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
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Engaging purchasers, plans, providers, and consumer advocacy organizations in collaboration
Excellent Very Good Average Fair Poor
Comments____________________________________________________________________
_____________________________________________________________________________
Engaging health information exchanges, quality improvement organizations, and other community stakeholders
Excellent Very Good Average Fair Poor
Comments____________________________________________________________________
_____________________________________________________________________________
Obtaining or generating standard performance information
Excellent Very Good Average Fair Poor
Comments__________________________________________________________________
__________________________________________________________________________
Engaging providers to improve
Excellent Very Good Average Fair Poor
Comments____________________________________________________________________
_____________________________________________________________________________
Facilitating consumer decisionmaking
Excellent Very Good Average Fair Poor
Comments___________________________________________________________________
____________________________________________________________________________
Promoting policies and incentives for better performance
Excellent Very Good Average Fair Poor
Comments____________________________________________________________________
_____________________________________________________________________________
Promoting health information technologies and health information exchange
Excellent Very Good Average Fair Poor
Comments____________________________________________________________________
_____________________________________________________________________________
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