Researching the most important questions shaping quality and safety

If you’ve never heard of AHRQ, you’re not alone. But the Agency for Healthcare Research and Quality is quietly fueling research that’s shaping the fundamentals of the U.S. healthcare system. In October, Modern Healthcare reporter Elizabeth Whitman spoke with Dr. Andy Bindman, who became AHRQ’s director in May, about the agency’s work, its influence, and the perks and perils of running a little-known federal agency (story, p. 14). A primary-care physician, Bindman spent nearly 30 years at San Francisco General Hospital—the city’s safety net provider—and much of his own research has investigated barriers in access to care. The following is an edited transcript.

Modern Healthcare: How would you describe AHRQ’s philosophy?

Dr. Andy Bindman: Our philosophy is to facilitate research on the most important questions that shape healthcare quality and safety. We are not a payer, we’re not a regulator. What we can do is really try to be a facilitator to work with healthcare providers and health systems to support quality improvement and safety improvements—ways of making the healthcare system work better.

We invest in research, and we’re also very involved in synthesizing research findings to formulate evidence. We draw this distinction between research findings versus evidence, which is the compilation of the findings from multiple studies on a topic area. Then, we are involved then in trying to disseminate and implement those findings. We don’t want a little evidence museum here at AHRQ.

Our third pillar is that we have data to try to measure the impact of our work. Are the ways that we’re getting information out there making a difference in terms of improving quality and safety and so forth?

MH: Are there any themes or similarities in the key areas of research you support?

Bindman: Our sister agency, the CMS, has obviously been experimenting with new payment models— paying for value instead of volume. We aren’t the organization that’s generating that call for change in payment, but there is a lot of research needed to know how to best do that.

What types of things in healthcare might be paid best through fixed amounts? What might be best paid through incentivized amounts? We have people think about that, study it.

MH: Social determinants have a significant impact on a person’s health. How do you approach the issue of patient outcomes being so greatly affected by factors that are outside the purview of the healthcare system?

Bindman: At AHRQ, we care a great deal about issues of accessibility, issues of equity, issues of affordability. We try to be a reliable source of information about progress that we’re making in addressing these issues. For example, we put out a national quality report as well as a disparities report.

Second is, we are a research agency, investing to determine strategies that can be used within healthcare to bridge the kinds of gaps that you’re talking about.

As healthcare systems have more of this population focus and have responsibility for the outcomes of their patients, they can start to see maybe it is worth making an investment in food programs, or in working with local officials to make investments so that we can have savings related to reducing hospitalizations, or addressing some housing instability issues in communities.

I think that having research that demonstrates the return on these investments would probably give payers more confidence about whether they could creep into areas which were not always historically thought of as healthcare.

MH: Are you saying that the boundaries have changed?

Bindman: I think people are trying to think about how to work better across the boundaries, and there’s an openness to rethinking where the boundaries should be. I don’t think it’s AHRQ’s role to tell payers how to change the boundaries.

“We want practitioners to help determine the important questions we need to be addressing, and for that research to be fed back to them so they can apply it in practice.”

But I do think that there are ways to research the interaction of healthcare with these other social services that could give us feedback. What are the associated savings to healthcare by making these kinds of investments in effective case management and things like that?

If we don’t figure out how to address some of these social determinants, we’re always going to be left with addressing the problem in a less than efficient way in healthcare delivery.

MH: Last year, legislators tried to slash your budget. There were claims that AHRQ’s work is redundant. How you deal with that perception and the challenges it poses when legislators who determine funding deem your work unnecessary?

Bindman: It’s a very legitimate question and an important one that I have thought a lot about since being here for the last five months or so.

I think AHRQ’s work is critical. We’re really the only federal agency whose mission is to improve the safety and quality of the U.S. healthcare system. We have a relatively small budget ($325 million annually) to be able to take on an enormous challenge.

We’re very strategic in our investments and trying to find innovative opportunities that can have a big impact. Our successes come about because we hand off tools to others who then put them in place. And so that doesn’t necessarily result in someone saying, “We did this because AHRQ gave it to us.”

What I’ve been trying to do is identify and communicate those stories. We’re not about trying to be the name brand. That’s not our goal. Our goal is to make you be able to provide healthcare better and safer. But we’ve learned that because if we don’t tell these stories in this way, that we are subject to questioning about what role we’re playing.

MH: We have an election coming up and a new president next year. Is there anything that you hope to accomplish by the end of the year?

Bindman: We’re not coasting by any means. We’re continuing to go full speed ahead. And I think some of the areas that we’re particularly excited to make sure we have the foundational pieces in place for our work to continue on into the next administration. AHRQ is at its heart a research agency that generates knowledge, and so what we think is critical is to have a very effective feedback loop between practitioners and research. We want practitioners to help determine the important questions we need to be addressing, and for that research to be fed back to them so they can apply it in practice.

These are things that I think have a long horizon, well beyond the election, but we’re trying to make sure that the pieces are in place to have them started before the end of the year. ●

Editor’s note: Bindman provided the following statement after the election of Donald Trump on Nov. 8: “AHRQ’s focus continues to be about making healthcare safer, higher quality, more accessible, equitable and affordable for Americans. We have not received any indications at this point that there will be any changes in AHRQ’s mission.”