Ready to provide evidence for 'making adjustments' in Obamacare

Richard Kronick is the new director of the Agency for Healthcare Research and Quality at HHS. He was named to the post in August, succeeding Dr. Carolyn Clancy, who held the position for nearly a decade. He joined HHS in 2010 as deputy assistant secretary for planning and evaluation, overseeing the Office of Health Policy. Prior to that, he worked as a health policy researcher at the University of California at San Diego in the department of family and preventive medicine. Modern Healthcare's Maureen McKinney recently interviewed him about his vision and priorities for AHRQ's work in making healthcare better and safer and in evaluating the impact of the Patient Protection and Affordable Act on expanding healthcare coverage and access. The following is an edited excerpt:

Modern Healthcare: Tell us your vision about AHRQ going forward.

Richard Kronick: Our new mission statement is to produce evidence to make healthcare safer, higher quality, more accessible, equitable and affordable and to work with HHS and other partners to make sure that the evidence is understood and used. The mission statement calls out that our job is to produce evidence. What we will do is to produce evidence to improve how healthcare is delivered in the U.S. and crucially to work with HHS and other partners to make sure that the evidence is understood and used, because evidence by itself, as we all know, doesn't do anything. The evidence needs to really be understood and adopted by the people who are making decisions about how healthcare is delivered and financed.

MH: What will the agency's priorities be?

Kronick: We are proposing four priorities for the coming years for the agency that follow the mission statement. The first is to produce evidence to make healthcare higher quality; the second is around safety; the third, accessibility; and the fourth, affordability. On the first priority, we are proposing a major initiative to provide supports to small and medium-sized physician practices to improve performance on cardiovascular risk factors, aspirin, blood pressure, cholesterol and smoking and to provide the ability for these practices to adopt new Patient-Centered Outcomes Research Institute findings as they emerge. That's a very exciting initiative that I and others are looking forward to.

The second priority to produce evidence to make healthcare safer follows on successes the agency has had in producing methods of reducing hospital-acquired infections. We have started with central-line infections and catheter-associated urinary tract infections and are extending that in a variety of other areas, as well as producing evidence about how to reduce the friction and difficulties associated with medical malpractice once harm occurs.

The third priority, producing evidence to improve the accessibility of healthcare, will focus on evaluating the effects of the coverage expansions, the Medicaid and marketplace coverage expansions, in the Affordable Care Act.

The fourth priority of producing evidence to improve affordability will include an initiative to work with states that are trying to provide information on prices that hospitals and physicians and other providers receive. That means improving price transparency and also working on creating information about comparative performance of health systems in the U.S. If we look across the country at a thousand or so different healthcare systems, it will be very valuable to have evidence about how they perform on resource use, things like hospitalization, ICU days, use of MRIs and CT scans, as well as on quality.

MH: You said that you will be looking at evidence on reducing other types of infections. Will you be looking at other types of harm as well?

Kronick: Yes. Through the work of Dr. Peter Pronovost and others, we developed tool kits that have led to over a 40% reduction in central-line infections; and more recently, to about a 20% reduction in catheter-associated urinary tract infections. We will be extending that work to surgical-site infections and ventilator-acquired pneumonia in the hospital. We will also be looking at other kinds of adverse events, particularly falls and pressure ulcers.

We have some early work that suggests the possibility of major progress in those areas in hospitals as well as in nursing homes. We will also be working on extending some early work on reducing harms from obstetrical care.

MH: You mentioned AHRQ's role in evaluating the expansion of insurance through the Obamacare insurance exchanges. Are you expecting pushback from being involved in that?

Kronick: I am sure there will be some people who will be upset at our involvement there. Clearly there are some people who think the Affordable Care Act should be repealed and probably will argue that any government investment in trying to understand the effects of the ACA is money that is misspent. My own view is that we are an agency responsible for producing evidence that will lead to improvements in accessibility, affordability, quality and safety.

We are in the midst of the largest change in healthcare financing since the Medicare and Medicaid programs were established in 1965 and the HHS secretary and members of Congress will need information about the effects of this change as they work on making adjustments moving forward.

MH: How will the evidence produced by AHRQ help policymakers?

Kronick: We have seen already that the Affordable Care Act is not static. There have already been changes in policy, and I am sure that in two years and in four years the secretary and members of Congress, assuming that the ACA is still on the books, will be looking at further changes and these decisionmakers will need information about things such as: What is the effect of the Affordable Care Act on the labor market?

There has been a lot of concern about potential increases in part-time labor and perhaps increases in entrepreneurship and reduction in job lock. The decisionmakers will need good information to make better-informed decisions moving forward as well as in trying to understand the effects of coverage on newly covered people, on utilization, health services and on health status and financial security. So, I am sure that there will be some pushback. There is clearly some risk in this. There is also risk that my boss, HHS Secretary Kathleen Sebelius, may well be unhappy with some of what we produce. But again, I don't see how we can do our job responsibly if we ignore this major change in how we finance healthcare.

MH: One of the priorities you mentioned is comparative effectiveness research. Is AHRQ is planning to work with PCORI, and, if so, how will the two organizations work with each other?

Kronick: We coordinate very closely with our colleagues at PCORI. I and many staff members are in frequent contact with staff at PCORI. You know the statute provides some help in understanding the prospective roles of PCORI and AHRQ. PCORI's primary role is to conduct patient-centered outcomes research to try to figure out whether treatment A works better than treatment B. And AHRQ's primary roles are in dissemination, training and development of methods to conduct this outcomes research.

And the first priority that I discussed outlines a way in which we would use the resources from the Patient-Centered Outcomes Research Trust Fund for a major initiative to test what effective methods of dissemination of patient-centered outcomes research would be.