Meeting Minutes, July 2017

Contents

Summary
Call to Order and Approval of November 2, 2016, Summary Report
Director's Update
Update on Learning Health Care System
Update on EvidenceNOW
AHRQ Data and Analytics To Answer Emerging Issues
Public Comment
Chair’s Wrap-Up and NAC Input
Adjournment

Summary

NAC Members Present

Elizabeth A. McGlynn, Ph.D., Kaiser Permanente (Chair)
Christina J. Calamaro, Ph.D., CRNP, Children’s Healthcare of Atlanta 
José Julio Escarce, M.D., Ph.D., University of California, Los Angeles (via telephone)
Donald A. Goldmann, M.D., Institute for Healthcare Improvement, Harvard Medical School
Kevin L. Grumbach, M.D., School of Medicine, University of California, San Francisco
Monica E. Peek, M.D., M.P.H., M.Sc., The University of Chicago
Lucy A. Savitz, Ph.D., M.B.A., Intermountain Healthcare
J. Sanford Schwartz, M.D., University of Pennsylvania

Alternates Present

David Atkins, M.D., U.S. Department of Veterans Affairs
Paul Rosen, M.D., M.P.H., Centers for Medicare & Medicaid Services (for Patrick Conway)

AHRQ Staff Members Present

Gopal Khanna, M.B.A., Director
Sharon B. Arnold, Ph.D., Deupty Director
Jaime Zimmerman, M.P.H., PMP, Program Analyst
Karen Brooks, CMP, NAC Coordinator

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Call to Order and Approval of November 2, 2016, Summary Report

Elizabeth A. McGlynn, Ph.D., Chair of the National Advisory Council (NAC), Agency for Healthcare Research and Quality (AHRQ), called the group to order at 8:30 a.m. and welcomed the NAC members, other participants, and visitors, including viewers of the meeting’s webcast. She referred to the draft minutes of the previous NAC meeting (November 2, 2016) and asked for changes and approval. The NAC members voted unanimously to approve the November meeting minutes with no changes. Dr. McGlynn noted that the day’s agenda would include two periods for public comment, and she asked the NAC members to introduce themselves.

Dr. McGlynn introduced the new Director of AHRQ, Gopal Khanna, M.B.A., who was appointed in May 2017. Mr. Khanna has wide experience working in Federal and State Governments, in particular, specializing in employing data-driven strategies to improve organizational performance. He recently was Director of the FRAMEWORK project in Illinois, which developed a vision for that State’s Healthcare and Human Services Innovation Incubator. He served as Minnesota’s Chief Information Officer and served in the second Bush administration in senior policy positions, including Chief Information Officer and Chief Financial Officer for the Peace Corps and Chief Financial Officer of the Executive Office of the President’s Office of Administration.

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Director's Update

Gopal Khanna, M.B.A., Director, AHRQ, and Sharon B. Arnold, Ph.D., Deputy Director, AHRQ

Mr. Khanna thanked the NAC members for their past and ongoing work in support of the Agency. He described his vision for the Agency, including a desire to think boldly and to consider ways to serve the U.S. health care system more effectively. He stressed four priorities—examining how we use data, considering the next generation of scientists, accelerating system improvement, and encouraging a holistic view of the patient. He cited U.S. Department of Health and Human Services (HHS) Secretary Tom Price’s call to address the opioid epidemic, to address the issue of physician burnout, to create interoperability of systems, and to make more effective use of evidence in practice. A particular challenge is to determine ways to use and leverage the large amounts of health care data that are being collected.

Mr. Khanna stated that his vision also includes a focus on addressing core competencies, as in tools and training, to bring scientific evidence into medical practice more rapidly. AHRQ can serve as a bridge between research and implementation. Its collected data are universally accepted. It features unique qualifications. Mr. Khanna extolled the Agency’s ability to build strong relationships with clinicians (including primary care), to provide a broad-based approach, and to encourage research. AHRQ has expertise in developing knowledge and tools. It is embracing the effort to establish the Learning Healthcare System (LHS). AHRQ’s reports and evidence are informing Congress. It has potential for innovative partnerships and potential for a good return on investment. The Agency must increase uptake of its results and identify unmet needs. The NAC members can illuminate scenarios in which AHRQ can have an impact.

