Patient-Centered Outcomes Research Institute (PCORI) – Has the Time Come for an Expanded Mandate?
Under the Affordable Care Act (ACA), Congress took a step to create a source of trustworthy and understandable information about the costs and benefits of pharmaceuticals and other types of care. By creating the Patient-Centered Outcomes Research Institute (PCORI), Congress funded a research organization that specifically examines the comparative effectiveness of alternative therapies of all types.
As part of this legislation however, Congress explicitly forbade PCORI from doing any research on the costs of comparative treatments, and how the benefits stack up against those costs. For an insurer or patient preparing to spend hundreds or thousands of dollars for a type of treatment, having a cost and benefit analysis is essential to making the best choice.
The approved mandate for PCORI is to pay for studies of comparative effectiveness of alternative therapies from an independent and trusted source. The vision and mission of PCORI is described on their website as:
“Our vision: Patients and the public have information they can use to make decisions that reflect their desired health outcomes.
And our mission: PCORI helps people make informed healthcare decisions, and improves healthcare delivery and outcomes, by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader healthcare community.”
This is good, but does it go far enough? Without looking at comparative costs, PCORI’s effectiveness is significantly diminished. What patient or insurer wants a qualitative analysis without a quantitative one? Having the private sector complete the cost analysis work reduces trust in the studies. Would you believe the company, provider or source which had a stake in the profit? Probably not. We need an “Underwriters Laboratories” sort of system to sort out the best options.
So why did Congress prevent PCORI from doing research on the comparative costs and benefits of therapies? As always, special interest groups from the key healthcare industries lobbied members of Congress to eliminate any cost vs. benefit analysis mandate. The primary reason was that if insurers and patients had this information, then care would be rationed. Well, this is happening anyway as insurers are always trying to limit costs.
Has the time come to reintroduce legislation to complete PCORI’s mandate? Politics may trump logic and best practice for this very important subject. In the long run independent organizations like PCORI will assist patients, providers and insurers to drive innovation and efficiency in the industry. Our organization continues to provide our clients with benchmarked medical therapies and pharmaceutical costs to solve risks within their programs, and we will continue to review and report on developments in the healthcare field like PCORI.