Effects of Accountable Care Organizations on Patient-Centered Outcomes

Workgroup Meeting

January 9, 2015

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Steven Clauser, PhD, MPAProgram Director, Improving Healthcare Systems

Welcome and Introductions

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Question for this Working Group

Are there patient-centered comparative clinical effectiveness research questions on the impact of Accountable Care Organizations on patient-centered outcomes that PCORI should support?

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AgendaTime Agenda Item Speaker(s)8:30 – 8:45 AM Welcome and Introductions Steve Clauser, PCORI

8:45 – 9:05 AM Setting the Stage Steve Clauser, PCORIRobert Kaplan, AHRQ

9:05 – 9:15 AM Background and Objectives of Work Group Penny Mohr, PCORI

9:15 – 10:15 AM Discussion of Research Gaps: Why now and what are the important questions?

Mark McClellan, the Brookings InstitutionTricia McGinnis, Center for Healthcare Strategies

10:15 – 10:30 AM Break N/A

10:30 – 12:30 PM Breakout sessions – Discussion and ranking of PCOR questions

N/A

12:30 – 1:30 PM Lunch N/A

1:30 – 3:00 PM Plenary session: Report back and discussion of prioritized PCOR questions

Penny Mohr, PCORI

3:00 – 3:15 PM Break N/A

3:15 – 4:15 PM Priority Questions for PCORI and Justification Penny Mohr, PCORI

4:15 – 4:30 Closing Remarks Steve Clauser, PCORIBryan Luce, PCORI

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Housekeeping

Session is being webcast live and recorded; please use microphones when speaking and turn off your microphone when you are done

Webinar participants can provide input via e-mail (info@pcori.org); via Twitter (#PCORI); or the webinar “chat” feature.

Please submit questions as they occur to you. We will collect and synthesize these for inclusion in the meeting summary.

We welcome additional input through January 23, 2015 at 5:00 pm ET via e-mail info@pcori.org

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How PCORI Manages the Potential for Conflict of Interest

The researchers, patients, and other stakeholders who have been invited to this workgroup will be involved in the process of determining the specific subject areas that we should address in the PFA.

The broader community of researchers, patients, and other stakeholders who are participating by web, twitter and chat can be involved as well.

Participants in this workgroup are eligible to apply for funding if PCORI decides to produce a funding announcement.

Input received during the workgroup deliberations will be broadcast via webinar, and the webinar will be archived and made available to other researchers, patients, and stakeholders via the PCORI website.

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Webinar/teleconference and archiving this workshop

This workshop is advisory!

PCORI’s interest in collaborative funding of research

Reminders

Setting the Stage –Current State of Evidence

Setting the Stage

Steven Clauser, PhD, MPA Program Director, Improving Healthcare Systems

Robert Kaplan, PhDChief Science OfficerAgency for Health Care Research and Quality

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“The purpose of the Institute is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis...and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services...”

PCORI’s Mandate

-- from Patient Protection and Affordable Care Act

Compares two or more options for prevention, diagnosis, or treatment (can include “usual care”)

Considers the range of clinical outcomes relevant to patients

Conducted in real-world populations and real-world settings

Attends to differences in effectiveness and preferences across patient subgroups

Often requires randomized trial design

How We Define Comparative Effectiveness

Funding Exclusions: Cost-Effectiveness Analysis (CEA)

Examples of CEA

Research that conducts a formal CEA in the form of dollar-cost per quality-adjusted life-year (including non-adjusted life-years) to compare two or more alternatives Research that compares the relative costs

of care between two or more alternative approaches as the primary criterion for choosing the preferred alternative

Based on PCORI’s authorizing legislation, PCORI is not permitted to fund studies of CEA.

NOTE: PCORI does fund studies that explore the burden of costs on patients—for example, out-of-pocket costs.

Patient-Centered Outcomes Research (PCOR) helps people and their caregivers communicate and make better-informed healthcare decisions. PCOR:

Actively engages patients and key stakeholders throughout the research processCompares important clinical management options.Evaluates the outcomes that are the most important to patients.Addresses implementation of findings in clinical care environments.

What is PCOR?

PCORI’s National Priorities for Research

Assessment of Prevention,

Diagnosis, and Treatment Options

Improving Healthcare Systems

Communication & Dissemination

Research

Addressing Disparities

Accelerating PCOR and Methodological

Research

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IHS Goal Statement

To support studies of the comparative effectiveness of alternate features of healthcare systems that will provide information of value to patients, their caregivers and clinicians, as well as to healthcare leaders, regarding which features of systems lead to better patient-centered outcomes.