Updates, Transitions, and the Agency Budget

Sharon B. Arnold, Ph.D., reviewed the day’s agenda. She noted that NAC member Lucy A. Savitz, Ph.D., M.B.A., recently became Director of the Kaiser Permanente Center for Health Research. NAC member Christina J. Calamaro, Ph.D., became Senior Nurse Scientist and Director of Research for Nursing and Evidence-based Practice at Children’s Healthcare of Atlanta. Dr. Arnold reported that two new ex officio NAC members are Michael Lauer, M.D., of the National Institutes of Health (NIH), and Chesley Richards, M.D., M.P.H., FACP, of the Centers for Disease Control and Prevention.

The President’s budget proposal for fiscal year (FY) 2018 provides $378.5 million in discretionary funding for AHRQ. That is an 18 percent reduction from the FY2017 discretionary budget. The proposal calls for folding AHRQ into the NIH as a new institute: the National Institute for Research on Safety and Quality. The proposal retains the following AHRQ programs: investigator-initiated research, patient safety, Evidence-based Practice Centers, the Medical Expenditure Panel Survey (MEPS), the Healthcare Cost and Utilization Project (HCUP), and the U.S. Preventive Services Task Force. It eliminates the following AHRQ programs: health information technology (IT), quality indicators, Consumer Assessment of Healthcare Providers and Systems, data analytics support, and contracts for dissemination and implementation.

Dr. Arnold reported that AHRQ staff conducted 18 presentations at the 2017 AcademyHealth Research Meeting, with topics including improving measurement, filling evidence gaps in preventive services, and enhancing the primary care workforce. AHRQ also offered 32 posters at the meeting. 

In its AHRQ Works series, the Agency produced a new document describing issues and research findings regarding physician burnout.

How AHRQ Makes a Difference

Dr. Arnold stated that AHRQ invests in research and evidence to understand how to make health care safer and improve quality. It creates materials to teach and train health care systems and professionals to catalyze improvements in care. It generates measures and data used to track and improve performance and to evaluate progress. Dr. Arnold presented the following Agency updates:

Research and Evidence

• An AHRQ-funded analysis published in the journal Pediatrics reported that sensory-focused interventions reduced impairments in children with autism spectrum disorder. The interventions included massage, swinging, trampoline exercises, and exposure to various textures. 
• The U.S. Preventive Services Task Force produced final new recommendations for statin use for the primary prevention of cardiovascular disease in adults, serologic screening for genital herpes infection, folic acid for the prevention of neural tube defects, screening for obstructive sleep apnea in adults, and more. Topics addressed in draft recommendations included screening for thyroid cancer, vision screening in children ages 6 months to 5 years, screening for prostate cancer, and menopausal hormone therapy for the primary prevention of chronic conditions.
• The Evidence-based Practice Centers produced new and updated systematic reviews. New review topics included prevention of complications and treatment of symptoms of diabetic peripheral neuropathy, tympanostomy tubes in children with otitis media, and interventions to prevent age-related cognitive decline, mild cognitive impairment, and clinical Alzheimer’s-type dementia. AHRQ published a series of papers in the Journal of Clinical Epidemiology (July 2017) on methods for complex-intervention systematic reviews.

Tools and Training

• AHRQ published a press release noting recent results from the National Scorecard on Rates of Hospital-acquired Conditions (HACs). The period 2010-2015 saw 3 million fewer hospital-acquired conditions, for a decline of 21 percent and cost savings of $28 billion. Analysis of the use of Comprehensive Unit-based Safety Program in long-term care settings revealed a 54 percent drop in rates of catheter-associated urinary tract infections.  
• AHRQ released a funding opportunity announcement for the National Research Service Awards Institutional Research Training grants (T32).

Data and Methods

• New findings from the 2016 MEPS included no significant change in the percentage of employees covered by private sector-establishment health insurance and a lower rate (compared with recent years) of growth of premiums for families. Rates of growth for single and employee-plus-one premiums were similar to those in prior years. There was no significant change in the overall rate of employees working at establishments offering insurance.
• An analysis of MEPS data revealed medical care costs related to childhood obesity found that annual medical costs were larger than previously estimated. The costs of childhood obesity are borne almost entirely by third-party payers.
• AHRQ reported that, for women, overall hospitalizations for opioid pain relievers and heroin were up 75 percent from 2005 to 2014. As a result, the rates for men and women became virtually the same. The highest rates were found in Maryland, West Virginia, and Massachusetts.
• Data from AHRQ’s HCUP, presented in its Fast Stats series, showed the rapid rise in hospital use related to opioid use beginning in 2013. 
• HCUP released statistical briefs regarding hospital stays, indicating that from 2005 to 2014 the inflation-adjusted cost per inpatient stay increased 13 percent. Mean costs for stays covered by private insurance and Medicaid rose while costs for stays covered by Medicare did not change. Stays for septicemia/sepsis tripled from 2005 to 2014, making it the most common reason—other than childbirth—for inpatient stays. 

