Performance Budget Overview 2006

A. Statement of AHRQ Mission

The Agency for Healthcare Research and Quality (AHRQ) promotes health care quality improvement by conducting and supporting health services research that develops and presents scientific evidence regarding all aspects of health care. Health services research addresses issues of organization, delivery, financing, utilization, patient and provider behavior, quality, outcomes, effectiveness and cost.

It:

• Evaluates both clinical services and the system in which these services are provided.
• It provides information about the cost of care, as well as its effectiveness, outcomes, efficiency, and quality.
• It includes studies of the structure, process, and effects of health services for individuals and populations.
• It addresses both basic and applied research questions, including fundamental aspects of both individual and system behavior and the application of interventions in practice settings.¹

The vision of the Agency is to foster health care research that helps the American health care system provide access to high quality, cost-effective services; to be accountable and responsive to consumers and purchasers; and, to improve health status and quality of life.

AHRQ fulfills its mission through establishing a broad base of scientific research and promoting improvements in clinical and health system practices, including the prevention of diseases and other health conditions. To achieve the quality, safety, efficiency and effectiveness of healthcare for all Americans.

B. Discussion of Strategic Goals

AHRQ is, of course, a research agency; however, research is only a beginning and not an end in itself. On a daily basis, this means ensuring that providers use evidence-based research to deliver high-quality health care and to work with their patients as partners. Evidence helps patients to become better informed consumers and to be partners in their own care. It also means working at the grassroots level to help local policymakers understand what they can do to improve the quality of health care for their constituents and ensuring that local public health officials have the latest information to help them be better prepared for a possible bioterrorism event. Accomplishing this goal requires a strategic approach to assure that research findings are ready to use, widely available and actionable—e.g., bringing clinicians up-to-date findings via personal digital assistants (PDAs). This step is a critical component of the new vision for AHRQ.

To this end, we have made significant improvements in realigning the work we do with our strategic goals and those of the Department (Select for Links to HHS and AHRQ Strategic Plans). For information on the breakout of our budget by HHS strategic goal, please refer to the HHS Budget by Strategic Goal displays in the Overview of the FY 2006 Annual Plan. Over the past year, we examined the broad spectrum of our work and reorganized our activities into strategic plan goals and within 10 research portfolios that cut across our Offices and Centers. Our goal is to capitalize on the research strengths and expertise throughout the Agency, to communicate the focus of our research clearly, and to improve our ability to move research from idea generation to strategies that can be adopted into practice.

The FY 2006 Request is AHRQ's first submission that articulates, arrayed within our current budget lines, our best estimate of how funding will be allocated across our strategic plan goals. As we progress through the budget cycle, AHRQ will continue to make refinements to these estimates based on continued evaluation of the strategic plan goals and feedback from various customers.

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¹Eisenberg JM. Health Services Research in a Market-Oriented Health Care System. Health Affairs, Vol. 17, No. 1:98-108, 1998.

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C. Overview of AHRQ Performance

As a result of the increased emphasis on strategic planning, the Agency has shifted from a focus on output and process measurement to a focus on outcome measures. These outcome measures cascade down from our strategic goal areas of safety/quality, effectiveness, efficiency and organizational excellence. Portfolios of work (combinations of activities that make up the bulk of our investments) support the achievement of our highest level outcomes.

AHRQ strategic goals guide the overall management of the Agency. The annual performance contracts identify critical success factors that illustrate how each office and center contributes to AHRQ achieving its strategic and annual performance goals, as well as internal office and center management goals. This nesting of plans allows the individual employee to see how her or his job and accomplishments further the respective unit's goals and the Agency's mission. At the end of each year, the Office and Center directors along with portfolio leads review accomplishments in relation to the annual goals and draft the next year's plan. The results of the reviews contribute significantly to the performance reports that are influential in revising the Agency performance goals.

In continuing AHRQ's commitment to budget and performance integration, we reorganized the management structure. This new structure aligns those who are responsible for budget formulation, execution and providing services and guidance in all aspects of financial management with those who are responsible for planning, performance measurement and evaluation. These functions are now within one office.

Finally, AHRQ completed comprehensive program assessments on five key programs within the Agency:

• The Medical Expenditure Panel Survey (MEPS).
• The Healthcare Cost and Utilization Project (HCUP).
• The Consumer Assessment of Healthcare Plans Survey (CAHPS®).
• The grant component of AHRQ's Translation of Research into Practice (TRIP) activity.
• The Quality/Safety of Patient Care program.

