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Performance Measurement: Accelerating Improvement
iors; and public officials responsible for disease surveillance and health protection.
Recommendation 2: The NQCB’s membership and procedures should be designed to ensure that the board has structural independence, protection from undue special interests, substantive expertise drawn from the public and private sectors (including not-for-profit entities), contract authority, standards-setting authority, financial strength, and external accountability.
The committee believes that an NQCB without adequate authority and protection cannot succeed in this endeavor. Therefore, the committee proposes that the NQCB be armed with at least the following attributes:
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 U.S. Department of Health and Human Services (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. 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 the 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 the Agency for Healthcare Research and Quality (AHRQ) to focus on the achievement of all applicable national goals established by the NQCB through public reporting, payment reform, and other incentives such as health care improvement programs, benefit design, health professions edu-