By Nakela Cook
October 19, 2021 at 5:00 am ET
Few issues inspire more bipartisan concern than the rising cost of health care in the United States. To address this challenge, we must recognize that it is rooted in a simple fact: The overwhelming share of our health spending, 71 percent, goes toward care to help people living with multiple chronic conditions.
Understanding this fact fundamentally shifts the paradigm in how to approach America’s health care challenges. We can create an affordable, high-quality health care system by providing more effective and efficient care to those with chronic conditions while maintaining a focus on communicable and rare diseases that affect millions of Americans. To lower costs, we should ask how we can achieve better health outcomes for these individuals — by prioritizing prevention, accelerating recovery and mitigating economic and other burdens.
Answering this question requires evidence. That was the idea in 2010 when Congress created the Patient-Centered Outcomes Research Institute, an independent organization focused on funding comparative clinical effectiveness research, or CER. CER assesses multiple treatment options and approaches to delivering care to see what work best for different people with different circumstances and in different settings.
PCORI, which I have the privilege of leading, funds research addressing many complex issues in health care while operating on the simple premise that we need more patient-centered evidence of what works best for individuals, families and communities to allow them to make better-informed decisions.
What makes PCORI unique is its focus on the patient at the individual level. There is no one answer for everyone confronting a particular condition. What works for one person may not be the appropriate option for another. We must see patients as individuals with particular circumstances, needs and preferences — not as conditions to be treated. PCORI works closely with patients to understand their needs so that the work we fund is truly relevant to those it is intended to benefit.
In no area is that more important than in chronic disease prevention and treatment. To lower health expenditures and help people live better lives, we need to find ways to better address interconnected chronic conditions. Diabetes, hypertension, cardiovascular disease and cancer tend to be treated as individual conditions. However, they are often linked or share common risk factors, and better prevention and management is key to lowering morbidity and improving outcomes.
To date, PCORI has devoted $254 million to fund around 60 studies that are likely to yield evidence relevant to people with multiple chronic conditions. For example, PCORI is funding a study comparing two ways to treat people with high blood pressure, many of whom simultaneously suffer from diabetes, high cholesterol or heart disease.
Another PCORI-funded study comparing the two main types of weight-loss surgery found that, although people who had gastric bypass lost more weight than those who opted for sleeve gastrectomy, the former group had a greater need for additional surgeries and hospital stays. And among patients with type 2 diabetes, about the same number were able to stop taking their medicine after either procedure, but more people who chose sleeve gastrectomy had their diabetes return. Presented in a variety of formats, including simple evidence summaries designed for both patients and clinicians, these findings support better, more personalized decision-making.
Many factors that drive chronic conditions derive from nonclinical economic and social circumstances like poverty, low literacy and housing access. There are also clear racial, ethnic and geographic divides, which is why PCORI devotes resources to studying approaches to achieving health equity.
Following bipartisan reauthorization in 2019 that expanded the organization’s mandate, PCORI is broadening the collection of outcomes in its funded research studies to include the potential burdens and economic impacts associated with approaches to care. PCORI’s mission is patient-centered, and thus it makes sense that the cost to patients be a part of comparing different treatment options.
PCORI is not a government body. It does not set reimbursement rates, and it does not make determinations on the type of care that should be covered. Instead, PCORI-funded research provides transparency and greater evidence to enable a more informed, effective and patient-centered health care system.
Generating trustworthy information that can keep people healthy or care for them more effectively when they are ill is at the heart of what we do. Health research can — and should — be about what is best for patients. That concept may also be the key to solving America’s health care cost challenges.
Dr. Nakela Cook is the executive director of PCORI, an independent nongovernmental organization in Washington, D.C.
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