Discussion

Donald A. Goldmann, M.D., referred to the final item—hospital stays for sepsis—and questioned whether the apparent increase might have resulted in part from changes in data collection, as in altering the denominator. Referring to the mild trends in premiums for health insurance noted in the MEPS data, J. Sanford Schwartz, M.D., asked whether deductibles went up. They did. Dr. Schwartz also encouraged AHRQ to indicate, in reporting data, any possible differential effects resulting from the use of ICD-9 rather than ICD-10 diagnosis codes. David Atkins, M.D., M.P.H., suggested that AHRQ study the effects of State policies on the trends in opioid use and related HCUP data.

Monica E. Peek, M.D., M.P.H., M.Sc., asked about effects of the potential move of the Agency to NIH. Mr. Khanna responded that, were that to happen, AHRQ would remain as a singular enterprise, although it could rethink priorities and opportunities. Dr. Savitz encouraged AHRQ to add measures of social determinants of health to its HCUP data collection.

Dr. Goldmann noted the tensions that exist among the Federal agencies regarding various tasks. He encouraged AHRQ to consider addressing the burdens on primary care, for example, regarding health IT, to consider the nature of future research and data analytics, to study cost effectiveness, and to study the larger health system picture when considering the opioid crisis. Mr. Khanna agreed that data issues will be key. Dr. Arnold noted that the President’s proposed budget (and that of the House committee) includes a line item for a trans-NIH study of health services research.

Dr. Schwartz wondered whether, in light of possible program eliminations, AHRQ might repurpose some continuing programs to touch on certain issues (e.g., data analytics). Mr. Khanna asked the NAC members to suggest opportunities for new ways to use evidence. Dr. Savitz noted a National Academy of Medicine (NAM) meeting on health services research to take place in October. Dr. Atkins stressed the question of how big data and health IT will impact the delivery of care, including burdens on clinicians. Who will own this issue? Dr. Goldmann added that trends in data and data use will affect training and research. The types of places where people conduct research are changing.

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Update on Learning Health Care System

David Meyers, M.D., FAAFP, Chief Medical Officer, AHRQ, Brigid Russell, M.H.A., Senior Advisor, Office of the Director, AHRQ, Jaime Zimmerman, M.P.H., PMP, Program Analyst, Office of the Director, AHRQ

Dr. Meyers presented background on the LHS initiative and recent progress. The idea of an LHS proposes a system that allows systematic gathering and creation of evidence and then applies the most promising evidence-based practices to improve care. AHRQ’s role can involve helping organizations build capacity to move knowledge into practice.

Ms. Russell noted that in January AHRQ released a request for information in the Federal Register to better understand the process by which organizations and professionals select evidence and implement the strategies used to move evidence into everyday practice. The request featured a list of questions and received 44 responses from major stakeholders. Recommendations for future work addressed four themes: data and analytics, models and measures, tools and training, and dissemination/implementation. The following is a sample of responses within those areas:

• Elevate and promote AHRQ’s data resources to support health system benchmarking and facilitate spread.
• Develop and maintain large comparator datasets and provide access to data networks.
• Identify models of accountable care organizations focusing on characteristics that can be replicated.
• Define and validate innovative measures of system improvement that reflect the use of data and methods to inform care delivery.
• Modify existing tools developed by AHRQ to support the LHS’s ideals and aims.
• Develop a toolkit to support rapid, rigorous, and pragmatic trials.
• Continue to support training and professional development opportunities for health services researchers and health care professionals, helping them to understand, evaluate, and test interventions in the health care system.
• Invest in training that provides a bridge between academic institutions and health care systems.
• Identify the most effective approaches for diffusion of best practices across organizations.
• Refine existing practice transformation methodologies for supporting transformation at the system level.
• Convene a variety of stakeholders to foster a dialogue about the central importance of evidence-informed practice and practice-informed evidence to support collaboration.

