Affordable Care Act revision leaves science largely untouched

Psychological research funded through the Patient Centered Outcomes Research Institute is not being considered among proposed changes…so far.

The Republican leadership of the House of Representatives has just rolled out its plan to revise the Patient Protection and Affordable Care Act (ACA) and while in a letter (PDF, 95KB) to the Chairs of the two Committees who have so far passed the bill, APA has expressed broad concerns about the new bill, the provision of ACA that funds research, the Patient Centered Outcomes Research Institute (PCORI), appears to be under the radar for now.

According to its website, “PCORI is funded through the Patient-Centered Outcomes Research Trust Fund (PCOR Trust Fund), which was established by Congress through the Patient Protection and Affordable Care Act of 2010. The PCOR Trust Fund receives income from three funding streams:  appropriations from the general fund of the Treasury, transfers from the Centers for Medicare and Medicaid trust funds, and a fee assessed on private insurance and self-insured health plans (the PCOR fee).”

Perhaps of greater interest than how it’s funded, though, is what PCORI funds.  Psychologists should be gratified to learn that “mental and behavioral health” as a category, is first among the top five categories in PCORI’s research portfolio ($290 million), followed by cardiovascular health ($213 million), cancer ($188 million), multiple/comorbid chronic conditions ($186 million) and neurological disorders ($159 million).  Further, of the 456 projects funded between 2012-2016, fifty-seven were awarded to psychologists (Excel Spreadsheet, 102KB) totaling $132 million,  on such topics as attention deficit hyperactivity disorder, obesity, serious mental illness, traumatic brain injury, low back pain, medical decision-making, sleep apnea, and treatment of substance use disorders.

Staff of the American Psychological Association’s Science Government Relations Office monitor the activities of PCORI closely.  They have arranged for individual psychologists to be nominated to various advisory panels or invited to participate in thematic workshops to help shape the PCORI agenda.  Among those psychologists who have won appointments are Zeeshan Butt (Northwestern University Feinberg School of Medicine) to the Advisory Panel on Assessment of Prevention, Diagnosis, and Treatment Options, and Alfiee Breland-Noble (Georgetown University Medical Center) to PCORI’s Advisory Panel on Addressing Disparities.

That kind of input has borne fruit.  Soon after Rebecca S. Allen (University of Alabama) was invited to participate in a multi-stakeholder workgroup on Patient-Centered Palliative Care Delivery for Adult Patients with Advanced Illnesses and Their Caregivers in March 2016, PCORI released a targeted funding announcement “Community-based Palliative Care Delivery for Adult Patients with Advanced Illnesses and their Caregivers.”

At the core, PCORI’s mission is comparative effectiveness research, designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. But key to that mission is the patient-centered approach.  As its website notes, “For patients, this strategy means we must provide information about which approaches to care might work best, given their particular concerns, circumstances, and preferences. For clinicians, it means we must focus on providing evidence-based information about questions they face daily in practice. For insurers, it means we must produce evidence that can help them make the best decisions on how to improve health outcomes for their members. For researchers, it means we must support for studies designed to build a badly needed base of useful evidence for improving outcomes in high-burden, high-impact conditions.”

APA staff will be keeping a watchful eye on Congress as the ACA debates continue and are well-positioned to argue for the value of PCORI research thanks to the many psychologists who are funded by PCORI or who are helping to shape its scientific agenda.