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Distinctive Components of IHS Studies

Adapt PCOR model for CER beyond clinical treatment options to different levels of the healthcare system;

Require inclusion of well articulated and valid comparators, for both trials and studies using observational data;

Focus on outcomes relevant to patients;

Active involvement of patients and other stakeholders throughout the entire research process;

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PCORI Community

Patients/ Consumers Caregivers

Family Members

Clinicians

Patient Advocacy

Orgs

Hospital/ Health SystemTraining

Institution

Policy Maker

Industry

Payer

Purchaser

PCORI Relies on Engagement in Setting its Research Agenda, Conducting Research and Disseminating Findings

PCORI Collaborates with Other Funders

PCORI’s Board and its Strategic Plan express great interest in co-sponsoring and collaborative management of research with other funding agencies are Research and Quality

Falls Prevention Trial with the National Institute on Aging

Uterine Fibroids Registry with the Agency for Healthcare Research and Quality

In all cases, PCORI works with collaborators to ensure that its PCOR principles are reflected in the funding announcement, peer review process, and project award

Anticipate we will collaborate with AHRQ on any funding initiative arising from this workgroup

Impact of Accountable Care Organizations on Patient-Centered

Outcomes Workgroup Robert M. Kaplan

AHRQ Chief Science OfficerJanuary 9, 2015

To produce evidence to make health care safer, higher quality, more accessible,

equitable, and affordable, and work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and

used.

AHRQ’s Mission

Priorities

Priority #1Produce Evidence to Improve Health Care

Quality

Priority #2

Produce Evidence to Make Health Care Safer

Priority #3

Produce Evidence to Increase Access to

Health Care

Priority #4Produce Evidence to Improve Health Care

Affordability, Efficiency and Cost Transparency

A Few Activities

• Evidence Based Practice Centers (EPCs)

• United States Preventive Services Task Force (USPSTF)

• Medical Expenditures Panel Survey (MEPS)

• Healthcare Associated Infections Program

New Directions at AHRQ: Evidence, Data, & Methods to Build Learning

Health Systems of the Future (EDM)

• EDM Forum is an avenue to share innovations and lessons learned by those working at the interface of clinical informatics, quality improvement, research and clinical care.

• There are several freely-accessible resources:► eGEMs papers (over 70 papers and over 30,000

downloads), ► Webinars, toolkits, issue briefs, and summaries of

previous symposia and workshops.

New Directions at AHRQ: PA Margolis and Colleagues- The Learning Healthcare System Remission rate

(PGA, Centers >75% registered)

79%

APR 2007 NOV 2008 DEC 2010 AUG 2012 JUL 2014

71 Care Centers>19,500 patients>575 physicians>35% of all IBD patients

Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease. Pediatrics. 2012;129:1030-41

AHRQ Activities

•Provide data for researchers and policy makers

Collaboration with the Robert Wood Johnson Foundation on Implementing the Inclusion of a Linked Medical Organizations Survey (MOS) in AHRQ’s

Medical Expenditure Panel Survey (MEPS)-Focus on ACOs

• Starting in 2015, the MEPS MOS will obtain essential data on the medical organizational characteristics

• The following areas will be addressed in the MEPS-MOS► Organizational characteristics, e.g., size, specialties

covered, practice rules and procedures, patient mix and scope of care provided, membership in an ACO, certification as a primary care medical home

► Use of health information technology► Policies and practices related to the ACA► Financial arrangements, e.g., reimbursement methods,

number and types of insurance contracts, compensation arrangements within the practice

MEPS–MOS Can Be Used to Study the Effects of Practice Organization Upon:

• Access to care • Use of different types

of services.• Overall medical

expenditures for care.• Out-of- pocket costs

for care.• Health status of the

individuals receiving care

Jason M. Sutherland and Michael Furukawa- AHRQ Intramural

• Identify integrated health systems using commercial datasets.

• Derive performance indicators of integrated health systems (cost, quality, etc).

• Can be done similarly for ACOs.

New Directions at AHRQ: Comparative Health System Performance in

Accelerating PCOR Dissemination

• Up to $10.5 million per year for 5 years to support up to three Centers of Excellence on Comparative Health System Performance in dissemination of PCOR

• Develop and implement methods of measuring health system performance on cost and quality domains, with an emphasis on performance in disseminating PCOR

• Work will seek to understand the characteristics of high performing systems.

