Becoming a Chartered Value Exchange: Frequent Questions

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To make the process transparent for becoming a Chartered Value Exchange, these common questions, the Scoring Form, Guide to Scoring, and the Application are available.

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Contents

Why become a Chartered Value Exchange?
What are the specific benefits of becoming a Chartered Value Exchange?
What is the timeline for 2008 applications and announcement of chosen value exchanges?
Where can I get a copy of the application?
How is the application structured?
Are letters of support required?
Is there a word limit for the application?
What is the application review process and who are the reviewers?
How are applications scored?
Are certain stakeholder groups required to be collaborative members in order to qualify as a Chartered Value Exchange?
Should consumer representation come from randomly selected consumers of health care or consumer advocacy organizations?
How long does the Chartered Value Exchange designation last?
Can there be two Chartered Value Exchanges designated in the same community?
Can Chartered Value Exchanges lose their designation before the 3-year period ends?
Who do I contact with additional questions or concerns?

Questions and Answers

Question 1: Why become a Chartered Value Exchange?

Answer: There is growing recognition that improving the value of U.S. health care will require aligning stakeholder efforts within and among communities.  Critical to that alignment is the generation and use of standard performance information for:

• Improvement directly by providers.
• Public reporting and more informed consumer decisionmaking.
• Effective public policies, payment policies, and consumer incentives that reward or foster better performance. 

Becoming a Chartered Value Exchange brings a local multistakeholder collaborative into a community of like-minded communities all striving to achieve greater health care value and improve population health.

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Question 2: What are the specific benefits of becoming a Chartered Value Exchange?

Answer: Chartered Value Exchanges will receive Medicare claims-based physician group performance results calculated in such a way that the results may be combined with private sector claims.  In addition, Chartered Value Exchanges will automatically join an Agency for Healthcare Research and Quality (AHRQ)-sponsored Learning Network that provides:

• Peer-to-peer learning through facilitated meetings, both face to face and virtual.
• Tools, access to experts, and a shared Web-based knowledge management system.
• A channel for raising issues to be addressed by national consensus-building organizations.
• A channel for informing and participating in national goal setting for quality improvement.

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Question 3: What is the timeline for 2008 applications and announcement of chosen value exchanges?

Answer: AHRQ accepts applications twice a year, in April and October.  The next application period is April 19 through June 19. All applications will be reviewed after the application period ends.  Results will be announced 6 weeks later.   

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Question 4: Where can I get a copy of the application?

Answer: The application, this document, the scoring form, and reviewer evaluation guide are all accessible on the AHRQ Web site. To obtain the application, go to: http://www.ahrq.gov/qual/value/cveapp2008.htm

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Question 5: How is the application structured?

Answer: Part I of the application describes the demographics of the community (population, providers, plans, and employers).  Part II describes the collaborative membership, who makes decisions and how they are made, and the capacity the collaborative has to carry out its proposed Chartered Value Exchange activities and plans.  Part III describes the collaborative current activities and/or plans to address the following seven functions: 

• Engaging stakeholders in collaboration.
• Obtaining or generating standard performance information.
• Engaging providers to improve.
• Facilitating consumer decisionmaking.
• Promoting policies and incentives for better performance. 
• Promoting health information technology and health information exchange.
• Supporting transparency and conducting ongoing improvement of efforts.

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Question 6: Are letters of support required?

Answer: We are now requiring one letter of support from each of the following collaborative stakeholder groups:

• Private or public purchasers.
• Health plans.
• Providers.
• Consumer advocacy organizations.

In addition, although not required, letters from a variety of stakeholders such as health information exchanges, State data organizations, and quality improvement organizations that reflect broad support will be viewed more favorably than several letters of support from one stakeholder group.   

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Question 7: Is there a word limit for the application?

Answer: The cover page and Part I of the application (community demographics) are not counted in a word limit.  Parts II and III (collaborative membership, activities and plans to address Chartered Value Exchange functions) have a combined 3,000-word limit.  Letters of support and appendices are not counted in the word limit.

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Question 8: What is the application review process and who are the reviewers?

Answer: A peer-review process is used to review and score applications.  Reviewers are identified from the Quality Alliance Steering Committee membership and supplemented as needed to make three to four six-member review teams.  Reviewers are assigned to teams so that each team is comprised of one purchaser representative, one health plan representative, one provider representative, one consumer advocacy organization representative, one non-AHRQ Federal employee, and one person with expertise in community coalition building.  Each team is supplemented as needed to include quality improvement organization and health information exchange expertise.  Conflicts of interest are minimized through application assignment to specific teams.

Reviewers individually score their assigned applications and then discuss each assigned application via a conference call.  During that call, the team’s final average scores for each application are determined and submitted to AHRQ.  Results for all applicants are presented to a combined committee consisting of all review teams for discussion and recommendation.  Committee recommendations are subsequently presented to the AHRQ Executive Leadership Team to make final decisions of how many and which applicants will be chartered.  Attempts are made to maximize geographical and population diversity.  

