What should SGIM members know about the 2019 Health Services and Primary Care Research Study?

In 2018, Congress directed the Agency for Healthcare Research and Quality (AHRQ) to perform a study of the breadth, scope, and impact of health services research (HSR) and primary care research (PCR) supported by the U.S. Department of Health and Human Services (DHHS) and the Department of Veterans Affairs (VA) since 2012.¹ The study was performed by the RAND Corporation, which interviewed stakeholders, assembled two panels of leaders in HSR and PCR, and analyzed the federal portfolio of funded HSR and PCR.² The analysis included projects funded by AHRQ, the Administration for Community Living (ACL), the Office of the Assistant Secretary for Planning and Evaluation (ASPE), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and the VA. The most important findings are as follows:

1. Federal portfolios in HSR and PCR have distinct foci that reflect differing requirements of their congressional authorizations and missions. AHRQ has a unique focus on system-based outcomes and implementation of improvements across health care settings, and emphasizes patient safety, health information technology, and evidence synthesis. ACL concentrates on needs of community-living elderly and disabled people, with an emphasis on social factors. The CDC funds HSR and PCR focused on prevention and health promotion in community and health care settings. CMS supports HSR and PCR on needs of Medicare and Medicaid beneficiaries with an emphasis on cost, utilization, and financing of care. The VA focuses on needs of veterans. Last, but not least, the NIH supports HSR and PCR focused on specific diseases, body systems, or populations.
2. When agencies fund HSR and PCR on similar topics, the overlap is generally complementary, addressing different aspects of the topic. Nevertheless, the RAND team identified a need for more proactive coordination of the agencies’ HSR and PCR portfolios.
3. Federally funded HSR and PCR have had significant impact in advancing science, improving patient outcomes, improving professional knowledge and practice, improving health care systems and services, influencing health policy, and addressing societal issues. The RAND team also noted barriers to determining the full impact of the HSR and PCR.
4. The analysis revealed cross-cutting gaps in federally funded HSR and PCR, including needs to: examine outcomes for a full range of populations and settings; follow changes in implementation and outcomes over time; communicate results that are actionable; produce timely results for improving health care delivery; use theory to advance knowledge; and leverage digital health and link new sources of data.
5. The report also called attention to specific gaps in both HSR and PCR on: healthcare workforce issues; burdens of health information technology on health care providers; the role of health care systems in addressing social determinants of health; effects of social factors on demand for care; integration of patient preferences into care; need to address misinformation about health issues; development of harmonized measures to assess quality of care; identification of root causes and solutions for overcoming barriers to health care access; and costs of new care therapies and delivery models. In addition, more HSR is needed on effects of evolving models of financing on outcomes in different populations, and ways to reduce costs and disparities across the health care system, while more PCR is needed to examine the core functions of primary care, and transform the role of primary care in the health care system, including its role in reducing disparities.

Based on these findings, the RAND team made numerous recommendations to improve the relevance and timeliness of HSR and PCR, encourage innovation in HSR and PCR, and improve translation of HSR and PCR into practice. To strengthen the impact of HSR and PCR, they recommended that federal agencies identify HSR and PCR priorities to more effectively allocate funding, proactively identify potential overlap in portfolios, maintain AHRQ as an independent agency serving as a hub of federal HSR, and fund an entity to serve as a hub for federal PCR.

What is SGIM doing to advocate for federal funding of HSR and PCR?

Our Health Policy Committee (HPC) has had a long-standing commitment to advocating for “support of research consistent with the objectives of SGIM and for the types of research done by SGIM members.”³ For many years, the HPC has focused a lot of attention on HSR, with an implied but not explicitly stated commitment to PCR. The HPC’s priorities for 2020-21 include active advocacy for the highest possible funding and a supportive policy environment for the National Institute for Minority Health and Health Disparities and for the NIH Clinical and Translational Science Awards, as well as coalition advocacy for the highest possible funding for HSR and PCR at AHRQ, NIH, VA, and the Patient Centered Outcomes Research Institute. The HPC’s current priorities also emphasize the need for funding of research on healthcare disparities by AHRQ, CMS, CDC, and other relevant agencies, and the need for policies that allow members to conduct high quality research unencumbered by inappropriate restrictions.

In the past year, we have weighed in on many issues related to HSR and PCR. For example, we submitted a letter to Congress calling for increased funding of AHRQ to help generate the data needed to develop informed policies on telehealth flexibilities that the government should make permanent. We also submitted a letter to DHHS and CMS urging continuation and refinement of policies to facilitate use of telehealth, with a call for a data-driven approach to define and value telehealth services. We collaborated with the American College of Physicians on a letter to the Physician-Focused Payment Model Technical Advisory Committee, which included a call for more robust access to claims data from CMS to help develop more targeted evidence-based performance metrics and new payment models. We also have continued to urge the U.S. House and Senate to appropriate increased funding for research by AHRQ, NIH, and VA, and we have called for federal policies to be guided by science.

I believe the RAND report should help stimulate further advocacy for funding and policies that will help address the gaps in federal support of HSR and PCR. Although SGIM has consistently been a strong advocate for HSR, the report reminds us that we also need to strongly support PCR. To that end, I’m pleased to report that SGIM President Jean Kutner participated in a virtual Capitol Hill briefing about the need to invest in PCR. She explained the need for PCR and the differences between PCR and HSR, and she provided examples of PCR. We see this as a great opportunity to continue advocating for the research needed to achieve our vision for a just system of care in which all people can achieve optimal health.