Appendix B
TABLE B-1 National Organizations Involved in Performance Measurement
Name |
Primary Role |
Governance and Major Participants |
Agency for Healthcare Research and Quality (AHRQ) |
AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decision makers—patients and clinicians, health system leaders, purchasers, and policymakers—make more informed decisions and improve the quality of health care services. |
A Public Health Service agency in the U.S. Department of Health and Human Services (DHHS). Reporting to the DHHS Secretary, the Agency was authorized in 1989 as the Agency for Health Care Policy and Research and reauthorized in 1999 as AHRQ. |
Major Quality Measurement Activities |
Source of Core Funding |
|
Federal. |
Name |
Primary Role |
Governance and Major Participants |
AHRQ |
|
|
Ambulatory care Quality Alliance (AQA) |
AQA is a collaborative effort initially convened by AHRQ, the American Academy of Family Physicians, the American College of Physicians, and America’s Health Insurance Plans. The steering group has been expanded to include the American Medical Association, the American Osteopathic Association, the American College of Surgeons, the Society of Thoracic Surgeons, AARP, the National Partnership for Women and Families, and the Pacific Business Group on Health. Their mission is to improve health care quality and patient safety through a collaborative process in which key stakeholders agree on a strategy for measuring performance at the physician level; collecting and aggregating data in the least burdensome way; and reporting meaningful information to consumers, physicians and other stakeholders to inform choices and improve outcomes. |
Public–private partnership. The AQA consists of a large body of stakeholders that represents clinicians, consumers, purchasers, health plans, and others. Major participants: Health care organizations: ACP, AAFP, AMA, AMA Consortium, American Board of Internal Medicine, American Board of Medical Specialties, ACC, AAP, AAAAI, AOA, ACS, STS, MGMA, AHA, AAMC and state medical societies. Private participants: AARP, AFL-CIO, Consumer/Purchaser Disclosure Project, Employer Health Care Alliance Corp., Leapfrog Group, General Motors, National Business Group on Health, National Business Coalition on Health, Pacific Business Group on Health, Medstat, Motorola, UPS, BellSouth, Xerox, and Marriott. Public purchasers and other government agencies: CMS, OPM, AHRQ, and Department of Treasury. Health insurance plans: Aetna, Anthem, Cigna, Health Net, Health Partners, Humana, Independence BCBS, Kaiser Permanente, Pacificare, Presbyterian Health Plan, Regence BCBS, UnitedHealth Group, Wellchoice, Harvard Pilgrim HealthCare, AHIP, Blue Cross Blue Shield Association. Accrediting organizations: NCQA, JCAHO, and URAC. |
Major Quality Measurement Activities |
Source of Core Funding |
|
Combination of federal and private. |
*The AHRQ Quality Indicators initially were developed as metrics for quality improvement, however their use has evolved over time to include public reporting, and pay for performance. |
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Endorsed key parameters (criteria) for selecting performance measures. For example: evidence-based, clinical importance, scientific validity, feasibility, relevance to physician performance, consumers, and purchasers. |
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Endorsed a standardized set of 26 measures for physician practices that draws heavily on the 2004 ambulatory care clinical performance measure set released by the AMA Consortium, CMS, and NCQA. |
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Expanding the initial “starter” set of measures to include specialty and subspecialty care measures, efficiency measures and patient experience measures. |
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Working with CMS and AHRQ to finalize pilot projects that would utilize the endorsed measurement set and combine public and private payer data. |
Name |
Primary Role |
Governance and Major Participants |
Centers for Medicare and Medicaid Services (CMS) |
The federal agency responsible for administering the Medicare, Medicaid, SCHIP (State Children’s Health Insurance Program), HIPAA (Health Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and several other health-related programs. Their mission is to ensure health care security for beneficiaries. |
An agency of U.S. DHHS. On July 1, 2001, the Health Care Financing Administration (HCFA) became CMS. |
Hospital Quality Alliance (HQA) |
The purpose of the HQA initiative is to make information about hospital performance accessible to the public and to inform and invigorate efforts to improve quality. Voluntary reporting is essential to the success of this initiative. |
Public–private partnership of hospitals, government agencies, quality experts, purchasers, consumer groups and other health care organizations. These organizations have joined together to develop a shared national strategy for hospital quality measurement and are committed to advancing quality of care. Major participants:
|