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Question 9: How are applications scored?

Answer: Scoring is based on the following scale definitions: 

• Excellent (5 points):  Clear demonstration of activity already in progress.
• Very Good (4 points):  Activity partially in progress and effective plan to further mature articulated.
• Average (3 points):  Effective plan articulated.
• Fair (2 points):  Attempts to address but hasn’t effectively articulated plan or success.
• Poor (1 point):  Ignores issue.

Minimum average scores have been set for each function and are weighted to reflect the importance of the particular function:

• Engagement of purchasers, health plans, providers, and consumer advocacy organizations has a minimum average score of 4.5. 
• Engaging health information exchanges, quality improvement organizations, and others, obtaining/generating standard performance information, engaging providers to improve, facilitating consumer decisionmaking, promoting policies and incentives for better performance, promoting health information exchange, and having capacity to achieve functions each require a minimum average score of 3.0. 
•  Supporting transparent processes and conducting ongoing improvement of efforts requires an average score of 2.0. 
• Individual application scores can range from a possible high of 45 to a low of 9, but the acceptance of any applicant will be based on meeting the minimum average score required for each function as well as the capacity to achieve the functions. 

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Question 10: Are certain stakeholder groups required to be collaborative members in order to qualify as a Chartered Value Exchange?

Answer: Yes.  At a minimum an applicant must show that the collaborative has representation from public or private purchasers, health plans, providers, and consumer advocacy organizations, and that all four of these stakeholders participate in making decisions and guiding the work of the applicant/collaborative.  Ideally, each stakeholder group would have an equal voice.  If the applicant has a board of directors, that board must have representation from all four stakeholder groups.  If the applicant is an informal collaborative with a committee guiding the work of the applicant, that committee must have representation from all four stakeholder groups. 

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Question 11: Should consumer representation come from randomly selected consumers of health care or consumer advocacy organizations?  Exactly what constitutes adequate consumer stakeholder participation?

Answer: At a minimum, adequate consumer stakeholder participation means that the collaborative priority setting and decisionmaking involves purchasers, plans, providers, and representation from a consumer advocacy organization.   A consumer advocate is an individual who pleads the case of the consumer and calls attention to issues that concern the customer.  We believe professional consumer advocates have the system knowledge and skills to provide meaningful ongoing representation with purchaser, health plan, and provider colleagues.  Examples of acceptable consumer advocacy organizations include senior organizations, disease groups, broad-based consumer groups, and health care consumer organizations.  Non-national community-based advocacy organizations are also acceptable.  While unions are important partners, they are not sufficient to serve as the only consumer advocacy organization. 

The collaborative is also encouraged, although not required, to seek input from routine consumers of health care.  Routine consumers of health care often provide stark reality checks about progress occurring and priorities to be addressed.  As the ultimate customer of health care, it is best if they reflect the population served by the collaborative.  Possible ways to engage routine health care consumers include participation on Chartered Value Exchange committees, periodic focus groups, interviews, or surveys. 

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Question 12: How long does the Chartered Value Exchange designation last?

Answer: The designation is awarded for 3 years contingent on the Chartered Value Exchange’s demonstrating ongoing effort to achieve the seven functions listed in Question 5, above.    

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Question 13: Can there be two Chartered Value Exchanges designated in the same community?

Answer: A Chartered Value Exchange designation will not be awarded to two collaboratives requesting designation for the same geographic area.  There can, however, be more than one Chartered Value Exchange within a State or region.  For example, there can be two or more Chartered Value Exchanges within a State where each Chartered Value Exchange covers a separate geographic area within the State.  There can also be Chartered Value Exchanges that cross State boundaries.  An example would be a metropolitan statistical area whose boundaries encompass counties of two or more States.  It is also acceptable to have a Chartered Value Exchange designation for a broad geographic area, such as an entire State or region, and also have a Chartered Value Exchange designated for a collaborative that covers a subset of the State or region.  The applicant is responsible for justifying the need to have a second Chartered Value Exchange if the first Chartered Value Exchange already exists. The responsibility for the justification is on both applicants if applying concurrently.  The critical evaluation point is to describe how the Chartered Value Exchanges will coordinate, complement, and prevent public confusion about their activities.  

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Question 14:  Can Chartered Value Exchanges lose their designation before the 3-year period ends?

Answer: Yes.  If one of the four critical stakeholder groups (purchaser, plan, provider, consumer advocacy organization) drops out of the collaborative after the collaborative is designated a Chartered Value Exchange, the Chartered Value Exchange will be given 3 months to re-secure the stakeholder group membership.  If that does not occur, the Chartered Value Exchange designation will be rescinded.  

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Question 15: Who do I contact with additional questions or concerns?

Answer:

Nancy Wilson, M.D., M.P.H.
Senior Advisor, Value-driven Health Care
E-mail: nancy.wilson@ahrq.hhs.gov
Phone: (301) 427-1310

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Current as of April 2008

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Internet Citation:

Becoming a Chartered Value Exchange: Frequent Questions. April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/value/cvefaq.htm

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