For the FY 2006 budget, the agency conducted a PART of the Pharmaceutical Outcomes Program. These reviews provide the basis for the Agency to move forward in more closely linking high quality outcomes with associated costs of programs. Over the next few years, the Agency will focus on fully integrating financial management of these programs with their performance.

D. Overview of AHRQ Budget Request

The FY 2006 Request for AHRQ totals of $318,695,000, maintaining the FY 2005 Appropriation. This budget allows AHRQ to support ongoing efforts to improve the quality, safety, outcomes, access to and cost and utilization of health care services.

Details of FY 2006 Budget by Strategetic Goal

FY 2006 Strategic Plan Goals—Increase over FY 2005 Appropriation	HCQO	MEPS	Program Support	Total
Safety/Quality    (Patient Safety non-add)	+$226,000 (0)	0 (0)	0 (0)	+$226,000 (0)
Efficiency	+$150,000	0	0	+$150,000
Effectiveness	-$376,000	0	0	-$376,000
Organizational Excellence	0	0	0	0
Total Change	+$0	+$0	+$0	+$0

AHRQ's budget maintains the support provided in the FY 2005 Appropriation for the HCQO budget activity, with 64 percent of the total allocated for AHRQ's Safety/Quality strategic plan goal. One of this goal's primary missions is to increase the safety and quality of the health care for all Americans. This strategic plan goal supports AHRQ's patient safety program. The effectiveness strategic plan goal includes continuation funding of $15,000,000 for comparative effectiveness research authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The MEPS budget activity is maintained at the FY 2005 Appropriation. MEPS continues to provide the only national source for annual data on how Americans use and pay for medical care. Finally, Program Support is maintained at FY 2005 Appropriations to cover mandatory costs related to the overall direction of the Agency.

Mechanism Discussion

AHRQ’s research, in terms of funding mechanisms, follows:

• Research Grants: In total, the FY 2006 Request provides $89,009,000 for research grants, a decrease of $13,294,000 from the FY 2005 Appropriation of $102,303,000.

  This Request will provide $10,677,000 in new grant funds, a decrease of $15,683,000 from the FY 2005 Appropriation. The new grants will be used to continue research into our three strategic plan goal areas, as well as focus research to our 10 research portfolios of work, with an increased focus on prevention, pharmaceutical outcomes, and training. In terms of patient safety research, AHRQ will provide $2,434,000 for new research grants related to patient safety and health information technology.

• Non-MEPS Research Contracts and Inter-Agency Agreements (IAAs): In total, the FY 2006 Request provides an increase of $11,259,000 for non-MEPS research contracts and IAAs from the FY 2005 Appropriation of $106,827,000. These funds will be used to provide new and continuation support for research contracts and IAAs funded by our 10 portfolios of work, with an increased focus on prevention, pharmaceutical outcomes, and patient safety research. Funds are provided to continue $15,000,000 in non-MEPS contracts and IAAs to carry out components of Section 1013 of the MMA.

• Medical Expenditure Panel Surveys (MEPS) Contracts: The FY 2006 Request for the Medical Expenditure Panel Surveys (MEPS) totals $55,300,000, maintaining the FY 2005 Appropriation.

• Research Management: In FY 2006, AHRQ's Request provides an increase of $2,035,000 for research management costs. These funds will provide for mandatory increases.

• Patient Safety: In FY 2006 AHRQ will continue its work in the area of patient safety. AHRQ's patient safety program is aimed at identifying risks and hazards that lead to medical errors and finding ways to prevent patient injury associated with delivery of health care. The FY 2006 Request for patient safety is $84,000,000, the same level of support as the FY 2005 Appropriation.

  This budget provides $2,434,000 in new research grants related to patient safety and health information technology and continues the $49,886,000 for the Patient Safety Health Care Information Technology program begun in FY 2004. The Health Care Information Technology program supports a variety of activities aimed at improving health care quality and patient safety by promoting and accelerating the development, adoption and diffusion of interoperable IT in a range of health care settings, including small and rural communities where health information technology penetration has been low.

  The budget also continues $10,000,000 in contracts and inter-agency agreements (IAAs) for the development of clinical terminology, messaging standards, and other tools needed to accelerate the use of cost-effective healthcare information technology. (The patient safety program is contained in AHRQ's Safety/Quality strategic plan goal.)

For details, select Mechanism Table.

