Research on Health Costs, Quality and Outcomes (HCQO)
Budget Estimates for Appropriations Committees, Fiscal Year 2010
AHRQ requests $314,053,000 for Research on Health Costs, Quality, and Outcomes (HCQO) at the FY 2010 President's Budget Request level, maintaining the FY 2009 Omnibus level. These funds are being financed using PHS Evaluation Funds.
Within the HCQO budget activity, AHRQ supports research related to six research priorities. A summary of each research priority is provided below. For additional details related to these priorities, select Research on Health Costs, Quality, and Outcomes.
- Comparative Effectiveness. The FY 2010 President's Budget Request includes $50,000,000 for comparative effectiveness research, the same level of support as the FY 2009 Omnibus level. Comparative effectiveness research improves health care quality by providing patients and physicians with state-of-the-science information on which medical treatments work best for a given condition.
- Prevention and Care Management. The FY 2010 President's Budget Request includes $7,100,000 for research related to prevention and care management. This request maintains the level of support provided the prior year. This research priority focuses on two areas: translating evidence-based knowledge into current recommendations for clinical preventive services that are implemented as part of routine clinical practice to improve the health of all Americans; and research to improve care and reduce disparities for common chronic conditions like diabetes, asthma, and heart disease.
- Value Research. The FY 2010 President's Budget Request includes $3,730,000 for Value Research, maintaining the FY 2009 Omnibus level. Value research focuses on finding a way to achieve greater value in health care—reducing unnecessary costs and waste while maintaining or improving quality. AHRQ's Value portfolio aims to meet this need by producing the measures, data, tools, evidence, and strategies that health care organizations, systems, insurers, purchasers, and policymakers need to improve the value and affordability of health care. The aim is to create a high-value system, in which providers produce greater value, consumers and payers choose value, and the payment system rewards value.
- Health Information Technology (Health IT). The FY 2010 President's Budget level for health IT research is $44,820,000, the same level of support as the FY 2009 Omnibus level. AHRQ's research on health IT is a key element to the Nation's 10-year strategy to bring health care into the 21st century by advancing the use of information technology. Established in 2004, the purpose of the Health IT portfolio at AHRQ is to develop and disseminate evidence and evidence-based tools to inform policy and practice on how health IT can improve the quality of American health care. Through grants and contracts, AHRQ and its partners identify challenges to health IT adoption and use, solutions, and best practices for making health IT work, and tools that will help hospitals and clinicians successfully incorporate new IT.
Patient Safety Research. The FY 2010 President's Budget Request includes $48,889,000 for Patient Safety research, maintaining the FY 2009 Omnibus level. A total of $41,889,000 is provided for research related to patient safety threats and medical errors, of which $17,304,000 is for research on health care-associated infections. An additional $7,000,000 will continue to support research related to the Patient Safety and Quality Improvement Act of 2005 and patient safety organizations (PSOs).
AHRQ's patient safety research priority is aimed at identifying risks and hazards that lead to medical errors and finding ways to prevent patient injury associated with delivery of health care. AHRQ supports research that provides information on the scope and impact of medical errors, identifies the root causes of threats to patient safety, and examines effective ways to make system-level changes to help prevent errors. Dissemination and translation of these research findings and methods to reduce errors is also critical to improving the safety and quality of health care. To make changes at the system level, there also must be an environment, or culture, within health care settings that encourages health professionals to share information about medical errors and ways to prevent them.
- Crosscutting Activities Related to Quality, Effectiveness, and Efficiency Research. The FY 2010 President's Budget Request level provides $159,514,000 for Crosscutting Activities Related to Quality, Effectiveness and Efficiency research, the same level of funding as the prior year. Crosscutting Activities includes a variety of research projects that support all of our research portfolios. These activities include data collection and measurement, dissemination, rapid cycle research, training, research management and salary costs, and intramural and extramural research sponsored by multiple portfolios. There are two changes within this portfolio that provide a net change of $0:
- The FY 2010 President's Budget Request provides for the following increases: $1,872,000 for pay raise costs for AHRQ as a whole and $606,000 for research management increases within AHRQ's budget, including rent increases, travel, printing, and data costs.
- These increases are offset by a reduction of $2,478,000 (52 small investigator-initiated research grants with an average cost of $50,000) in total research grants funds for HCQO: Crosscutting Activities Related to Quality, Effectiveness and Efficiency from the FY 2009 level of $39,602,000. The FY 2010 President's Budget Request will fund $6,421,000 in new investigator-initiated research grants, for a total of $23,551,000 in investigator-initiated research. This is a decrease of $2,478,000 from the FY 2009 funding level of $26,029,000 for investigator-initiated research grants.
The FY 2010 President's Budget Request for the MEPS totals $55,300,000 in PHS evaluation funds, maintaining the FY 2009 Omnibus level. The funding allocation in FY 2010 for the three core MEPS Component Surveys follows: MEPS Household Component ($33,300,000); MEPS Medical Provider Component ($12,000,000); and the MEPS Insurance Component ($10,000,000).
The Medical Expenditure Panel Survey (MEPS), first funded in 1995, is the only national source for annual data on how Americans use and pay for medical care. It supports all of AHRQ's research related strategic goal areas. The survey collects detailed information from families on access, use, expense, insurance coverage and quality. Data are disseminated to the public through printed and Web-based tabulations, microdata files and research reports/journal articles.
The data from the MEPS have become a linchpin for the public and private economic models projecting health care expenditures and utilization. This level of detail enables public and private sector economic models to develop national and regional estimates of the impact of changes in financing, coverage, and reimbursement policy, as well as estimates of who benefits and who bears the cost of a change in policy. No other surveys provide the foundation for estimating the impact of changes on different economic groups or special populations of interest, such as the poor, elderly, veterans, the uninsured, or racial/ethnic groups. Government and non-governmental entities rely upon these data to evaluate health reform policies, the effect of tax code changes on health expenditures and tax revenue, and proposed changes in government health programs such as Medicare. In the private sector (e.g., RAND, Heritage Foundation, Lewin-VHI, and the Urban Institute), these data are used by many private businesses, foundations, and academic institutions to develop economic projections. These data represent a major resource for the health services research community at large. Since 2000, data on premium costs from the MEPS Insurance Component have been used by the Bureau of Economic Analysis to produce estimates of the GDP for the Nation.
Because of the need for timely data, performance goals for MEPS have focused on providing data in a timely manner. The MEPS program has met or exceeded all of its data timeliness goals.
For details, select Medical Expenditure Panel Survey.
The FY 2010 President's Budget Request for Program Support totals $2,700,000, the same level of support as the prior year. In FY 2010, AHRQ will:
- Fully implement the Departmental Learning Management System (LMS) for training and development needs (Strategic Management of Human Capital).
- Complete updating of all internal controls following AHRQ's conversion to HCAS (Improve Financial Management).
This budget activity supports the overall direction and management of the AHRQ.
For details, select Program Support.