FEATURE
PATIENT CENTERED OUTCOME RESEARCH
INSTITUTE (PCORI)—OBAMACARE GOES LONG ON
POPULATION RESEARCH
AUTHOR Tom James, MD
In December, I drove from Western Pennsyl-
vania to Washington to join a panel tasked to
evaluate research funded by a unique pub-
lic-private agency. As I scanned the snowy
Laurel Highlands of Pennsylvania, dipping
down mountain roads into Maryland, and
then braced for the busy highways of the
District, I thought about the job ahead. I
would be reviewing the worthiness of various research projects
being funded by the Patient-Centered Outcomes Research Insti-
tute (PCORI).
The (PCORI) was established in the 2010 Patient Protection and
Affordable Care Act, otherwise known as Obamacare. The feder-
al charge for PCORI is to provide funding for research regarding
the effectiveness of various care programs and products. There
was significant argument at the time of enactment about whether
the goal of PCORI was to fund research on “effectiveness” or on
“cost-effectiveness.” In order to ensure passage, there was biparti-
san support to deal only with effectiveness of products and pro-
grams and leave the cost factor out of consideration.
Funding for PCORI comes through the Patient-Centered Out-
comes Research Trust Fund (PCORTF). This fund receives its rev-
enues from the US Treasury and from an inflation-adjusted fee
on private insurance of $2 for every person covered by private in-
surance. One of the ironies of this legislation is that it is funded
in large part by insurers who push on reducing costs, but PCORI
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is not allowed to look at cost-effectiveness. PCORI has revenues
of about half a billion dollars annually and distributes over $300
million in research grants yearly.
When I applied to participate in a PCORI panel, I found that
there were two main tracks for funding, with various subdivisions.
The primary programs include "Evaluation and Analysis" and "En-
gagement." The former provides technical expertise in program
design and to “fill clinical information gaps by producing valid,
trustworthy, and useful new evidence comparing the effectiveness
of different clinical options.”
The other track includes subcommittees on Healthcare Delivery
and Disparities Research (HDDR), which is my panel, with oth-
ers being Evaluation and Analysis, and Engagement and Research
Infrastructure. The focus of HDDR is on “comparing patient-cen-
tered approaches to improve the equitability, effectiveness and
efficiency of care.” That rather broad and lofty set of principles
means that HDDR can evaluate a wide set of research topics on
the organization patterns of healthcare, the social interfaces with
medicine, coordination of services and how efficiently these all
function. PCORI does not actually do the research, but selects
the research efforts that will get federal money. After the initial
enabling legislation in 2010, PCORI is coming up for its first re-
authorization. Staff members expressed confidence publicly, but
privately they worried about the volatility of the budgetary process
in Washington.
Since its inception, PCORI has awarded $925 million, funding