Dr. Meyers listed current efforts by AHRQ to support LHSs, including the enhancement of workforce development, support for the use of health IT, fostering use of evidence in small primary care practices, and studying the characteristics and practices of high-performing health care systems. AHRQ’s Clinical Decision Support Initiative is helping care teams to apply evidence to practice. AHRQ’s EvidenceNow initiative is supporting the improvement of heart health by expanding the use of evidence in small primary care practices (see below). AHRQ’s Comparative Health Systems Performance Initiative, which features three large grantees, is supporting a study of how health care systems promote evidence-based practices in delivering care. It will result in a compendium that will enable users to access data on health systems and information about practices.

Ms. Zimmerman reported on the AHRQ-NAM meeting on the LHS, which took place June 29, 2017, at the National Academy of Sciences headquarters in Washington, DC. This meeting of thought leaders resulted in action items for the NAM and AHRQ to address to accelerate progress of the LHS initiative. The participants discussed how systems might be motivated to embrace principles of an LHS. They shared ideas for how AHRQ might catalyze the efforts, and they stressed that efforts should prioritize the interests of physicians and patients. The meeting will be followed by a summit to be convened by AHRQ in September 2017.

Discussion

Kevin L. Grumbach, M.D., welcomed the efforts concerning the LHS, and he stressed the need for examples of how health systems organize practices. He stated that primary care practices can be LHSs too (not only hospitals and integrated systems). Dr. Meyers responded that AHRQ is considering such ideas.

Dr. Schwartz encouraged AHRQ to consider ways to ensure that data are valid (including the various kinds of validity). The Agency also should use its perspective on quality measurement to indicate what makes a measure a good measure. Dr. Savitz suggested that AHRQ identify possibilities for leveraging its existing resources for the LHS and address issues around funding and timing. Dr. Calamaro called for standardization among large data sets. Different terms often are used in different places.

Dr. Goldmann called for a study of exemplars. We must differentiate between using data for improvement and engaging implementation science. Will LHSs develop procedures to test their own performance? Dr. McGlynn cited the importance of culture. We must cause people to be open to learning. We must build such capacities.  

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Update on EvidenceNOW

David Meyers, M.D., FAAFP, Chief Medical Officer, AHRQ, Deborah Cohen, Ph.D., Oregon Health & Science University, W. Perry Dickinson, M.D., University of Colorado

Dr. Meyers presented an overview of and update on AHRQ’s EvidenceNOW program, which features seven regional cooperatives that provide quality improvement support to small- and medium-sized primary care practices. The project draws from three initiatives: the HHS Million Hearts effort to improve health care quality focusing on heart health, the Patient-Centered Outcomes Research Trust Fund effort to disseminate research findings to improve care, and the ongoing AHRQ effort to advance primary care and primary care research.

EvidenceNOW is a $112 million investment launched in 2015, and it seeks to help practices build capacity to incorporate patient-centered research findings. It is reaching 1,500 small- and medium-sized primary care practices and about 5,000 primary care professionals. Dr. Meyers reviewed services provided by the program; the activities of program facilitators, who assess and teach; and the program’s use of measurement and evaluation. EvidenceNOW focuses on the Million Hearts’ intervention areas known as the ABCS—aspirin use, blood pressure control, cholesterol management, and smoking cessation. Each of the cooperatives is seeking to learn what works for whom in what situations. Dr. Meyers asked the NAC members to suggest additional opportunities for advancing primary care research. How should AHRQ build upon what it is learning?

Dr. Cohen discussed evaluation findings from the EvidenceNOW program. The program evaluators have sought to analyze the most effective combinations of interventions, practices, and contextual factors. They have been collecting and examining data. Dr. Cohen described the cooperative-extension structure of the program, featuring partnerships unique to each of the regional cooperatives. She described qualities the evaluators considered:

• Capacity for change.
• Capacity for quality improvement.
• Degree of disruption.
• Team member burnout.

The evaluators have been looking at measures of the data infrastructures of practices, including the presence of electronic health record systems, meaningful use, and ability to create quality reports. They have witnessed gradual improvements in the four heart-health areas of the ABCS. They have developed a list of research questions, such as the following: To what extent are the practices’ changes being sustained? How are practices using the data that are available?

