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Remarks on AHRQ's 20th Anniversary Celebration

Eric D. Hargan
AHRQ National Advisory Council, AHRQ staff
November 21, 2019
AHRQ Headquarters

Secretary Azar has laid out three cross-cutting platforms where HHS is working to deliver on the President's vision: first, reforming the financing of care; second, deriving better value from that care; and third, improving health in specific, impactable areas.
AHRQ is uniquely suited to help us deliver on these three different platforms. For the past 20 years, AHRQ has been a leader in bringing innovation to the delivery of healthcare in the U.S.

Thank you, Gopal, and good afternoon, everyone. It's an honor to join all of you today in celebrating AHRQ's 20th anniversary.

This anniversary is an important milestone for HHS and for AHRQ, and for our broader effort, as a nation, to improve the quality, safety, and value of our healthcare system.

I'm also pleased to see so many AHRQ staff members in the audience, as well as members of AHRQ's National Advisory Council. Unfortunately, the Council's outgoing chairman, Don Goldman, couldn't be here today, but I'd like to thank him for his service on the council, and also recognize Andy Masica, who is standing in today as the Council's chairman.

It's also terrific to see a number of other external leaders here, including Lisa Simpson and Bruce Siegel, who have been great promoters of AHRQ's work.

Because of the efforts of AHRQ staff members, past and present, as well as leaders like Don, Lisa, Bruce, and so many others, the Agency has had impact on patients that's far greater than could be have been imagined at its launch just 20 years ago.

In marking this anniversary for AHRQ, of course, we also remember its first director, John Eisenberg, who was so dedicated the quality of care the American people receive.

John cared about enhancing the quality of medical care, because delivering better quality care leads to better health for patients.

Better health is the fundamental goal of the vision President Trump has for our healthcare system, and that is why AHRQ's importance today looms as large as ever.

The President has a particular vision for healthcare: a system with affordable, personalized care, a system that puts you in control, provides peace of mind, and treats you like a human being, not a number.

Now, ironically, everyone at AHRQ is actually, in a sense, in the business of viewing patients as numbers.

But unlike the way things can too often feel in our healthcare system, the men and women of AHRQ, and the researchers they support, clearly appreciate and care about the human beings behind the numbers.

Secretary Azar has laid out three cross-cutting platforms where HHS is working to deliver on the President's vision: first, reforming the financing of care; second, deriving better value from that care; and third, improving health in specific, impactable areas.

AHRQ is uniquely suited to help us deliver on these three different platforms. For the past 20 years, AHRQ has been a leader in bringing innovation to the delivery of healthcare in the U.S.

AHRQ's focus is not curing specific diseases, but improving the delivery of healthcare itself.

As all of you know, the Agency doesn't foster development of new medications to treat diseases. Instead, AHRQ works to improve how patients access and use healthcare services, and how those services are provided.

Or, as Gopal likes to say, cure and care are two sides of the same coin. We need science and research to discover new cures, but we also need science and research to improve care, too. This means that AHRQ's work on improving care delivery, with the ultimate goal of better health, is a crucial piece of the President's and Secretary Azar's vision.

AHRQ's core competencies in health systems research, practice improvement, and data and analytics are absolutely vital to delivering the kind of better health and patient-centric system that we're aiming for.

The scope of AHRQ's work over the last 20 years is impressive: AHRQ has awarded nearly 3,900 grants to over 3,000 principal investigators, totaling more than $3.1 billion.

This is a transformational contribution to what we know about how healthcare works in America. We would have much less of an idea of how we can get to improved financing, value-based care delivery, and particular health areas without the research AHRQ has been doing.

So today, I want to mention a few particular highlights of AHRQ's work in some of these areas, before concluding with some thoughts on where AHRQ is headed next.

AHRQ's work is in part built on trying to track healthcare at the level of individual patients, healthcare settings, and systems, enabling rapid analyses of real-world trends and in-depth research to understand healthcare's most pressing issues.

AHRQ's flagship data sources, the Medical Expenditure Panel Survey, or MEPS, and the Healthcare Cost and Utilization Project, or HCUP, are two of the most used resources for defining and describing the U.S. healthcare system and expanding the healthcare knowledge base.

We would not know so much that we do know now about the financing and delivery of care in America without HCUP and MEPS.

These data sets aren't simply about what happened in the past. They are tremendous assets in addressing emerging, real-time needs of policy makers, health system leaders, local public health officials, and others—what's known as the field of predictive analytics.

As one example of forward looking work, AHRQ staff has used MEPS data to produce a variety of estimates for our work on drug pricing reforms.

These estimates featured analyses of drug coverage, trends in retail drug prices, payer discounts, and price mark-ups, and trends in out-of-pocket costs by drug type, patient characteristics, and insurance coverage. Understanding the immensely complicated world of American drug pricing is no easy task—and AHRQ has been an invaluable partner in that work.

But perhaps an even more daunting challenge is not just understanding financing and care delivery, but actually driving changes in medical practice to deliver higher value, better quality care. Changing clinical practices is difficult, and people delivering care need proven methods to apply research to their patients' situations.

