The Agency for Healthcare Research and Quality (AHRQ) has long played an instrumental role in supporting the nation’s health care priorities. For decades, AHRQ has been making innovative investments in large-scale dissemination and implementation to improve health care systems. While most NIH grant-making focuses on developing new treatments and technologies, AHRQ has consistently invested in ensuring that well-supported and evidence-based treatments reach the populations, communities, and individuals that need them efficiently and effectively. One example of the important grant-making role AHRQ has played in the nation is EvidenceNOW, an AHRQ-funded program that expanded its investments in healthcare extension programing.
Secretary Kennedy’s Make America Healthy Again (MAHA) initiative aims to address the U.S. health crisis and prioritize improving chronic care in the U.S. To achieve these goals, it is critical to support primary care practice. Health care extension programs, like AHRQ’s EvidenceNOW initiative, can play a key role in the implementation of MAHA initiatives, due to their potential to serve as a model for improving the health and wellbeing of individuals and families across the U.S. by delivering external support and facilitating learning among healthcare organizations, clinicians, clinical teams and patients to work together to meet the chronic and wellness care needs of the individuals and communities. AHRQ’s EvidenceNOW initiatives should be carefully considered as a part of Secretary Kennedy’s overall goal to Make America Healthy Again.
The healthcare extension program is modelled after the successful U.S. Department of Agriculture Cooperative Extension System established in the early 1900s that transformed agriculture by supporting, educating and fostering collaborative learning among farmers. Similarly, the health care extension aims to develop regional cooperatives with local extension agencies to share knowledge and better understand the local health care systems, develop connections between healthcare organizations and community partners, and facilitate practice improvement and community wellness.
AHRQ’s EvidenceNOW initiative has been effectively improving prevention and early treatment of chronic conditions at primary care clinics, directly supporting the Secretary’s goal to reduce the chronic disease burden in the U.S. The initial EvidenceNOW program, “Advancing Heart Health,” funded seven regional cooperatives that spanned 12 states, reached over 1700 primary care practices who cared for over eight million people. The aim was to provide the training and support needed to ensure that primary care clinicians and teams help patients get important cardiovascular preventive care: taking aspirin, as needed, managing blood pressure and cholesterol, and taking steps to quit smoking. These low-cost, evidence-based treatments can reduce the likelihood of cardiovascular events – such as heart attacks and strokes. EvidenceNOW grantees reached primary care practices in their region (over 200 practices in each region) and delivered training and support to these practices which improved heart health preventive care. The lessons learned from the Advancing Heart Health program were used to further refine the EvidenceNOW Model, which has since been applied to “Managing Unhealthy Alcohol Use” and “Managing Urinary Incontinence” projects.
AHRQ planned to continue its effective EvidenceNOW programming through a grant notice of funding opportunity it called “State-based Healthcare Extension Cooperatives to Accelerate Implementation of Actionable Knowledge into Practice.” This opportunity was released in late summer of 2025, with grants due and submitted to AHRQ in early January 2025.
Even though AHRQ’s EvidenceNOW initiative has had ongoing success and is aligned with Secretary Kennedy’s MAHA objectives, the state-based health care extension initiative is under threat due to the recent Department of Health and Human Services (HHS) reorganization. The initiative is housed within the larger Center for Evidence and Practice Improvement at AHRQ, which faced large and crippling cuts during the reorganization. With this, the “State-based Healthcare Extension Cooperatives to Accelerate Implementation of Actionable Knowledge into Practice” notice of funding opportunity to extend AHRQ’s investment in the health care extension by funding a broader set of state-based partnerships to tackle some of state’s most complicated behavioral health challenges, such as treatment for substance use disorder, currently hangs in the balance. Grant applications for this initiative have been submitted, however the DHHS reorganization has stalled the progress of their review. The status of this new initiative remains uncertain despite its alignment with MAHA’s goal to address the rising rates of mental health conditions.
AHRQ has developed an unmatched level of knowledge about how to implement a health care extension. Discontinuing AHRQ’s important work conflicts with Secretary Kennedy’s priorities to improve health outcomes. However, the Secretary could continue this work if EvidenceNOW is preserved. The authority and funding are already positioned to secure the health of U.S. populations who have long been neglected, particularly people located in rural communities whose clinicians and clinical teams would benefit greatly from the support the EvidenceNOW program provides.
This blog post was written with additional support from Beth Bortz, Sam Cykert, Perry Dickinson, David Dorr, Larry Green, Kevin Grumbach, Andrew Kaufman, Abel Kho, Andrew Kirst, Bob Phillips, Donna Shelley.