Advocacy for National Performance Standards and Disclosure

Problem: Improved disclosure of valid performance at all levels of the health care system is a high priority because lives and economic vitality are at stake. The key to improved disclosure is the creation and movement into use of a robust set of standardized performance measures for hospital, physicians and treatments. If you can’t measure it, you can’t improve it. To date, purchasers and consumers have lacked a coherent voice for accelerating the availability to Americans of such measures.

PBGH Role and Project Description: PBGH serves as a leader, providing both clinical and political guidance, for the Consumer/Purchaser Disclosure Project, which seeks to unite the “buy side” of the market—consumers, purchasers and labor—into a single voice demanding nationally standardized quality measures by 2007. More than 60 organizations have united as the Disclosure Group to advocate for the development and institutionalization of measurement systems. Collaborating with measure developers such as the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA), they act together to encourage the identification and disclosure of measures at every level of the health care system. The group advances measures through the National Quality Forum (NQF), a not-for-profit membership organization created in response to the President’s Commission on Health Care Quality. NQF’s mission is to develop and implement a national strategy for health care quality measurement and reporting.

As public access to standardized measures is achieved, the Disclosure Group will use market levers to promote their use, including consumer information and tools, benefit design changes that engage consumers and provider payment incentives. The group will define and promote roles for employers, states, consultants and health plans.

Other examples of how PBGH gives voice to its members’ demand for better quality information include: Arnold Milstein, MD, PBGH medical director, sits on NQF’s Strategic Advisory Council; David Hopkins, PhD, PBGH director of quality measurement and improvement, is a member of the Business Advisory Group of the Joint Commission for the Accreditation of Healthcare Organizations, and is also on the Stakeholders Council of the Centers for Medicare and Medicaid Services; Emma Hoo, PBGH director of value-based purchasing, is part of eValue8, a group of purchasers that use a common request for proposal to push for standardized HMO expectations and contracting; and Peter Lee, PBGH president and CEO, serves on the board of directors of the National Committee for Quality Assurance.

Impact: With significant input from the Disclosure Group, NQF’s initial set of standardized national hospital performance measures was dramatically expanded. Equally important, NQF adopted the policy of including three additional measurement “domains” (economic sufficiency, patient experience and equity/fairness) with the clinical domains of quality (safety, timeliness and effectiveness), thus ensuring that the full definition of quality as defined by the Institute of Medicine was addressed.

Current Activities: NQF recently approved most of the first subgroup of initial hospital measures. It also analyzed and approved for upcoming member consideration an additional set of measures championed by consumers and purchasers. NQF is accelerating an expert review process to attain consensus on a single national measure of patient experience of hospital care. Furthermore, CMS has embarked on an effort to create a standardized hospital patient experience survey.

Choose any of the following links to learn more about the Consumer/Purchaser Disclosure Project.

Goals for Progress by 2005. A summary of the steps that need to be taken between 2003 and 2005 if we are to make the needed progress to reach the 2007 target.

Letter on Strategic Priorities and 2003 Work Plan. February 28, 2003, letter from the Employer Health Care Alliance Corporation, the National Partnership for Women and Families and the Pacific Business Group on Health to participating and supporting Consumer-Purchaser Disclosure Project organizations.

The National Movement Towards Improved Disclosure & Transparency. PowerPoint presentation by Lori Armbruster, 3M Company, and Peter Lee, PBGH, delivered March 5, 2003, to the Washington Business Group on Health.

Status Report: Consumer and Purchaser Disclosure Report. October 2002 report from the National Health Care Purchasing Institute.

A User's Manual for the IOM's 'Quality Chasm' Report succinctly summarizes the Institute of Medicine March 2001 report, providing a useful framework to discuss the needed four-level changes to the national health care system so as to bridge the great divide between what our health system is and what it can and should be.

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