Defining the New AHRQ: A Race for 21st Century Care

What does a digital revolution mean for patient health? How will investments in data and technology transform the way healthcare is delivered in the United States? What new research and scientific evidence do we need to improve the delivery of care?

Our healthcare system is at a crossroads. Over the last 5 years, advances in mobile devices, software, digital displays, sensors, cameras, and other data collection and location-aware technologies have created tremendous opportunities for healthcare providers and policymakers to gain a broader, deeper understanding of patients’ health and health behaviors. We now live in a world with an abundance of raw information at health experts’ disposal, and an abundance of new insights to be discovered.

But when it comes to leveraging new discoveries, bending the cost curve, and actually improving the safety and quality of healthcare delivery, we still have a long way to go. If we have learned one thing from the COVID-19 crisis, it is that the United States is in desperate need of a focused, concerted effort to bring healthcare out of the brick-and-mortar models of delivery, and into the digital age.

Setting a National Priority for Healthcare Services and Delivery

To achieve this, we must first recognize that the United States has had tremendous success saving lives when we choose to make that focus a national priority. Each day, medical breakthroughs bring us closer and closer to cures and therapies for previously untreatable conditions, such as cancer, Alzheimer's disease, and diabetes. The United States is the clear-cut world leader in biomedical science and research, thanks in large part to our commitment to robust funding at the National Institutes of Health (NIH) and Food and Drug Administration.

And yet, when it comes to delivering those cures to patients, the United States has a serious problem. Even when we do see significant biomedical breakthroughs, those 21st century cures do not always translate into 21st century care.

In order to restore our global leadership in healthcare excellence, the United States must make it a national priority to improve the efficiency, quality, and safety of healthcare services delivery.

Closing the Quality Gap: a 21^st Century Care Initiative

At AHRQ, we have been focusing on improving the delivery of care for decades, and more recently over the last 2 years we have referred to this work as our 21st Century Care Initiative. Through this initiative, we have focused on exploring ways to expand the scope and impact of health services and primary care research in the United States, with a key focus on data, technology, and practice improvement.

Investments in basic science and research at NIH have had a tremendous impact on global leadership in biomedical excellence. Just imagine what a similar effort will do for healthcare delivery.

I have often talked about the need to get to zero harm and zero defects in healthcare delivery. That goal should be shared by everyone in the healthcare community. When I look at other complex industries such as aviation and auto manufacturing, they have made tremendous strides toward zero harm and zero defects. But unfortunately, healthcare delivery has lagged behind.

Today, we have a tremendous opportunity to achieve 21^st century care, as COVID-19 is fundamentally changing both patient demand for healthcare and the way care is delivered. Pair this with new possibilities for quality improvement and cost reduction thanks to advances in data, analytics, and technology, and the United States has a generational opportunity to fundamentally change our healthcare system.

The Core Tenets of 21^st Century Care

Insights from Data:  At the core of 21^st century care is a crucial effort to generate, consolidate, integrate and use new and existing types of data to inform care delivery. Our approach is two-pronged, addressing the needs of both health system leaders and policy makers and the needs of front-line clinicians, patients, and families.  To that end, we are building an insight platform designed to advance evidence-based policymaking by aggregating local and State data on health and human services, while at the same time contributing to the revolution in how medical evidence, medical history, biometrical data, social determinants of health, and patient-reported contextual data are brought together in real time to improve patient-centeredness, quality, safety, value, and equity at the point of care.

Primary Care: Perhaps most importantly, we aim to support the Department of Health and Human Services, Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration; the private sector; and healthcare experts through a massive effort to reimagine primary care. Primary care will remain the foundation of the 21^st century care delivery system as it weaves together data, evidence, safety, and whole-person care, and provides a foundation for a high-value delivery system. AHRQ will provide the research and evidence for successful innovations in primary care delivery, workforce, technology, and financing, while optimizing the benefits of digital health through new models of care planning and care coordination. AHRQ will then work to help primary care providers implement new evidence-based practices through a new national, State-based primary care extension service and center of excellence, building on our groundbreaking EvidenceNOW initiative.

Patient Safety:  At the same time, 21st century care must be deeply rooted in patient safety and preventing the tens of thousands of patient deaths that occur each year due to threats and hazards we know exist in healthcare.  We believe savings of hundreds of millions of dollars per year could easily be achieved through targeted investments to improve diagnostic safety and reduce hospital-acquired conditions (HACs). HAC events amount to more than $28 billion in excess healthcare costs, including pressure ulcers ($9.9 billion), adverse drug events ($4.1 billion), and falls ($1.5 billion), while diagnostic errors have been estimated to cost our health care system $100 billion each year. By advancing our efforts to reduce these events, we can lessen these avoidable financial burdens and, more importantly, save lives.