• Currently in peer review. Awards expected Spring 2015

http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-14-011.html

1%

21.4%5%

49.9%

10%

65.6%

86.4%

25%

97.2%

50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

U.S. Population Health expenditures Mean expenditures

Perc

enta

ge

$87,570Top 1%

$26,851 Top 10%

$40,876 Top 5%

$14,155 Top 25%

$7,960 Top 50%

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2010.

Total = 1.263 Trillion

Figure 1. Distribution of health expenditures for the U.S. population by magnitude of expenditure and

mean expenditures, 2010

Conclusion

• AHRQ is a federal research agency

• AHRQ has a center focused on Delivery Organization, and Markets (recruiting for a new director)

• Look for opportunities relevant to ACOs at AHRQ

Setting the Stage –Current State of Evidence

Background and Objective of Workgroup

Penny Mohr, MAWorkgroup ModeratorSenior Program OfficerImproving Healthcare Systems

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‘‘(A) IDENTIFYING RESEARCH PRIORITIES.—The Institute shall identify national priorities for research, taking into account factors of disease incidence, prevalence, and burden in the United States (with emphasis on chronic conditions), gaps in evidence in terms of clinical outcomes, practice variations and health disparities in terms of delivery and outcomes of care,……”

Identifying Research Priorities

-- from Patient Protection and Affordable Care Act

PCORI’s Research Prioritization Process

Prioritized Research

Topics

Topics Come from multiple sources

GapConfirmation

ResearchPrioritization

(Multi-stakeholderAdvisory Panels)

PCORI Website

Workshops,Roundtables

• Eliminating non-comparative questions

• Aggregating similar questions

• Assessing Research Gaps

• Preparing Topic Briefs

1:1 interaction w Stakeholders

Guideline Efforts, Evidence Syntheses

IOM 100AHRQ Future

Research Needs 33

Post-Prioritization Process: Board Review and Final Disposition of Topic

• From Advisory Panel Process

• From Staff or Board with Advisory Panel Input

Prioritized Research

Topics

Further Topic Assessment and

Refinement

Landscape Reviews

Topic-specific Workshop

Science OversightComm &

BoardReview

Board Approval

Final Disposition

Place Topic in a Broad PFA

Approve for Targeted PFA

Place on PCS* List

None of the above

“Fast track”

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*Pragmatic Clinical Study

Evolution of the Topic

1,000+ research topics collected

841 accepted

308 assigned to IHS program Program Director screened, consolidated, and rated topics

89 resulted from Program Director screening, and were scored

15 scored highest and selected for Advisory Panel consideration Topic briefs commissioned for all 15 topics Reviewed and ranked by IHS Advisory Panel – April 19-20, 2013

Link to PCORI Website - Full Description 35

PCORI Advisory Panel on IHS

Topic was prioritized by IHS Patient and Stakeholder Advisory Panel in April 2013: Features of Health Insurance Coverage

IHS staff worked with panelists and other stakeholders; two subtopics of interest arose: Enrollee Support for HDHPs (workgroup yesterday) and Effects of Accountable Care Organizations

IHS staff commissioned updated topic briefs and conducted numerous key informant interviews to produce an initial set of PCOR questions

Workgroup participants submitted additional questions, which we used to develop the final list

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Workgroup Objectives: Narrowing the Broad Topic

How do different models of ACOs (e.g., ownership, structural, risk) compare in their ability to improve patient-centered care, e.g., access to appropriate care, improved care coordination, improved care experiences, and health outcomes?

Are there patient-centered comparative effectiveness research questions that PCORI should pursue?

If so, how would this multi-stakeholder group prioritize these questions in terms of importance?

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Taxonomy of ACOsD

egre

e of

inte

grat

ion

Outpatient

Inpatient

Full spectrum

Centralization of ownership

Multiple owners Single ownership

Full spectrum integrated

Independent Physician Group

Physician Group Alliance

Independent Hospital

Hospital Alliance

Full spectrum integrated

Adapted from Muhlstein et al. A Taxonomy of ACOs. Leavitt and Partners. June 2014.

