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Value Exchange Scoring Form

This scoring form will be used by reviewers to evaluate applicants to become Chartered Value Exchanges. To make the process transparent, the Scoring Form, the Guide to Scoring, Frequent Questions, and the Application are available.

Applicant Name________________________________________________________

Rater___________________________________________________

Scoring Guide: To standardize the interpretation of the rating scale, please use the following definitions to guide your choices:

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

Engaging purchasers, plans, providers, and consumer advocacy organizations in collaboration

Excellent Very Good Average Fair Poor

Comments____________________________________________________________________
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Engaging health information exchanges, quality improvement organizations, and other community stakeholders

Excellent Very Good Average Fair Poor

Comments____________________________________________________________________
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Obtaining or generating standard performance information

Excellent Very Good Average Fair Poor

Comments__________________________________________________________________
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Engaging providers to improve

Excellent Very Good Average Fair Poor

Comments____________________________________________________________________
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Facilitating consumer decisionmaking

Excellent Very Good Average Fair Poor

Comments___________________________________________________________________
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Promoting policies and incentives for better performance

Excellent Very Good Average Fair Poor

Comments____________________________________________________________________
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Promoting health information technologies and health information exchange

Excellent Very Good Average Fair Poor

Comments____________________________________________________________________
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Capacity: staff/consultant arrangements to provide needed expertise, ability to raise funds or in-kind support from multiple stakeholders, and ability to manage projects and finances

Excellent Very Good Average Fair Poor

Comments___________________________________________________________________
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Supporting transparent processes and conducting ongoing improvement efforts

Excellent Very Good Average Fair Poor

Comments____________________________________________________________________
_____________________________________________________________________________

Applicant Name___________________________ Rater_______________
This applicant meets minimum scores on all items:

_____Yes _____No

E-mail or fax results to:

Nancy Wilson
nancy.wilson@ahrq.hhs.gov
Fax:(301) 427-1201
Phone: (301) 427-1310

Current as of April 2008

Internet Citation:

Value Exchange Scoring Form, 2008. April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/value/cvescoringform.htm