What is PCORI? Learn more about the research institute that seeks to improve patient outcomes.
Two of the biggest drivers of escalating healthcare costs are the lack of knowledge about the cost of medical services and the low levels of engagement from patients in their healthcare decisions. Thanks to healthcare consumerism, this is starting to change.
Healthcare consumerism is a movement to improve the quality of healthcare services while making the delivery more efficient and cost-effective. It tries to accomplish this goal by putting the purchasing power and decision-making in the hands of consumers. The movement is supported to a large degree by agencies that provide information and resources to help patients become more actively involved in their healthcare decisions. The Patient-Centered Outcomes Research Institute (PCORI) is one such organization.
What Is PCORI?
PCORI is a nonprofit research organization that funds studies designed to help patients and healthcare consumers make better-informed healthcare choices. Its primary goal is to see that healthcare consumers have the information they need to make decisions that reflect their desired health outcomes. PCORI works to achieve this goal by:
- Funding research guided by patients, caregivers, and the broader healthcare community
- Producing and promoting evidence-based information based on the research PCORI supports
- Working to improve healthcare delivery and outcomes
- Helping people make informed healthcare decisions
Priorities and Programs
PCORI’s research priorities – outlined in the organization’s National Priorities for Research – focus on five key areas:
- Assessment of prevention, diagnosis, and treatment options
- Improving healthcare systems
- Communicating and disseminating research results
- Addressing disparities in prevention, diagnosis, and treatment effectiveness
- Accelerating methodological research in patient-centered outcomes
The organization’s programs to address these priorities include:
Clinical Effectiveness and Decision Science (CEDS)
To make good healthcare decisions, patients need access to reliable information about both the potential benefits and harms of treatments and protocols recommended by healthcare providers. CEDS aims to fill clinical information gaps by producing valid evidence that can be used to compare the effectiveness of different treatment options.
Healthcare Delivery and Disparities Research (HDDR)
HDDR addresses two of PCORI’s five national research priorities for research – improving healthcare systems and addressing disparities. The program compares patient-centered approaches to improve the effectiveness and efficiency of healthcare and providing equal access to patients.
Evaluation and Analysis (E&A)
PCORI is committed to studying the importance of internal evaluation and analysis. E&A’s goal is to ensure continuous improvement in the quality, efficiency, and effectiveness of PCORI’s work through:
- Assessing the impact of PCORI’s work
- Understanding what PCORI funds
- Informing PCORI process improvement
- Building evidence for the science of engagement
This program brings together all the various healthcare stakeholders to help set research priorities and evaluate applications. Its primary goal is to make sure PCORI funds and conducts research relevant to their priorities.
This program is spearheading the creation of a national network, PCORnet, designed to foster clinical effectiveness research studies. Results from these studies will be used to develop faster and more cost-effective ways of conducting research that improves healthcare and healthcare delivery throughout the U.S.
Funding and Research
As a nonprofit research organization, PCORI depends on outside funding to conduct its work.
To provide PCORI with funding, the Affordable Care Act initially required certain insurers and employers to pay a fee that goes directly to the nonprofit. Insurance companies that offer certain types of healthcare plans and employers with certain types of self-insured plans (including HRAs) fall into this category.
The fee for a plan is based on the average number of lives covered under the policy and the ending date for the plan year. To determine their payments, plans required to pay the fee multiply their average number of lives in the plan by an amount set by the federal Secretary of Health and Human Services. The fee is due annually on July 31 following the end of the plan year, using Form 720 on the Quarterly Federal Excise Tax Return.
Under the ACA, PCORI’s charter expired at the end of September 2019, but Congress has voted to reauthorize PCORI funding for 10 more years.
On Tuesday, June 8, 2020, the IRS announced updated PCORI fees. The new rate is $2.54 for plan that end on or after October 1, 2019 and before October 1, 2020. Since 2014, PCORI has provided $2.6 billion in funding for more than 700 research projects.
One indication of the quality of PCORI’s work is the growing number of funded research studies that are being summarized in leading medical journals and presented at major scientific meetings.
For example, a recent PCORI-funded study focused on reducing errors in hospitals through improved communications between staff and the patient’s family. Another PCORI-funded study looked at how chronic pain disproportionately affects less educated and low-income patients.
What is PCORI: Engagement
PCORI believes that involved patients, caregivers, clinicians, and other healthcare stakeholders are vital for producing the most useful research results. Engagement starts with initial planning, to conducting the study, and then disseminating the final results. PCORI also sees the researchers they fund, patients, and other healthcare stakeholders as equitable partners rather than research subjects.
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