E. Program Assessment Rating Tool (PART)

PART Summary Table, FY 2004-06 (Dollars in Millions)

FY 2004 PARTs	FY 2004 Enacted	FY 2005 Appropriation	FY 2006 Request	Narrative Rating
Data Collection and Dissemination	$65	$65	$63	Moderately Effective
Translating Research into Practice	$8	$6	$1	Adequate
FY 2005 PARTs
Patient Safety	$80	$84	$84	Adequate
FY 2006 PARTs
Pharmaceutical Outcomes	$13	$27	$26	Moderately Effective

Data Collection and Dissemination

This program collects data on the cost (Medical Expenditure Panel Survey), use (Healthcare Cost and Utilization Project), and the quality of health care in the United States and develops and surveys beneficiaries regarding their health care plans (Consumer Assessment of Health Plans). In FY 2004 and FY 2005, the portfolio was given additional funding due to performance-based improvements coming from the PART. This funding supports efforts to ensure continued collection and availability of national health care cost, use, and quality data. This support was not provided in FY 2006.

Translating Research into Practice

In FY 2005, AHRQ requested $5.8 million for studies focused on translating research into practice (TRIP). In FY 2006 this program decreases by $5.2 million. The drop in funds reflects a refocus of our TRIP activities. Although not part of our TRIP request for applications, in FY 2005 AHRQ funded a new grant and contract program: Research Empowering America's Changing Healthcare System (REACHES). These grants and contracts will expand work in the area of adopting research findings in real-world settings and assessing their impact and generalizability. REACHES places greater emphasis on translation, dissemination, and implementation in a broader sense. AHRQ's planned revision of the strategic goals and its organizational realignment allows for this implementation strategy.

Patient Safety

Patient safety research is a vital component to AHRQ's continuing efforts to make improvements in the safety and quality of care. The FY 2006 Budget includes $84 million. This level of support provides continuation funds of $49.9 million for the Patient Safety Health Care Information Technology program begun in FY 2004. This program will support a variety of activities aimed at improving health care quality and patient safety by promoting and accelerating the development, adoption and diffusion of interoperable information technology in a range of health care settings, including small and rural communities where health information technology penetration has been low.

Pharmaceutical Outcomes

In FY 2005, AHRQ requested $27 million for this portfolio, including $15 million in funds authorized by Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. These funds will continue into FY 2006. These funds support a series of state-of-the-science studies that review existing scientific information on which drugs work best, for which patients, and under what circumstances. This portfolio also includes funding for the Centers of Excellence for Research and Therapeutics (CERTs) program. These grants are a vital funding component of this portfolio. The CERTs currently consist of seven research centers and a Coordinating Center. The CERTs receive funds from both public and private sources with AHRQ providing core financial support. The CERTs seek to develop new and effective ways to improve the use of therapeutics throughout the Nation's healthcare system.

For details, select FY 2004-2005 PART Summaries and FY 2004-2005 PART Recommendations.

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Budget Activities

The budget is arrayed by AHRQ's budget activities:

1. Health Care Costs, Quality, and Outcomes (HCQO).
2. Medical Expenditure Panel Survey (MEPS).
3. Program Support.

Health Care Costs, Quality, and Outcomes (HCQO)

The purpose of the Research on Health Care Costs, Quality and Outcomes activity is to support and conduct research that improves the outcomes, quality, cost, use and accessibility of health care. The Agency has identified four main strategic plan goal areas:

1. Safety/Quality.
2. Efficiency.
3. Effectiveness.
4. Organizational Excellence.

For details, select Research on Health Costs, Quality, and Outcomes.

Medical Expenditure Panel Survey (MEPS)

The Medical Expenditure Panel Survey is the only national source for annual data on how Americans use and pay for medical care. It supports all of AHRQ's research-related strategic goal areas. The survey collect detailed information from families on access, use, expense, insurance coverage, and quality. Data are disseminated to the public through printed and Web-based tabulations, micro data files, and research reports and journal articles.

MEPS provides public and private sector decisionmakers with the ability to:

• Obtain timely national estimates of health care use and expenditures, private and public health insurance coverage, and the availability, costs and scope of private health insurance benefits among the U.S. population.
• Analyze changes in behavior as a result of market forces or policy changes (and the interaction of both) on health care use, expenditures, and insurance coverage.
• Obtain information on access to medical care, quality and satisfaction for the US population and for those with specific conditions, and for important subpopulations.
• Develop cost and savings estimates of proposed changes in policy.
• Identify the impact of changes in policy for key subgroups of the population (i.e., who benefits and who pays more).

For details, select Medical Expenditure Panel Survey.

Program Support

Program Support provides support for the overall direction and management of the AHRQ. This includes the formulation of policies and program objectives; and administrative management and services activities.

For details, select Program Support.

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Current as of February 2005

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Internet Citation:

Budget Estimates for Appropriations Committees, Fiscal Year 2006: Performance Budget Submission for Congressional Justification. February 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/cj2006/cjweb06.htm

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