In identifying priority conditions, the Agency for Healthcare Research and Quality (AHRQ) should consider using the list of conditions identified through the Medical Expenditure Panel Survey (MEPS), a nationally representative household survey of health care use, expenditures, sources of payment, and insurance coverage conducted by AHRQ and the National Center for Health Statistics that includes information on health conditions (Medical Expenditure Panel Survey, 2000). MEPS identifies 15 “priority conditions” based on their prevalence, expense, or policy relevance: cancer, diabetes, emphysema, high cholesterol, HIV/ AIDS, hypertension, ischemic heart disease, stroke, arthritis, asthma, gall bladder disease, stomach ulcers, back problems, Alzheimer’s disease and other dementias, and depression and anxiety disorders.
The action plan for each priority condition should include strategies for designing and maintaining evidence-based processes; promoting primary, secondary and tertiary prevention; building the necessary information technology infrastructure to support delivery and coordination of care, system design and ongoing management, payment, and accountability; and aligning the incentives inherent in payment and accountability processes with the goals of quality improvement. AHRQ should also ensure that each action plan is supported by key stakeholders. In identifying and convening stakeholders, AHRQ should work with the National Quality Forum, a public-private partnership charged with development of a comprehensive quality measurement and public reporting strategy. Input should also be obtained from organizations that have made significant efforts to improve quality, such as the Institute for Healthcare Improvement, the Quality Center at the Bureau of Primary Health Care in the Health Resources Services Administration, the Veterans Health Administration, local delivery systems, and others.
Since the identification of priority conditions is a starting point toward achieving the six aims, AHRQ should conduct this work expeditiously. The number of priority conditions identified should grow over time to eventually cover the majority (e.g., 80 percent) of the care provided to patients.
Recommendation 6: Congress should establish a Health Care Quality Innovation Fund to support projects targeted at (1) achieving the six aims of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity; and/or (2) producing substantial improvements in quality for the priority conditions. The fund’s resources should be invested in projects that will produce a public-domain portfolio of programs, tools, and technologies of widespread applicability.
Policies, incentives, tools, and technologies will be needed to support the changes required to achieve the six aims and redesign the health care system in accordance with the new rules set forth in Chapter 3. The formation of an innovation fund is one mechanism that can be used to seed projects aimed at redesigning care and developing programs to support the other recommendations