Recently, Congress passed a short-term continuing resolution (H.R. 4378) to fund the government through November 21 and included an important extension for the Patient-Centered Outcomes Research Institute (PCORI). That is the independent, non-profit organization whose mission is to provide patients and providers with valuable information so they can make better-informed decisions that improve health outcomes.
However, Congress failed to extend PCORI's funding mechanisms in this extension. Without further congressional action, this puts PCORI's ability to support new clinical research with FY2020 funds in serious jeopardy. That is why we are urging Congress to act on bipartisan efforts in both the House and the Senate to provide a full, long-term reauthorization of PCORI and its funding streams.
Our nation's health research enterprise is the envy of the world. Studies supported by the National Institutes of Health and other Health and Human Services agencies, our academic medical centers, private foundations, and the life sciences sector have led to clinical advances that have improved the lives of millions of Americans.
Despite these achievements, some experts believe that less than half of the medical care provided in the U.S. is based on adequate evidence of effectiveness. If this is even partially accurate, it would suggest that our country is significantly overutilizing medical services that are not necessarily improving the quality of care but still adding to the overall cost of care.
Unfortunately, far too often, the evidence for the real-world effectiveness of many medical procedures is incomplete or unavailable, in part due to a chronic underinvestment in the field of health services research. In a consumer-driven healthcare world, patients and their providers need more information about what treatments are effective. That's why the work of PCORI is so important because it helps fill this gap and thus should be reauthorized by Congress.
PCORI was created with bipartisan congressional support in 2010. It funds and disseminates clinical comparative effectiveness research, or CER, studies that compare healthcare options to learn which works best given a patient's circumstances and preferences. PCORI's research is unique among funders. It requires that patients and other stakeholders be engaged in the studies it supports from the start and remain involved all the way through the dissemination of results. This makes it more likely that PCORI-funded studies will get the research questions right and that the results will be placed into clinical practice more quickly.
Not getting the proper return on our healthcare investments is costly -- nearly one out of every five dollars spent in the U.S. is on healthcare. But this is not just about the dollars spent on drugs, procedures, and technological innovations, it is about the value of the dollars expended and the patients who deserve access to evidence-based treatments.
Today, we see a growing number of examples of PCORI-funded projects producing results that can address some of the challenges our healthcare system faces. Here are just two discussed at a recent forum at the Bipartisan Policy Center.
One project seeks to make broader use of a simple decision-making tool found to help people who go to the ER with chest pains but are at low risk of a serious heart problem. It allows physicians and patients to make more informed choices about whether these patients should be admitted for further tests or go home and return for outpatient follow-up. Using this tool cut hospital admission rates within 30 days, with no change in patients' health outcomes. If this tool was offered to all Americans in a similar situation, up to 1.4 million might safely choose outpatient follow-up, meaning 800,000 fewer heart tests and up to $4.8 billion in nationwide savings over five years.
A second project is working with insurers to implement a model for predicting who will benefit most from a lifestyle program to keep the estimated 84 million Americans at risk for type 2 diabetes from developing the condition. One insurer already has identified nearly 100 people through timely screening and is working with them and their doctors on ways to stay healthy. That not only helps these patients but saves the insurer $3,500 per person for each year that diabetes is delayed. The project's goal is to improve care for one million people with type 2 diabetes by 2021.
PCORI-funded studies are producing results that promise to help patients make better-informed treatment decisions that are right for them. They also reduce the burden that many major health conditions, such as cancer, heart disease, opioid abuse, obesity, and arthritis impose on patients, their families, and the healthcare system. In a growing number of cases, that includes cost savings for patients and insurers.
By reauthorizing the Patient-Centered Outcomes Research Trust Fund, Congress has an opportunity to reaffirm its support for patient-centered care. In the interim and in the event of another short-term continuing resolution, it is imperative that Congress not only extend PCORI but also continue its funding mechanisms. Simply taking into account the success of the PCORI-funded projects mentioned above, it is clear that the Trust Fund's $630 million annual budget is a small price to pay to improve quality of care for patients and reduce excess costs in our nation's $3.6-trillion health economy. It is the right thing to do.
G. William "Bill" Hoagland is senior vice president and Anand Parekh, MD, is chief medical advisor at the Bipartisan Policy Center, a non-profit organization that combines the best ideas from both parties to promote health, security, and opportunity for all Americans.