A top health care priority for President Biden is the creation of the Advanced Research Projects Agency for Health (ARPA-H), which would be tasked with building high-risk, high-reward platforms that drive biomedical breakthroughs. Biomedical innovation is important, but to be truly transformative it is critical that these discoveries focus on ending health disparities and are designed to treat a real-life patient.
Health services research (HSR) provides the framework and process to ensure the “last-mile” of the journey from discovery to delivery is safe and equitable. HSR examines factors such as how care is organized and delivered, the role of each clinician in the workforce, who gets care and why – and importantly who does not and why.
In her remarks during an NIH listening session on ARPA-H on July 30, 2021, AcademyHealth President and CEO Dr. Lisa Simpson highlighted HSR’s unique perspective to illuminate the best way to implement breakthroughs in discovery science so that every patient and all communities receive the benefit of these breakthroughs, regardless of income, gender, race, ethnicity, or geography. A transcript of her remarks is below:
“AcademyHealth is the professional home of health services researchers and practitioners from both public and private sectors, and our members are the producers and users of research to improve health care for patients and communities.
Health services research focuses on systems-based outcomes – making health care safer, higher quality, more accessible, more equitable, and of higher value for patients, communities, and practitioners. It encompasses research on effectiveness, dissemination and implementation, disparities, and primary care. It is conducted in partnership with communities, health systems, industry, and other stakeholders.
In short, health services research generates the evidence and innovations we use to improve the design and delivery of health care. Our focus is really on the “last mile” of the journey from discovery to delivery – factors such as how care is organized and delivered, the role of each clinician in the workforce, who gets care and why – and importantly who does not and why -- and the best way to implement breakthroughs in discovery science so that every patient and all communities receive the benefit of these breakthroughs, regardless of income, gender, race, ethnicity, or geography.
The establishment of the Advanced Research Projects Agency for Health (ARPA-H) is a critical opportunity to super-charge the development of big, high-risk, high-reward research projects, and could be a game changer for millions of patients. This potential must be specifically structured from the outset with equity as a goal or we risk worsening the longstanding and pervasive health and healthcare disparities that the pandemic has made so tragically evident to all.
Thus, ARPA-H must couple innovation in medical discovery with innovation in care delivery from the outset. The faltering uptake of the COVID vaccine is an all too stark reminder of the individual and societal tragedy that can unfold when evidence-based discovery is not coupled with evidence-based delivery. Understanding how innovations will be delivered, accepted, accessed, and paid for in everyday patient care and in diverse communities is essential for ARPA-H to make measurable progress on disparity reduction in the next five years and beyond.
AcademyHealth is pleased to see that you recognize the need to exempt ARPA-H from traditional peer review processes. We urge you to consider new ways to allocate research funding so as to prioritize projects that are more timely, nimble, and equitable and that reward innovation. For example, innovations in care delivery have multiplied in response to technology and the pandemic, but we know far too little about which ones will prove effective and for whom. No health system, public health department or private innovator can wait for a 3-year study to learn the effectiveness of an innovation. Structuring ARPA-H to develop and test new models of research funding allocation can increase not only the timeliness of research, but also the diversity of the investigators and topics funded – also a priority for this nation.
In conclusion, AcademyHealth believes it is critical that a substantial commitment to health services research, implementation research, and disparities research studies be included in the appropriation for ARPA-H.
Thank you again for this opportunity, and I look forward to working with you closely in the coming weeks and months.”