Given these competing needs, the committee has opted to recommend locating the NQCB as an independent entity within the U.S. Department of Health and Human Services (DHHS), reporting directly to the DHHS Secretary. This arrangement will allow the board to perform its functions while preserving its structural independence from other agency priorities that could impede its activities.

The committee believes that an entity without adequate authority and protection cannot succeed in this endeavor. The chance of succeeding through new relationships with and among existing players will depend on the board’s ability to withstand the intense short-term political pressures that without doubt will arise as current stakeholders perceive the threats enumerated above. Change will not be accomplished without discomfort, and the NQCB must be able to ride out that discomfort and adhere to the goals articulated in this report. Therefore, the committee proposes that the NQCB be armed with at least the following forms of authority and protection:

  • Structural independence. The NQCB should have the capacity to move the health care system beyond the status quo. The committee recommends that the board be housed within the DHHS and report directly to the Secretary.

  • Protection from undue influence. The membership of the NQCB should be appointed by the President, with terms that are staggered and long enough to protect the board against short-term political influence and major stakeholder interests.

  • Substantive expertise. As noted above, the committee’s intention is not to supplant or duplicate the often outstanding work of the many organizations currently involved in developing, evaluating, vetting, and implementing performance measures in health care. Rather, the goal is to accelerate progress through coordination and direct financial support for these current activities. Thus the membership of the NQCB should encompass the technical competence needed to assess and guide that work.

  • Contract authority. In the event that the major organizations currently engaged in measurement development, implementation, and reporting prove unwilling or unable to undertake the activities outlined by NQCB or to deliver under contract the required levels of standardization, analysis, and reporting, the board should have the backup authority and sufficient funding to broaden the array of contractors through which it can execute its key functions.

  • Standards-setting authority. The Secretary of DHHS should direct CMS (including Medicare, Medicaid, and the State Children’s Health Insurance Program), the Health Resources and Services Administration, and AHRQ to focus on the achievement of all applicable national goals established by the NQCB through public reporting, payment reform and other



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