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Making Health Care Measure Up

By Mary Agnes Carey, CQ HealthBeat Associate Editor

February 28, 2007 -- As part of the Bush administration's ongoing efforts to promote greater transparency in health care, Department of Health and Human Services Secretary Michael O. Leavitt Wednesday announced a new venture that would create local health care collaboratives to provide public reports on the cost and quality of health care providers.

Under the plan, HHS would select qualified regional collaboratives, which would be chartered as "Value Exchanges." Local physicians, nurses, hospitals, and other health care providers would work together with health plans, employers, unions, and other health care purchasers toward the goal of publishing reports, which consumers could use to help comparison shop for health care, much like they do in other areas, such as cars or appliances.

"This is what this economic sector has lacked that every other sector has," Leavitt said during a breakfast with health care reporters.

With a mantra in mind of "national coordination, local control," Leavitt said the groups would be independent, nonprofit organizations administered at the local level, with the hope of bringing such collaboratives into a national system administered by HHS' Agency for Healthcare Research and Quality (AHRQ). HHS has asked for $4 million in fiscal 2008 to establish and operate the collaboratives, and AHRQ Director Carolyn M. Clancy said providers would lead in the development of standards.

Leavitt predicted that within two years the collaborations would start to publish data on a limited number of procedures with a national network developing in five years. Such reporting is part of the administration's plan of "four cornerstones" to achieve value-driven health care, which also include broader use of health information technology and providing incentives for better quality and value in health care services.

The system Leavitt described would include two types of collaboratives: "community leaders," which are less developed collaboratives with the goal of increasing stakeholder participation and quality measurement capacity, and the more developed "Value Exchanges," already functioning collaboratives that meet existing criteria and are selected by HHS to be chartered and carry out quality improvement and public reporting.

Last August, President Bush signed an executive order that requires providers and health plans doing business with federal health programs to publicize data on the cost and quality of their care and to organize billing and insurance claims in a way that allows the cost and quality of medical procedures to be compared easily. The administration also has reached out to major employers to do the same.

Separately, the Robert Wood Johnson Foundation (RWJF) Thursday announced a two-year $115 million program to build upon an already established program the foundation has created to help community coalitions improve the quality of care provided for chronic illnesses in doctors' offices, clinics, and other outpatient settings.

Much like the collaborations Leavitt described, the RWJF grantees will work to establish measures to help health care providers improve their ability to provide care and publicly report their performance. RWJF will work in up to 20 communities to improve the quality of health care in those communities by focusing more on coordinating care around the needs of patients and reducing racial and ethnic disparities in care.

"There is no one health care system in America, and communities have different strengths and weaknesses when it comes to health care," RWJF President and Chief Executive Officer Risa Lavizzo-Mourey said in a statement. "RWJF can help align the many organizations, government and non-government, at the national level on issues like performance measures and public reporting. And we can support the efforts of doctors, nurses, patients and other stakeholders to achieve high-quality health care in their own communities."

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