ACO Risk Sharing Models

Shared Savings

Shared risk and savings, pay for performance for selected performance metrics

Bundled payments, case management fee

Partial capitation, targeting high-risk chronic disease population

Full capitation, population-based risk

Adapted from Delbanco et al. Promising Payment Reform: Risk Sharing with ACOs.The Commonwealth Fund. 2011

Advisory Panel Advice

Focus on comparing across different types of ACOs

Shared Savings Plan are early in trajectory of risk and not where the market is going focus more on shared risk arrangements

Better define what is important about an ACO from the patient’s perspective, and which patient-important outcomes to include

Examine the impact of ACOs on managing the high-risk population

Look at Medicaid and private ACO market, not Medicare

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PCORI-Funded Studies on ACOs

Relative Patient Benefits of a Hospital-PCMH Collaboration within an ACO to Improve Care Transitions Principal Investigator: Jeffrey Schnipper, MD, MPH

Improving Care Coordination for Children with Disabilities Through an Accountable Care Organization Principal Investigator: Paula Song, PhD

The Comparative Impact of Patient Activation and Engagement on Improving Patient-Centered Outcomes of Care in Accountable Care Organizations Principal Investigator: Stephen Shortell, PhD, MPH, MBA

Caring for the Whole Person: A Patient-Centered Assessment of Integrated Care Models in Vulnerable Populations Principal Investigator: Bill Wright, PhD

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Compares two or more options for prevention, diagnosis, or treatment (can include “usual care”)

Considers the range of clinical outcomes relevant to patients

Conducted in real-world populations and real-world settings

Attends to differences in effectiveness and preferences across patient subgroups

Often requires randomized trial design

How We Define Comparative Effectiveness

What Research Questions are Within PCORI’s Mandate?

PCORI funds studies that compare the benefits and harms of two or more approaches to care.

Cost-effectiveness: PCORI will consider the measurement of factors that may differentially affect patients’ adherence to the alternatives such as out-of-pocket costs, but it cannot fund studies related to cost-effectiveness or the costs of treatments or interventions.

Disease processes and causes: PCORI cannot fund studies that focus on risk factors, origins, or mechanisms of disease.

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Examples of Out of Scope Questions

How does local market context influence the formation, structure, and activities of ACOs?

How effective have we been in having patients believe that they have an investment in high quality low cost care?

How do ACOs perform relative to traditional FFS in terms of encouraging the use of preventive services? If so, what are Medicare ACOs doing to encourage or enable this utilization? What is the impact on patient-centered outcomes?

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How to make a PCOR question

Can the ACO/system accommodate patients using evidence based care?

Are ACOs that have adopted a fully integrated medical record across providers better than those that have not at facilitating the uptake of evidence-based care and reducing avoidable hospitalizations, improving patient quality of life, and satisfaction with care?

Comparators

Patient-centered Outcomes

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Discussion of Research Gaps

Mark McClellan, MD, PhDDirector of Healthcare Innovation and Value InitiativeBrookings Institution

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Commercial ACO Discussion Questions

How do different models of ACOs (e.g., ownership, structural, risk) compare in their ability to improve patient-centered care, e.g., access to appropriate care, improved care coordination, improved care experiences, and health outcomes?Are different models of patient engagement in ACOs better at improving patient-centered outcomes than others? Are different models of patient engagement more effective for different subpopulations (e.g., children versus adults, socioeconomic status)?

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Commercial ACO Discussion Questions

How do different models of distributing risk and shared savings among providers within an ACO (e.g., primary care, secondary care, hospitals) affect practice changes and patient-centered outcomes?What are the most effective mechanisms to communicate CER findings, promote evidence-based care, and affect practice change within an ACO model? What is the impact of this on patient experience with care and patient-centered outcomes?

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Commercial ACO Discussion Questions

Which components of ACOs are driving the biggest changes/have the largest impact on improving patient-centered outcomes for high-risk, beneficiaries with chronic disease? Which arrangements for care coordination and care management within ACOs have the largest benefit for long-term (5-year) beneficiary health on high-risk, beneficiaries with chronic disease?What is the comparative effectiveness research of different ACO models in terms of encouraging activation and use of preventive services? What is the impact on patient-centered outcomes?

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Commercial ACO Discussion Questions

Which components of ACOs are driving the biggest changes/have the largest impact on improving patient-centered outcomes for high-risk, beneficiaries with chronic disease? Which arrangements for care coordination and care management within ACOs have the largest benefit for long-term (5-year) beneficiary health on high-risk, beneficiaries with chronic disease?What is the comparative effectiveness research of different ACO models in terms of encouraging activation and use of preventive services? What is the impact on patient-centered outcomes?

