Research on Health Costs, Quality and Outcomes (HCQO)
Performance Budget Submission for Congressional Justification, Fiscal
AHRQ requests $267,664,000 for Research on Health Costs, Quality and Outcomes (HCQO) at the FY 2009 Estimate level—a decrease of $8,900,000 from the FY 2008 Enacted 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. For additional details related to these priorities, select Research on Health Costs, Quality, and Outcomes.
- Comparative Effectiveness. The FY 2009 Request includes $30,000,000 for comparative effectiveness research, the same level of support as the FY 2008 Enacted level. The goal of this research priority is to provide high-quality research to help everyone, including patients, health care providers (including nurses, doctors and other clinicians), and policymakers to make the best health decisions. One of the greatest challenges is finding reliable and practical data that can inform these decisions. The Comparative Effectiveness priority is dedicated to fulfilling this need through high-quality research and getting that information to you, someone who needs to make health care decisions.
- Prevention and Care Management. The FY 2009 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 2009 Request includes $9,730,000 for Value Research, an increase of $6,000,000 from the FY 2008 President's Budget. The Value Research priority includes research related to the Value-driven Healthcare Initiative and a new Initiative—the Health Insurance Decision Tool. Support for the Value-driven Healthcare Initiative is maintained at $3,730,000 in FY 2009. The FY 2009 Request includes $6,000,000 for the Health Insurance Decision Tool. This new initiative provides an integrated set of decision tools to assist States in the development of innovative programs which are consistent with the President's goal to provide access to basic health insurance at an affordable price.
Other Quality, Effectiveness and Efficiency Research. The FY 2009 Request includes $143,959,000 for Other Quality, Effectiveness and Efficiency Research, a net decrease of $12,841,000 from the FY 2008 Enacted level. Overall, decreases of $15,163,000 include the following: $7,277,000 reduction in research and training grants related to AHRQ's three strategic plan goals, $5,000,000 drop in funding for research related to methicillin-resistant staphylococcus aureus and related infections (MRSA), and $2,886,000 in research contracts and IAAs. The FY 2009 Estimate does provide for two increases: $1,042,000 in pay raise costs for AHRQ staff, and $1,280,000 in required increases for research management costs including rent increases, funds for the Unified Financial Management System (UFMS), and data costs.
AHRQ's research related to quality, effectiveness and efficiency touches on nearly every aspect of health care, including the research management costs that support the overall direction of AHRQ. AHRQ supports research grants, contracts and IAAs related to:
- Effectiveness research—Assure that providers and consumers/patients use beneficial and timely health care information to make informed decisions/choices.
- Efficiency Research—Achieve wider access to effective health care services and reduce health care costs.
- Quality Research—Reduce the risk of harm from health care services by promoting the delivery of appropriate care that achieves the best quality outcome.
- Health Information Technology (Health IT). The FY 2009 Request includes $44,820,000 for Health Information Technology (Health IT) research, the same level of support as the FY 2008 Enacted level. In FY 2009, $7,477,000 in grants related to the Ambulatory Patient Safety Program will end. AHRQ will re-invest these funds in new Health IT grants to support the next phase of the Ambulatory Patient Safety Program. AHRQ's research on health information technology (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. The AHRQ initiative includes more than $166 million in grants and contracts in 41 states to support and stimulate investment in health IT, especially in rural and underserved areas. Through these and other projects, AHRQ and its partners will 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 2009 Request includes $32,055,000 for Patient Safety research, a decrease of $2,059,000 from the FY 2008 Enacted level. A total of $25,055,000 (-$2,059,000 from the prior year) is provided for research related to patient safety threats and medical errors and $7,000,000 (+$0 from the prior year) is provided for 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.
Medical Expenditure Panel Survey (MEPS)
The FY 2009 Request for the MEPS totals $55,300,000 in PHS evaluation funds, maintaining the FY 2008 President's Budget level. The MEPS Household component of the survey is supported at $35,700,000, the Medical Provider component totals $10,400,000 and the insurance component is supported at $9,200,000.
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, micro data 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. In addition, the MEPS establishment surveys have been coordinated with the National Compensation Survey conducted by the Bureau of Labor Statistics through participation in the Inter-Departmental Work Group on Establishment Health Insurance Surveys.
For details, select Medical Expenditure Panel Survey.
Program Support (PS)
The FY 2009 Request for the Program Support totals $2,700,000, the same level of support as the prior year. AHRQ will continue to strive for green in all Presidential Management Agenda areas. In FY 2009, 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 UFMS (Improve Financial Management).
- Fully meet milestones established for E-gov green status for FY 2009 (Information Technology and E-Gov).
- Maintain "green" status on the Program Improvement initiative.
This budget activity supports the overall direction and management of the AHRQ. Five major government-wide initiatives comprise the President's Management Agenda: Strategic Management of Human Capital; Competitive Sourcing; Improved Financial Performance; Expanded E-Government; and Performance Improvement Initiative. For each of these initiatives, the Office of Management and Budget (OMB) prepares a scorecard consisting of "green, yellow, and red lights" reflecting Departmental status and progress in meeting the standards for success for an individual initiative. In shorthand terms, the standards for success are collectively known as "Getting to Green". AHRQ has instituted a systematic approach to addressing and implementing the President's Management Agenda by working to achieve the goals set forth by HHS as part of its internal Scorecard process.
For details, select Program Support.