AQA Invitational Meeting Summary

Opening Remarks

Carolyn Clancy, Agency for Healthcare Research and Quality (AHRQ)

Carolyn Clancy opened the meeting by welcoming participants and noting that there were a record number of people (over 160, representing 100 stakeholders) in attendance. Clancy said that the increase was due in part to the fact that there were representatives present from the organizations involved in the pilot programs.

Review of AQA Governance

John Tooker, American College of Physicians

John Tooker provided an overview of the AQA. He stressed that the AQA employs a collaborative process that includes consumers, health insurance plans, physicians, purchasers, and other key stakeholders. He also reiterated that the quality improvement movement is voluntary, and that it involves a series of interlocking groups working together.

Tooker briefly reviewed the AQA's governance model, which he said has no formal structure and relies on the voluntary commitment and collaborative spirit of the multiple stakeholders. He noted that there have been at least three open meetings annually, and that the steering committee (made up of representatives from consumer groups, health insurance plans, physicians, and other participants) meets before every meeting and occasionally otherwise. Between meetings, each of the three workgroups meets regularly.

The AQA uses a consensus process for getting work done, continued Tooker. At the same time, he emphasized that there was a balancing act between the need for urgency and the desire to take advantage of opportunities. On the latter subject, he pointed out that new challenges are constantly providing opportunities that the AQA needs to take advantage of in a timely manner.

The AQA is really focused on implementation and adoption of measures in the field, said Tooker. As a result, there is a need to coordinate with organizations that are developing performance measures. Tooker added that the intent is to develop a robust series of measures for all areas and then to implement them in the field. In addition, he stressed that there needs to be an orderly process from development to implementation and then the principles must be maintained.

The principles must be workable in the field, stressed Tooker, and hence there are six pilot projects underway to evaluate whether measures can be adopted in the field.

Tooker also noted that it was clear that performance measures must be implemented in coordination with the work being done by the HQA. As a result, he said, an AQA/HQA Quality Alliance Steering Committee has been established in order to look at how to expand the pilot projects and how to establish a health quality network in the United States.

Finally, Tooker took a minute to talk about the AQA's communications philosophy. The AQA is a transparent process, he said, and all its meetings and agendas are posted on a public Web site. At the same time, because the AQA is not a formal entity the AQA Steering Committee has agreed that it is not appropriate for the AQA to provide formal public comment on its activities. Rather, the steering committee believes that it is more appropriate for individuals representing their own companies to do so.

Discussion

Following Tooker's remarks, Carolyn Clancy reiterated that that the AQA process is highly transparent, and that the goal of the process is better health care.

One participant said that she wanted the opportunity for all participants to at least listen in on workgroup activities, something that has not been done. Clancy responded that this was a very good point and promised that the AQA Steering Committee would discuss the matter. Kevin Weiss (who chairs the workgroup on performance measurement) said the problem stemmed from the way the cost-of-care subgroup had started. He and others learned from that process that it was important to bring more people into the room and into the conversation.

There also was a question about the voting process. Clancy responded that the AQA generally takes an up/down vote, although there have been times that an item has been sent back to a workgroup for further discussion.

Finally, one participant expressed concern that the direction taken by a workgroup often depends on who is participating in any given conference call or meeting. He said that he was sometimes uncomfortable that the process was moving very fast without adequate representation from all parties.

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