Major Quality Measurement Activities |
Source of Core Funding |
|
Federal. |
|
Combination of federal and private. |
Name |
Primary Role |
Governance and Major Participants |
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) |
JCAHO evaluates and accredits more than 15,000 health care organizations and programs in the United States. Its mission is to continuously improve the safety and quality of care provided to the public. |
Private, nonprofit. Governed by a 29-member Board of Commissioners that includes nurses, physicians, consumers, health care executives, purchasers, labor representatives, quality experts, ethicists, and educators. Major participants: Commonwealth Fund, California Endowment, Robert Wood Johnson Foundation, and AHRQ. |
Leapfrog Group |
The Leapfrog Group is a voluntary initiative to mobilize employer purchasing power to improve the safety, quality, and affordability of health care for Americans. Their mission is to trigger leaps forward by supporting informed health care decisions by those who use and pay for and promote high-value health care through incentives. |
Private. The Leapfrog Group includes over 170 members from a growing consortium of Fortune 500 companies and other large private and public healthcare purchasers that provide health benefits to more than 34 million Americans in all 50 states. Major participants:
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National Committee for Quality Assurance (NCQA) |
NCQA is dedicated to improving health care quality through evaluation of health care at various levels of the system from health plans to medical groups and individual doctors. NCQA’s mission is to transform health care through measurement, transparency, and accountability. |
Private, nonprofit. Advised by a board of directors. NCQA frequently works with the federal and state governments to advance shared goals. Major participants:
|
Major Quality Measurement Activities |
Source of Core Funding |
|
Combination of federal and private. |
|
Private. |
|
Combination of public and private. |
Name |
Primary Role |
Governance and Major Participants |
National Quality Forum (NQF) |
Established consequent to a Presidential Commission, the NQF was created primarily to standardize national performance measures, quality indicators, and similar metrics for health care. It was envisioned to be the singular body performing this function. Other functions envisioned for the NQF were to develop and implement a national strategy for health care quality measurement and reporting and to be an “honest-broker” convener for health care quality matters. The mission of the NQF is to improve American health care through endorsement of consensus-based national standards for measurement and public reporting of health care performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable, and efficient. |
Not-for-profit membership organization. Unique public–private partnership. About 300 member organizations. NQF is governed by a 29-member Board of Directors representing health care providers, health plans, consumers, purchasers, accreditors, researchers, and quality improvement organizations. Government members of the Board include CMS, AHRQ, VHA, ONCHIT, and NIH. Board also includes JCAHO, NCQA, IOM, AARP, GM, Physician Consortium for Performance Improvement, and elected representatives of the 4 Member Councils. Major participants:
|
The Physician Consortium for Performance Improvement convened by the American Medical Association (AMA) |
The Physician Consortium for Performance Improvement’s (the Consortium) mission is to improve patient health and safety by (1) identifying and developing evidence-based clinical performance measures; (2) promoting implementation of effective and relevant clinical performance improvement activities; and (3) advancing the science of clinical performance measurement and improvement. |
Professional societies. The Consortium is currently formalizing its governance and structure. The Consortium includes physicians and experts in methodology convened by the AMA. The Consortium includes representatives from more than 70 national medical specialty and state medical societies, the AHRQ, CMS, and others. Representatives from employers, health plans, and consumer groups participate in measure development work groups. |
Major Quality Measurement Activities |
Source of Core Funding |
Over 200 national consensus standards have been endorsed so far for care settings across the continuum of care (e.g., acute care hospitals, ambulatory care, nursing homes, home care, palliative and hospice care, other) as well as for conditions (e.g., cancer, asthma, acute coronary syndrome, diabetes, and deep vein thrombosis) and issues (e.g., patient safety, reportable events, medication use). A variety of workshops have been conducted to address specific issues related to quality. |
Membership dues, contracts and grants; combination of federal and private. |
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AMA. In-kind funding, national medical specialty societies. Additional funding for measure development from contracts with CMS. |