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Tricia McGinnis, MPP, MPH Director of Delivery System ReformCenters for Health Care Strategies, Inc

Discussion of Research Gaps

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www.chcs.org

PCORI Accountable Care Organization WorkgroupJanuary 9, 2015

Tricia McGinnisVice President, CHCS

Overview of ACOs in Medicaid

A non-profit health policy resource center dedicated to improving services for Americans receiving publicly financed care

► Priorities: (1) enhancing access to coverage and services; (2) advancing quality and delivery system reform; (3) integrating care for people with complex needs; and (4) building Medicaid leadership and capacity.

► Provides: technical assistance for stakeholders of publicly financed care, including states, health plans, providers, and consumer groups; and informs federal and state policymakers regarding payment and delivery system improvement.

► Funding: philanthropy and the U.S. Department of Health and Human Services.

► Medicaid ACO Learning Collaborative: Participating states include CO, MA, ME, MN, NY, OR, WA and VT

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Medicaid ACOs: A National Perspective

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Medicaid ACO Organization Structures Vary

Provider-Driven ACOs

• Providers establish collaborative networks

• Provider network assumes some level of financial risk

• Providers oversee patient stratification and care management

• State or MCO pays claims

• STATES: Maine, Minnesota, Vermont

MCO-Driven ACOs

• MCOs assume greater role supporting patient care management

• MCOs retain financial risk but implement new payment models

• Providers partner with the MCO to improve patient outcomes

• STATES: Oregon

Regional/Community Partnership ACOs

• Community orgs partner to develop care teams and manage patients

• Regional/community org receives payment, shares in savings

• Providers partner with regional/community orgs and form part of the care team

• MCOs/states retain financial risk

• STATES: Colorado, New Jersey

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Key Observations from State Approaches

• Most payment arrangements based on MSSP► Many Medicaid shared savings approaches offer multiple

“tracks” or options► No state requires downside risk in its shared saving

program’s first year► Oregon uses global payments for its CCOs

• Quality metrics reflect priorities for Medicaid populations

• Most states will hold ACOs accountable for behavioral health services, with other services added in the future

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Medicaid ACO Program Results to Date

• Colorado Accountable Care Collaborative:► Estimated $29-33 million in net savings over three years,

associated with 600,000 beneficiaries

• Minnesota Integrated Health Partnerships:► $10.5 million year over year cost savings associated with

100,000 beneficiaries► Three out of six ACOs eligible for shared savings payments

• Oregon Coordinated Care Organizations:► ED visits declined 17% in two years► Decreased hospitalizations: 27% for CHF, 32% for COPD,

and 18% for adult asthmaSources: Accountable Care Collaborative Annual Report 2014. https://www.colorado.gov/pacific/hcpf/accountable-care-collaborativeMN: http://mn.gov/governor/newsroom/pressreleasedetail.jsp?id=102-136054OR:http://www.oregon.gov/oha/Metrics/Documents/2013%20Performance%20Report%20Executive%20Summary.pdf

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Examples of Quality Metrics for Medicaid ACOs

Oregon Minnesota Screening for depression and follow-up plan Depression remission at six months Timeliness of prenatal care Pneumonia appropriate care measure Elective delivery Heart failure appropriate care measure Outpatient and ED utilization Optimal asthma care composite (kids) Colorectal screening Optimal asthma care composite (adults) PCMH enrollment Home management asthma care plan Developmental screening for 1st 36 months of

life Optimal vascular care composite Adolescent well-care visits Optimal diabetes composite Controlling high blood pressure CG-CAHPS Diabetes: HBa1c poor control HCAHPS Alcohol or other substance abuse (SBIRT) Follow-up after hospitalization for mental

illness CAHPS access to care composite (adults &

kids) CAHPS satisfaction with care composite

(adults & kids) EHR adoption Mental and physical health assessment within

60 days for children in DHS

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Visit CHCS.org to…

Download practical resources to improve the quality and cost-effectiveness of Medicaid services

Subscribe to CHCS e-mail updates to learn about new programs and resources

Learn about cutting-edge efforts to transform the way Medicaid delivers and pays for care

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www.chcs.org

Setting the Stage

Why this is an important area that needs research (what makes this compelling)Why this is an issue where PCORI can play a unique role-compared with other groups funding research in this area (what makes this a particularly patient centered question?)What are some of the key questions that PCORI research might address?

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Medicaid ACO Discussion Questions

How well have Medicaid ACOs performed on patient-centered outcomes relative to Medicaid Managed Care? Are Medicaid ACOs more effective than traditional Medicaid Managed Care in reducing health disparities?What are the best mechanisms to integrate traditional carve-out services into Medicaid ACOs to improve patient-centered outcomes? Long-term services and support Behavioral and mental health Social services

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BREAK

10:15 – 10:30 a.m.