Dr. Dickinson described aspects of the EvidenceNOW program in the Colorado-New Mexico cooperative, known as EvidenceNOW Southwest. It features 211 primary care practices. The program has fostered the engagement of partners, development of enhanced infrastructure for transformation, community engagement, and implementation research. It has improved alignment and coordination. Dr. Dickinson described in particular the Colorado Health Extension System, which includes more than 20 “practice transformation organizations,” which provide support for practices. Major goals (among many) of the system are to support innovation, quality improvement, and transformation in primary care and specialty practices. The program features the use of “regional health connectors,” who are local individuals functioning as connectors in communities. Dr. Dickinson listed challenges for such programs, including data issues; the need for many practices; the need for “boots on the ground”; and the time needed for change to occur, for measurement to be made, and for building relationships and infrastructure.

Discussion

Dr. Savitz encouraged the programs to develop playbooks dealing with forming and maintaining the cooperatives. The programs might demonstrate how to capture costs. Dr. Dickinson noted the difficulty of building momentum in the programs—people tend to move along from one project to the next. Dr. Cohen added that much of what gets accomplished remains somewhat invisible. Dr. Meyers noted the debate about whether, over time, new funding should target the deepening of a particular project or seek to create efforts that reach new areas.

Dr. Goldmann encouraged the programs to develop messages for policymakers. Is Medicaid expansion a facilitator for such projects? Dr. Cohen noted the importance of separate funding streams. Dr. Peek asked whether the projects were stepped, as in developing practices then moving resources into the communities. Dr. Dickinson replied that such activities are conducted simultaneously.

Dr. Atkins encouraged the programs to go further and deeper to make the work sustainable and to reach more practices, even in the absence of more AHRQ funding. The facilitators/facilitation would seem to be key. Dr. Cohen noted the problem of employing reporting algorithms that do not draw from all data sources. That reduces validity. Dr. Grumbach cautioned that AHRQ cannot support practice coaching over an extended period in private practices. The practices have to consider themselves as test laboratories. Dr. Schwartz reminded the group of the need to consider cost-effectiveness.

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AHRQ Data and Analytics To Answer Emerging Issues

Sharon B. Arnold, Ph.D., Deputy Director, AHRQ, Joel W. Cohen, Ph.D., Center for Financing, Access and Cost Trends, AHRQ, Herbert S. Wong, Ph.D., Center for Delivery, Organization, and Markets, AHRQ, Chris Dymek, Ed.D., Center for Evidence and Practice Improvement, AHRQ, Edwin Lomotan, M.D., FAAP, Center for Evidence and Practice Improvement, AHRQ

Dr. Arnold introduced a discussion session focusing on AHRQ activities in data and analytics. Data include patient survey data, administrative data, and clinical data. Major areas of important and useful data are health insurance coverage, health care use and expenditures, access/quality/satisfaction, health status and behaviors, sociobehavioral issues, clinical issues, and quality/safety in health care settings. Dr. Arnold asked the NAC members to consider the future of data and AHRQ’s role.

Dr. Joel Cohen discussed the MEPS, which was initiated 22 years ago. Its three main components are a household survey, a medical provider survey, and an insurance survey. These surveys indicate, respectively, how care is used/covered, what providers pay for care, and what plans employers offer. The MEPS began with goals of defining insurance take-up and demand for care. It has grown to provide information such as descriptions of health care systems, trends, premiums, and sociodemographics. The data are internally consistent and are used by consumers, State policymakers, and Federal policymakers. Many published research papers make use of MEPS data. Today AHRQ is working to expand MEPS sampling.

Dr. Wong discussed the HCUP, another longstanding AHRQ data project. The HCUP gathers administrative data, which offers a supply or market angle, in contrast to the demand angle the MEPS offers. HCUP draws on inpatient information from 47 States, deriving from patients, hospitals, and more. Its collection process features partnerships between State institutions and the Federal government. The data, relating to 30 million inpatient stays each year, are converted into research databases. HCUP data shift over time and reveal responses to changes in, for example, the regulatory environment (e.g., Medicaid expansion) or national medical emergencies (e.g., the opioid crisis). The data can be linked to other data sources such as MEPS and can lead to understanding issues, such as costs.

Dr. Dymek and Dr. Lomotan discussed AHRQ’s attention to clinical data, for which it does not maintain a large dataset. Dr. Dymek suggested that clinical data are a fuel that helps to power LHSs. Dr. Lomotan cited AHRQ-supported research networks and registries, which feature patient-reported outcomes and involve predictive models. One goal of the Agency is to harmonize data from outcomes measures across registries and health IT networks. AHRQ is working on incorporating contextual factors in clinical data collection. It is addressing quality and the collection of metadata from electronic health records. It is supporting research in artificial intelligence and will publish, with the Robert Wood Johnson Foundation and the Office of the National Coordinator, a report this year on the future of artificial intelligence in health care. AHRQ is encouraging the creation of a Center for Clinical Informatics and Improvement by a researcher in California. We need to investigate new methods for integrating electronic health data into workflows.

