2004). Similarly, spending levels vary widely among U.S. regions, yet there is no evidence that more expensive regions have either better quality or improved health outcomes (Baicker and Chandra, 2004; Fisher et al., 2003a,b). Racial, ethnic, and class disparities are pervasive; moreover, the numbers of uninsured are rising, currently making up more than 15 percent of the population (IOM, 2002, 2004). For the sizable investments being made in health care services, Americans should be getting much greater value from the care they receive.

There are many obstacles to rapid progress in improving the quality of health care, but none exceeds the fact that the nation still lacks a coherent, goal-oriented, consistent, and efficient system for assessing and reporting on the performance of the health care system. Thus if quality improvement initiatives are to achieve their full potential, a concerted national effort to consolidate health care performance measurement and reporting activities will be essential.


In September 2004, the IOM launched the Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Project in response to two congressional mandates in the Medicare Prescription Drug, Improvement, and Modernization Improvement Act of 2003 (Public Law 108-173, Section 109). The committee empaneled by the IOM to carry out this project is producing three reports for Congress, the Centers for Medicare and Medicaid Services (CMS), and other public and private purchasers on strategies for accelerating the diffusion and pace of quality improvement efforts in the United States (see Table ES-1).

Each of these reports, known collectively as the Pathways to Quality Health Care series, is focused on a specific policy approach to improving the quality of health care: (1) measurement and reporting of performance data, (2) payment incentives, and (3) quality improvement initiatives. All three approaches depend upon the availability of accurate, reliable, and valid performance measures. Performance measures can serve as the foundation for public reporting programs intended to promote accountability among providers and to aid consumers in making informed choices, serve as the basis for payment incentives that reward providers who deliver more effective and efficient care, and guide and inform clinicians and organizations in their quality improvement initiatives.

This first report in the Pathways series focuses on the selection of measures to support the quality improvement efforts of a diverse set of stakeholders, and on the creation of a common infrastructure for guiding and managing a consistent set of such measures nationally and regionally. Future reports, to be released in 2006, will address payment incentive strate-

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