AQA Third Invitational Meeting Summary

Improving the Quality and Efficiency of Health Care in the Ambulatory Setting

Mark McClellan, Centers for Medicare & Medicaid Services (CMS)

Mark McClellan began by thanking participants for their tireless leadership and dedication to making a critical difference for patients, physicians, and others who are working to improve health care. He then stressed that it was important to ensure that physicians take the lead on getting clinicians involved with performance measurement and related activities. Physician leadership is critical to improving quality and efficiency in health care, he said.

The Ambulatory Care Quality Alliance (AQA) has made a great start in working quickly to get widely accepted, valid performance measurement, said McClellan, adding that this was similar to what was achieved by the Hospital Quality Alliance.

McClellan stressed that the performance measurement workgroup's starter set is a very important and urgently needed first step. He noted that it was encouraging that AQA is working in concert with the National Quality Forum (NQF) by starting with measures that are under NQF's consideration. The AQA and NQF processes will be vital for future efforts to expand the starter set that is currently under discussion. McClellan added that it will be important to work with specialists to identify additional performance measures that may be endorsed and implemented. He also strongly encouraged AQA to think about addressing efficiency measures. The goal is not merely to measure efficiency, he said, but also to provide better evidence and support for encouraging efficiencies and avoiding unnecessary costs in the system.

Next, McClellan said his agency wanted input and guidance from AQA on measures of physician impact on resource use and how to provide feedback to practitioners on a confidential basis.

We have been exploring how to meet data needs for quality improvement and other purposes, and we want to coordinate our activities with those of AQA, said McClellan. We have no preconceived notions of the optimal data aggregation model, he added, and understand that there are a variety of ways that data can be produced and aggregated. There are roles for many entities, including community initiatives, plans, and provider organizations.

McClellan emphasized the need for all stakeholders to work together to create consistent models of data collection and storage. In addition, he encouraged the data aggregation workshop to address the issue of consistent standards of data capabilities that will allow for the exchange of information.

Finally, McClellan stressed that in order to create a real, comprehensive systematic change in quality, processes must be transparent and inclusive. It is also imperative that we act now, he concluded.

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