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Penny Mohr, MASenior Program OfficerImproving Healthcare Systems

Introduction to Breakout Sessions

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Questions Grouped Into Four Topic Areas

ACO Structures and Risk Sharing Arrangements Location: Main event room Facilitator: Stephen Shortell Scribe: Kaitlin Hayes Rapporteur: John Martin

Patient and Provider Activation Location: Conference Room P

(4th Floor) Facilitator: Joel Weissman Scribe: Michelle Johnston-

Fleece Rapporteur: David Bruhn

Delivery Services Location: Conference Room M Facilitator: Lewis Sandy Scribe: Beth Kosiak Rapporteur: Kurt Wrobel

Medicaid Location: Conference Room O (4th Floor) Facilitator: Tricia McGinnis Scribe: Lauren Azar Rapporteur: Lisa Angus

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Key Questions to Answer

Describe ACO models and/or components to compareWhy or why not are the questions particularly well suited for PCORI to fund?What specific questions would you recommend PCORI target?If you have developed more than one question – which of these is the most compelling and why?What are the challenges raised in conducting research on these questions, and how might those challenges be addressed?

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For each question

Clearly describe the comparators

What populations should be targeted?

Which patient-centered outcomes should be examined?

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Collaborative Workgroup Discussion

Focus: Provide targeted input without scientific jargon

Participate: Encourage exchange of ideas among diverse perspectives that are present today: Researchers Patients Other stakeholders

Be respectful: Disagree with ideas, not people

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Webinar participants are invited to submit questions via:

Email: info@pcori.orgTwitter: #PCORIWebsite:

http://www.pcori.org/events/2015/understanding-impact-accountable-care-organizations-patient-centered-outcomes-workgroup

Additional Questions

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BREAKOUT SESSIONS

10:30 a.m.– 12:30 p.m.

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LUNCH

12:30 – 1:30 p.m.

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Moderated by

Penny Mohr, MASenior Program OfficerImproving Healthcare Systems

Report Back from Breakout Sessions

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Breakout Group 1: ACO Structures and Risk Sharing Arrangements

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Breakout Group 2: Patient and Provider Activation

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Breakout Group 3: Delivery Services

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Breakout Group 4: Medicaid

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BREAK

3:30 – 3:45 p.m.

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Moderated by

Penny Mohr, MASenior Program OfficerImproving Healthcare Systems

Priority Research Questions for PCORI and Justification

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Priority Questions

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Criteria to Keep in Mind

Patient-Centeredness: is the comparison relevant to patients, their caregivers, clinicians or other key stakeholders and are the outcomes relevant to patients?Impact of the Condition on the Health of Individuals and Populations: Is the condition or disease associated with a significant burden in the US population, in terms of disease prevalence, costs to society, loss of productivity or individual suffering? Assessment of Current Options: Does the topic reflect an important evidence gap related to current options that is not being addressed by ongoing research. Likelihood of Implementation in Practice: Would new information generated by research be likely to have an impact in practice? (e.g. do one or more major stakeholder groups endorse the question?)Durability of Information: Would new information on this topic remain current for several years, or would it be rendered obsolete quickly by new technologies or subsequent studies?

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Voting Sheet

1 (low) 2 3 (modest) 4 5 (high)Patient-

CenterednessImpact on Health and

PopulationsAssessment of

Current OptionsLikelihood of

ImplementationDurability of Information

Overall Importance

Are different models of patient engagement in ACOs better at improving patient-centered outcomes than others? Are different models of patient engagement more effective for different subpopulations (e.g., children versus adults, socioeconomic status)?Score this topic from (1 – low / does not or barely meets the criterion) to (5 – High scoring / fully addresses the criteria). Please reference the scoring criteria guide as reference. The total score will measure how highly this topic is prioritized.

Given your consideration of all CER questions, which one would you recommend that PCORI should pursue and why?

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Steven Clauser, PhD, MPAProgram Director, Improving Healthcare Systems

Closing Remarks

Bryan Luce, PhD, MS, MBAChief Science Officer, Office of the Chief Science Officer

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We Still Want to Hear from You

We welcome your input on today’s discussions.We are accepting comments and questions for consideration on this topic through January 23rd, 2015 via email (info@pcori.org) We will take all feedback into consideration.

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Thank You for Your Participation

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