mittee of clinicians, health services researchers, medical directors of health plans, and others that would consider how to organize and conduct a major national effort on clinical effectiveness and outcomes for Medicare's elderly and disabled populations. This effort would build on the Agency for Health Care Policy and Research's work and other efforts in these areas.

Option #2. Assure effective public accountability and high professional standards for the accrediting organizations for Medicare health plans . The reconciliation bill's requirement that health plans pass muster with an accrediting organization is potentially a critical element of their accountability for meeting high professional standards. The accrediting organizations' identities, structure, and accountability are not spelled out. Too often, health care licensing and accrediting organizations have settled for (or eroded to) standards that can easily be met and become rubber stamps for second-rate performers. There are also examples of professional standard setting, under government oversight, that seem to work well, for example, the Financial Accounting Standards Board (which is sponsored by all of the major professions involved)-Securities and Exchange Commission relationship. NCQA, FAcct, and the Joint Commission on Accreditation of Healthcare Organizations are among those already vying for an accreditation role. The nature, sponsorship, funding, and accountability of the accrediting organization(s) for Medicare health plans are worthy of careful consideration by public policy makers if they are to require high standards rather than minimally acceptable performance.

Option #3. Develop best practice benchmarks and centers of excellence as competitive Medicare options. The competitive market can be used to influence health plan performance by making sure that the fee-for-service Medicare program offers the toughest possible competition with health plans for excellent health care. If the Medicare program identifies best practices and outstanding providers-and selectively contracts with such providers, possibly using a centers of excellence and preferred provider model-it can ensure that there are high competitive standards, on a procedure-by-procedure and disease-by-disease basis, that health plans will need to meet if they want to attract patients. If health plans do not measure up to these

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