcare decisions
PCORI sees the funded researchers, patients, and other healthcare stakeholders as equitable partners rather than research subjects. Involved patients, caregivers, clinicians, and other healthcare stakeholders are vital for producing the most valuable research results. Engagement starts with initial planning, conducting a study, and disseminating the final results.
Programs and Priorities
PCORI’s research priorities, outlined in the organization’s National Priorities for Research, focus on five key areas:
- Assessing prevention, diagnosis, and treatment options
- Improving healthcare systems
- Communicating and disseminating research results
- Addressing disparities in prevention, diagnosis, and treatment effectiveness
- Accelerating methodological research in patient-centered outcomes
The organization’s programs that address these priorities include:
Clinical Effectiveness and Decision Science (CEDS)
To make good healthcare decisions, patients need access to reliable information about the potential benefits and harms of treatments and protocols recommended by healthcare providers. CEDS aims to fill gaps in clinical knowledge by producing valid evidence to compare the effectiveness of different treatment options.
Healthcare Delivery and Disparities Research (HDDR)
HDDR addresses two of PCORI’s five national research priorities for research improving healthcare systems and addressing disparities. The program compares patient-centered approaches to improve healthcare effectiveness and efficiency in providing equal access to care.
Evaluation and Analysis (E&A)
PCORI is committed to studying the importance of internal evaluation and analysis. E&A’s goal is to ensure continuous improvement in the quality, efficiency, and effectiveness of PCORI’s work through:
- Assessing the impact of PCORI’s work
- Understanding what PCORI funds
- Informing PCORI process improvement
- Building evidence for the science of engagement
Engagement brings together all the various healthcare stakeholders to help set research priorities and evaluate applications. Its primary goal is to ensure the receipt of continual PCORI funds and use them to conduct relevant research.
This program spearheads the creation of a national network, PCORnet, to foster clinical effectiveness research studies. Results will support the development of faster, more cost-effective research methods to improve healthcare and healthcare delivery.
Funding and Research
As a nonprofit organization, PCORI depends on outside funding. The Affordable Care Act initially required Insurance companies that offered certain types of healthcare plans and employers with specific self-insured plans to pay a fee to the nonprofit. PCORI’s charter under the ACA expired in September 2019. Congress voted to reauthorize PCORI funding for ten more years.
The fee calculation comes from the average number of lives covered under the policy or plan and the ending date for the plan year. Entities determine the amount due by multiplying their average number of plan lives by an amount set by Health and Human Services. The annual fee is due on the July 31 following end of the plan year.. Form 720, or Quarterly Federal Excise Tax Returns, will reflect those calculations.
The IRS announces new PCORI fees every year. For plans ending on or after October 1, 2022, but before October 1, 2023, the rate is $3.00.
PCORI has provided $2.8 billion in cumulative funding commitments as of FY2020.
One indication of the quality of PCORI’s work is the growing number of funded research studies summarized in leading medical journals and presented at major scientific meetings.
For example, a recent PCORI-funded study focused on reducing hospital errors through improved communications between staff and the patient’s family. Another PCORI-funded study examined how chronic pain disproportionately affects less educated, low-income patients.