Do You Know About PCORI?

Do you know how PCORI affects patients and employers? Learn more here.

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 delivery more efficient and cost-effective. It aims to accomplish this goal by putting the purchasing power and decision-making in the hands of consumers. The movement is supported by agencies that provide resources to help patients become more involved in their healthcare decisions. The Patient-Centered Outcomes Research Institute (PCORI) is one such organization.

What Is PCORI?

PCORI is a nonprofit research group that funds studies to help 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

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.

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 the potential benefits and harms of treatments and protocols recommended by healthcare providers. CEDS aims to fill gaps in clinical information by producing valid evidence 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 healthcare effectiveness and efficiency in providing equal access to care.

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

Engagement

Engagement 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.

Research Infrastructure

This program is spearheading the creation of a national network, PCORnet, to foster clinical effectiveness research studies. Results will be used to develop faster, more cost-effective research methods to improve healthcare and healthcare delivery.

Funding and Research

PCORI Fees

As a nonprofit organization, PCORI depends on outside funding. The Affordable Care Act initially required Insurance companies that offer certain types of healthcare plans and employers with certain types of self-insured plans to pay a fee to the nonprofit. PCORI’s charter under the ACA expired at the end of September 2019, but Congress has voted to reauthorize PCORI funding for 10 more years.

The fee is based on the average number of lives covered under the policy or plan and the ending date for the plan year. To determine the amount due, the entities multiply their average number of lives in the plan by an amount set by 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. 

The IRS announces updated PCORI fees annually. For plans ending on or after October 1, 2021, but before October 1, 2022, the rate is $2.79.

PCORI has provided $2.8 billion in cumulative funding commitments as of FY2020.

Research

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.


DataPath, Inc. creates healthcare benefits administration solutions for third party administrators.

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