AHRQ Announces Interest in Research on Healthcare Delivery System Affordability, Efficiency, and Quality

Notice Number: NOT-HS-14-005

Key Dates
Release Date: December 18, 2013

Related Announcements

Issued by
Agency for Healthcare Research and Quality (AHRQ)


The mission of the Agency for Health Care Research and Quality is to produce evidence to make health care 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. 

One major priority is producing evidence that will increase the affordability, efficiency and quality of health care.  AHRQ seeks to develop and spread evidence and tools to measure and enhance the efficiency of health systems– the capacity to produce better quality and outcomes while avoiding overutilization, or to maintain quality and outcomes with lower resource use. This includes analyzing variations in quality and resource use, and identifying the factors that differentiate higher-performing (more efficient and higher quality) from lower-performing systems, with special emphasis on understanding the policy-relevant effects of different workforce configurations, organizational strategies, and compensation methods.  AHRQ also will fund work to develop and test interventions to improve performance, with the goal of providing promising models to the Center for Medicare and Medicaid Intervention (CMMI), states, and private payers and systems. 

Research Areas of Interest

Health Care Delivery Systems:  The Affordable Care Act has catalyzed interest in delivery system reform. AHRQ is interested in funding research that will provide information to compare delivery systems on resource use and quality metrics.   Potential research questions include, but are not limited to:

  • What are alternative methods of defining delivery systems, and what are the advantages and disadvantages of alternative approaches for the purpose of comparing systems on efficiency and quality metrics?  Such methods could include, for example, self-identified Accountable Care Organizations; identification of hospitals that are jointly owned and the physicians that are affiliated with them; identification of physicians who share patients and appear to refer frequently to each other.
  • What are alternative methods of attributing patients to delivery systems, and the advantages and disadvantages of these methods for the purpose of comparing systems on efficiency and quality metrics?
  • What metrics are available to characterize performance (quality and resource use) between and within systems, and how can these metrics be improved?
  • How do delivery systems compare on quality and resource use metrics? 
  • To what extent do differences in delivery system performance on quality and resource use simply reflect regional variations, and to what extent do these performance differences reflect characteristics specific to a particular system?  
  • Does delivery system performance for care delivered to Medicare beneficiaries differ from that of care delivered to privately insured, uninsured or Medicaid beneficiaries in the same region or market? In other words, are regional variations consistent across payers?
  • What are alternative methods of defining organizational and practice characteristics?  Using a preferred (or feasible) method of defining such characteristics, what is frequency of each type of organization, and how are methods of organization changing over time? Are organizational characteristics systematically related to efficiency or quality metrics?
  • What structural, functional (including clinical), financial, and operational features are associated with higher performance? What are the factors, especially factors amenable to policy or operational interventions, that most strongly differentiate higher performing from less high performing systems?  Factors to consider include, for example, physician characteristics, workforce composition (the skill mix and the ways that different clinicians are deployed within care teams), organizational culture and leadership, compensation methods, and market characteristics (e.g. level of competition).  
  • What is the impact of consolidation and other market characteristics on the price of health care in particular markets? What is the impact on health care disparities and safety net facilities?

Incentives for Improving Performance of Systems and Providers:  The Affordable Care Act, Federal and state regulations, and public and private payers have provided a variety of financial and nonfinancial incentives to improve the performance of health care systems, as well as hospitals, group practices and other providers.  Potential research questions include, but are not limited to:

  • How have markets organized and what new payment arrangements have emerged in response to the Affordable Care Act? Have these changes affected the organization, delivery, quality, cost, and price of health care services? 
  • What non-financial incentives, such as public and private performance reporting, professional norms, etc., work to improve system performance, and under what circumstances? 
  • What is the impact of variations and/or changes in system performance on health care equity and disparities?

Interventions to Improve Performance:  While alignment with external incentives is very important, it is the provider or system that implements interventions to increase efficiency, while maintaining or improving quality, equity, access, and reducing disparities.  Potential research questions include, but are not limited to:

  • What interventions have been most successful in improving performance and why? What conditions are necessary for implementing these interventions?
  • How readily can successful interventions be adapted and implemented by systems operating under other conditions?

Further Guidance

Priority Populations.  Priority populations continue to be an area of interest to AHRQ. For purposes of this Notice, priority populations include low-income patients and the uninsured along with AHRQ's other priority populations (children, women, elderly, racial and ethnic minorities, and individuals with special health care needs). 

Use of Multiple Funding Mechanisms.  AHRQ will use standing grant mechanisms such as the R01, R03, R18, and K08 funding mechanisms to support this research. The relevant general AHRQ Funding Opportunity Announcements for R01, R03, R18, and K08 mechanisms can be found at: http://www.ahrq.gov/funding/research/announcements/index.html.

Application Submission.  Applicants should consider this Notice active until further notice.  AHRQ will provide updates of new developments and research priorities as research budget information becomes available. Applications focused on areas identified in this Notice should be submitted on regular research grant receipt dates and will be reviewed by AHRQ's standing study sections. Information about the grant application process, including e-grant applications and the funding mechanisms noted above, can be found at http://www.ahrq.gov/funding/index.html.

Applicants are encouraged to use relevant AHRQ, DHHS, and federal and non-federal public and private data resources to support these research efforts.  Examples of such data may be the MEPS, HCUP,  National Health Interview Survey (NHIS), Medicare and Medicaid data resources and other Departmental data resources http://healthdata.gov/.


Please direct all inquiries to:

Michael Hagan
Agency for Healthcare Research and Quality (AHRQ)
Center for Delivery, Organization, and Markets (CDOM)
Telephone: 301-427-1409
Email: Michael.Hagan@ahrq.hhs.gov


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