AHRQ has been a leader in synthesizing evidence and then developing practical, useable tools and resources for health systems and frontline clinicians to use in delivering safe, high-quality, high-value care.

AHRQ's EvidenceNow initiative is one example. This $116 million effort is one of AHRQ's largest primary care projects to date and is helping primary care practices implement evidence to improve patients' heart health.

I'll mention a couple other examples of particular transformative efforts. Earlier this year, I had the opportunity to visit University Hospitals Health System, in Cleveland, Ohio, and meet with Peter Pronovost.

I had met Peter previously, but not had the chance to spend time with him and hear about his work.

In 2004, AHRQ funded Peter in testing the Comprehensive Unit-based Safety Program, or CUSP, a team-based intervention to prevent deadly central line-associated blood stream infections in over 100 hospital ICUs in Michigan. That project's success led AHRQ to deploy CUSP in more than 1,100 intensive care units nationwide. Across the nation, potentially fatal central line infections decreased more than 40 percent.

I'll give you another example: AHRQ's funding for reducing readmissions led AHRQ grantee Brian Jack, of Boston University Medical Center, to create the RED, the Re-Engineered Discharge Toolkit, a standardized approach to discharge planning.

Patients whose care incorporated the RED protocol had almost one-third fewer return trips to the hospital within 30 days and an average of $400 in lower costs. Because of those successes, AHRQ funded a project to train scores of hospitals across the United States to implement the RED Toolkit.

I want to make a particular point about care delivery: As we're moving toward a system where more and more providers are paid based on outcomes rather than procedures, these kinds of best practices are going to become even more important and more valuable.

If you think AHRQ's work on identifying and disseminating solutions like this has been important over the past couple decades, just wait until we're not just giving doctors information about these tools—we're also rewarding them for the outcomes they can get from using them.

The final platform for delivering on the President's healthcare vision is making progress on impactable health challenges, like our crisis of opioid addiction and drug overdose, advancing American kidney care, ending the HIV/AIDS epidemic in America, and improving rural health.

AHRQ's work has helped identify promising ways forward on many of these challenges, too.

I'll mention a particular example many of you may be familiar with: In 2004, AHRQ awarded a grant to Sanjeev Arora, of the University of New Mexico's School of Medicine, to establish and evaluate the first clinic for the Extension for Community Healthcare Outcomes initiative, known as Project ECHO.

This project opened the lines of communication between disease experts at an urban academic medical center and rural primary care physicians to combat widespread untreated hepatitis C in New Mexico.

Since then, Project ECHO has become a national and international success story for a large number of particular disease areas.

This fall, I had a chance to travel to New Mexico and hear some more about these successes.

Most of you here don't need me to tell you what an amazing impact ECHO has had.

I will just note that no one who's heard me talk about promising rural health efforts needs a reminder of it, either, because I mention Project ECHO just about every time I'm talking about that topic.

Today, additional AHRQ funding is currently supporting states to use the ECHO model for opioid-addiction treatment—just a piece of a number of efforts AHRQ has undertaken to help combat our country's crisis of opioid addiction and drug overdose.

Now, I've laid out some of the accomplishments AHRQ has already delivered, within the strategies Secretary Azar has identified.

But we also have to look to the future, and I know Director Khanna, the Agency's Senior Leadership Team, staff members, and all of AHRQ's partners are thinking about where you can go next to continue improving our healthcare system.

That's why I've been so pleased to learn about the three areas that, together, you have determined are priorities for AHRQ and critical to making sure that patients receive 21st century healthcare: first, improving care for people with multiple chronic conditions; second, improving diagnostic safety; and third, supporting healthcare decision making at the local level through greater access to data that creates a 360-degree view of the whole patient.

Each of these areas is compelling and demands attention.

More than 25 percent of Americans are living with multiple chronic conditions, including 80 percent of Medicare beneficiaries.

Just imagine the impact that these conditions have on our financing systems—and how important it is to get care delivery right for the patients living with them.

Twelve million Americans suffer a diagnostic error each year; more than 4 million people each year suffer severe consequences as a result of diagnostic delays and errors. Think about what a costly mistake that can be in care delivery—and the impact it can have on a patient's health.

And healthcare decision makers too often lack access to timely, reliable data and analytics to make informed policy and operational decisions.

Think about how that can keep them in the dark about ways to bring down costs, deliver better value, tackle particular health challenges, and, above all, put the patient at the center.

So I'm very glad to hear that AHRQ has identified these major challenges. I applaud your work so far, and I'm confident that your work is going to continue to bear fruit for the American people.

So thank you for holding this terrific event and allowing me to be part of saluting AHRQ and each one of you.

Under this administration and in the coming years, we can make a lasting difference in the care that patients receive, and make a lasting improvement in the health of the American people. I look forward to working with AHRQ and all of you to do just that.

Content created by Speechwriting and Editorial Division 
Content last reviewed on November 21, 2019