Discussion

Dr. Atkins wondered whether HCUP data might be linked with the CMS beneficiary files, which could provide a denominator for analyses. Dr. Wong noted that HCUP has information on all payers, including Medicare, and can calculate some population rates, although that can be difficult in the area of private payers.

Dr. Atkins asked about varying participation by States in the MEPS and analytical capacity. Dr. Cohen replied that AHRQ attempts to incorporate as many cases as it can. To expand greatly would require new models and more funding. Dr. Atkins encouraged AHRQ to seek greater sample sizes.

Dr. Savitz suggested that we learn from results, like Sweden has. It has created, in its Parkinson’s disease registry, an interactive space for measures of patient data.

Dr. Schwartz wondered whether the States will become more important, in part, as a result of Medicaid expansion. Perhaps the governors’ associations could be encouraged to make the case for the need for data and prioritizing. Dr. Schwartz proposed that the NIH institutes collect data on their diseases of interest and make them available. He supported AHRQ’s efforts to create harmonization among measures, allowing crosswalks between MEPS and HCUP. The Agency should ask investigators to suggest data (from MEPS and HCUP) that would be helpful in research.

Dr. Grumbach agreed that State efforts are critical and suggested that AHRQ assume a role of leadership. The Agency should seek to determine how to handle patient-reported outcomes via the electronic health record. It should optimize data for research and to support the LHS. Dr. Schwartz encouraged AHRQ to identify a problem and then determine how to address it.  

Dr. Goldmann agreed with the suggestion to determine what data researchers need. AHRQ could help to rationalize the field, developing use cases and testing what drives practices and what is cost-effective. Dr. McGlynn added the need to predict questions that will be asked in the future.

Mr. Khanna reminded the group of the need to consider not only health but also human services—the patient/customer. Dr. Peek wondered whether AHRQ might help to operationalize the research enterprise to link health and human services. Dr. Grumbach welcomed efforts to address social determinants of health. Dr. Calamaro suggested analyzing social media to drill down to health issues. Dr. Goldmann agreed that the opinions of patients regarding health care experiences are important.

Dr. Lomotan stated that AHRQ has efforts devoted to advancing patient-centeredness. Should a learning network be focused on that idea? AHRQ could perhaps support an information-sharing network for patients. Dr. Arnold cited the ability of the Consumer Assessment of Healthcare Providers and Systems program to collect some of the patient information being discussed. Dr. Calamaro called for health data collection through social media.

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Public Comment

There were no public comments.  

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Chair’s Wrap-Up and NAC Input

Dr. McGlynn asked the Council members to propose ideas for discussion in future NAC meetings.

• Dr. Savitz proposed an update on the centers of excellence.
• Dr. Goldmann proposed further discussion of the effectiveness of an LHS, including issues of AHRQ funding.
• Dr. Peek suggested further updating and discussion of data issues.
• Dr. Calamaro agreed and suggested a discussion of feedback on this meeting.
• Dr. Atkins proposed having a report on the NAM’s October meeting on the future of health services research. What might be a role for AHRQ?
• Paul Rosen, M.D., proposed discussion of synergy across the Federal agencies. The Centers for Medicare & Medicaid Services is working on topics including clinician burden, opioid use, cost savings, quality outcomes, and a learning network that reveals top performers and ideas.
• Dr. McGlynn seconded Dr. Rosen’s idea, proposing discussion of what each agency brings to the table. How can the power of Government be leveraged in addressing health problems?
• Dr. Arnold noted that the Partnership for Patients program is a good example of Federal agencies working together. Perhaps a NAC meeting could feature a report on it.

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Adjournment

Dr. McGlynn asked the council members to forward any additional ideas for the agendas of future meetings. She reminded them that the next NAC meeting will take place on November 3, 2017, at AHRQ headquarters. Mr. Khanna thanked the NAC members and the AHRQ team.

Respectfully submitted,

Elizabeth A. McGlynn, Ph.D., Chair
National Advisory Council
Agency for Healthcare Research and Quality

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