• The science-based and peer-reviewed literature on public accountability and informed purchasing for Medicare beneficiaries under a market-oriented choice paradigm is sparse since the field is young and continues to evolve at an unprecedented pace. The state-of-the-art information in this arena resides primarily among a number of large private and public purchasers that currently define the field and various other organizations and agencies such as the National Committee on Quality Assurance (NCQA), HCFA, the U.S. General Accounting Office, the Physician Payment Review Commission (PPRC), the Foundation for Accountability, and the Agency for Health Care Policy and Research, which have a major interest in and programs directed to this area. With that in mind, the committee developed a symposium primarily around real-world experts who could comment on and respond to the commissioned papers, to other relevant and available research findings, and to the Medicare reform proposals from their well-recognized experiences.
  • The committee was primarily interested in learning about current best practices in the public and private sectors as they relate to public accountability, informed purchasing, and competition based on excellence. There was a caution that the term best practices should be reserved for interventions that had been tested and evaluated on the basis of quality and cost-effectiveness and that the term promising interventions or models might be more accurate.
  • The committee was fortunate to be able to commission eight papers—including five literature reviews and two case studies that review the state-of-the-art and consider a continuum of organizational and policy options for assuring public accountability and informed purchasing-written by national experts. These papers cover the most critical aspects of ensuring public accountability and informed purchasing for Medicare beneficiaries in an environment of choice.
    • To frame the symposium dialogue and the committee's later deliberations, the committee asked Lynn Etheredge to write a paper proposing a conceptual framework for ensuring public accountability and informed choice from the perspective of beneficiaries by looking at how and where the various loci of responsibilities would be placed in the continuum of three alternative potential models: letting the market prevail (market

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