ers to strive for excellence by providing financial and other rewards and public recognition to providers who achieve superior levels of quality.

  1. Government health care programs should actively collaborate with each other and private-sector quality enhancement organizations with regard to all aspects of quality enhancement—including use of standardized measures and sharing of data—where doing so will likely result in greater gains in quality or reduced provider burden.

  2. Government health care programs should encourage and enable active consumer participation in efforts to enhance quality through such means as the following:

    1. Raising consumer awareness of the magnitude of quality and safety shortcomings and the means of addressing these problems

    2. Seeking consumer input into the design and evaluation of quality enhancement processes

    3. Including patient assessments of quality and service in the portfolio of performance measures

    4. Providing patients with health information necessary to evaluate treatment options and participate in care management

    5. Providing consumers with comparative performance data on providers and health plans

  1. Government health care programs, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), should pursue a rich agenda of applied research and demonstrations focusing on tools, techniques, and approaches to quality enhancement.

There are many variations in quality enhancement requirements across the government health care programs, some rooted in differences among the needs of the populations served, but most stemming from the fact that the programs have developed their quality enhancement processes independently. In the absence of compelling reasons for differences in quality enhancement requirements, the federal government should strive to provide the same minimal level of quality protection to all populations served. Efforts should also be made to streamline the implementation of quality enhancement processes so as to minimize the burden on providers, especially those in the private sector, who typically have relationships with multiple third-party payers.

The federal government has far less experience in pursuing purchasing strategies to enhance quality than in establishing regulatory requirements. Given the seriousness of current safety and quality shortcomings in the health care system, it is imperative that the government be given the flexibility and resources necessary to explore value-based purchasing. Regulations alone cannot solve the problem. Purchasing initiatives should be carefully evaluated to determine whether they are effective. Purchas-



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