Whole-Person Care: Additionally, we aim to accelerate the transformation toward whole-person precision care. This is care that puts people at the center of care, with a focus on keeping people healthy and providing evidence-based care that reflects their values and preferences in the setting that they prefer. By leveraging both evidence and data, care will also be customized to the individual. AHRQ will begin catalyzing this by: reengineering and testing models of care that focus on patients with underlying conditions (and multiple chronic conditions); increasing our digital healthcare research portfolio; supporting patients and caregivers through better use of patient-reported outcomes (PROs) and patient preferences; and generating new data, research, and evidence to address growing health disparities among high-priority populations.

Clinician Well-Being:  And finally, the 21^st century care system must be designed for those who provide our care—doctors, nurses, and front-line health professionals who work tirelessly to save and improve lives.  Especially in light of the COVID-19 crisis, we’ve seen the significant harm clinician burnout can have on healthcare professionals, as well as the patients for whom they care.  At the same time, violence against nurses and other healthcare professionals remains a significant and troubling issue, as do workplace injuries. From a financial perspective, we know the downside of clinician well-being is $4.6 billion per year in lost productivity, and we aim to address these avoidable costs through a systems engineering approach that will require: producing new evidence to reduce administrative burden and prevent physician burnout; contributing to new public-private partnerships that include the National Academy of Medicine’s Action Collaborative; and supporting research to determine how digital healthcare technology can be optimized to support clinicians in providing high-quality, safe, high-value patient care.

Understanding Stakeholder Needs in 21^st Century Care

At the center of our 21^st Century Care Initiative is a focus on improving care for patients. Imagine a world where patients are offered—on an individualized basis and with an unprecedented degree of certainty—strategies and care plans that are most effective and best aligned with their preferences. Imagine a patient profile that offers granular detail about the social and economic factors having the greatest impact on a patient’s health, connecting providers to well-established best practices for overcoming these challenges. We are at the precipice of a breakthrough in data-driven, technology-supported care plans that incorporate as much or as little information as a patient desires. For patients, 21^st century care is a game-changer.

As for providers, the user-friendly, data-driven research we aim to produce will provide cutting-edge clinical decision support, dramatically improve diagnosis, prevent medical errors, reduce provider burden, and identify and eliminate the provision of low-value care—a source of waste that University Hospitals’ Clinical Transformation Officer Dr. Peter Pronovost calls the “trillion dollar problem.”

Health system administrators share a common interest in 21^st century care as well, as a shift toward value-based payment methods and a greater emphasis on rewarding quality have led many C-suite executives to abandoned traditional fee-for-service business models for more comprehensive care plans that focus on optimizing value. As Dr. Brent James, the former Executive Director of the Institute for Health Care Delivery Research at Intermountain Healthcare notes, improving quality and safety in healthcare can significantly reduce unnecessary costs and dramatically increase value.

Data and technology are paving the way for new research that will help health system administrators successfully shift toward things like learning health systems approaches, systems engineering, and integration of clinical workflow design. By optimizing resources, understanding where value is gained and lost, and incorporating strategies that are proven to reduce or prevent adverse patient safety events, health system administrators can improve healthcare quality while reducing costs.

Other, less traditional stakeholders have an interest in 21^st century care as well. For instance, pharmaceutical companies and patients alike stand to benefit from improved medication adherence and management. As an example, we know definitively that when taken regularly, statins play a critical role in preventing major medical events such as heart attack and stroke. And yet a presentation at a recent national meeting demonstrated that 25% of patients deemed at high risk of these events never fill their first prescription, while another 25% never refill their first prescription. The 21^st Century Care Initiative presents a major opportunity to reduce preventable adverse medical events and improve medication management through new, evidence-based, individualized care management strategies that use data, analytics, and technology.

And of course, improvements to quality and safety through 21^st century care benefits the payer and purchaser communities as well, whether it be major insurers, employers, private payers, or taxpayers. The United States spends 17 percent of its total GDP on healthcare each year—more than 5 percent greater than that of the next leading nation, and conservative estimates consider roughly one-third of spending on healthcare services to be wasted. 

Call to Action

AHRQ’s 21^st Century Care Initiative is a jumping off point for a larger discussion within the healthcare community about the need for a focused and expanded effort to build a greater research and evidence base for driving high-quality, high-value care. As we move forward with our initiative, we will build on recommendations and insights from the AHRQ-commissioned RAND report published in 2020, the 2018 National Academy of Medicine Future of Health Services Research report, and numerous roundtables, summits, and listening sessions AHRQ has hosted over the last 2 years.

We have so much to contribute toward improving the delivery of healthcare, and we look forward to unlocking the potential of 21^st century care for all Americans.  

Gopal Khanna is Director of AHRQ.

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