[Federal Register: August 3, 2007 (Volume 72, Number 149)]
[Notices]
[Page 43274-43277]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr03au07-74]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities Proposed Collection;
Comment Request
AGENCY: Agency for Healthcare Research and Quality, Department of
health and Human Services.
ACTION: Notice.
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SUMMARY: This notice announces the intention of the Agency for
Healthcare Research and Quality (AHRQ) to request that the Office of
Management and Budget (OMB) allow the proposed information collection
project: ``Chartering Value Exchanges for Value-driven Health Care.''
The information collection will take the form of narrative responses to
semiannual Requests for Proposals to participate in a learning network
of mature multi-stakeholder community health care collaboratives
established to measure, report, and improve the quality and cost of
available healthcare. In accordance with the Paperwork Reduction Act of
1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)), AHRQ invites the
public to comment on this proposed information collection.
DATES: Comments on this notice must be received by September 4, 2007.
ADDRESSES: Written comments should be submitted to: Karen Matsuoka by
fax at (202) 395-6974 (attention: AHRQ's desk officer) or by e-mail at
OIRA_submission@omb.eop.gov (attention: AHRQ's desk officer).
Copies of the proposed collection plans, application form, and
specific details on the estimated burden can be obtained from AHRQ's
Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ, Reports
Clearance Officer, (301) 427-1477, or by e-mail at
doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
[[Page 43275]]
Proposed Project
``Charting Value Exchanges for Value-driven Healthcare''
This project proposes to twice annually post a public call for
parties interested in becoming chartered as Value Exchanges for Value-
driven Healthcare, described in the Background Section below.
Anticipated benefits of being a chartered Value Exchange include (1)
Participation in an AHRQ-managed Learning Network and (2) access to
Medicare patient de-identified provider performance measurement
results.
Background
The Secretary of Health and Human Services has created and is
implementing a Value-driven Healthcare Initiative to enhance person and
population-centered care by improving the quality of healthcare
services and reducing healthcare costs. Related HHS goals and
objectives reflect the President's Executive Order 13410: Promoting
quality and Efficient Health Care in Federal Government Administered or
Sponsored Health Care Programs (August 2006) and encompass (1)
Promotion of the establishment of health information technology
interoperability standards for exchanging price and quality healthcare
data; (2) promotion of the availability and use of transparent,
nationwide consensus based and endorsed quality measures; (3) promotion
of the availability and use of transparent, nationwide consensus based
and endorsed measures of price/cost; and (4) promotion of the use of
provider and consumer incentives for high quality and cost efficient
healthcare.
This Initiative's designed on three fundamental principles. The
first is that at its care, healthcare is ``local''--provided in
uniquely constituted cultural and market-based environments. As such,
improving the value of healthcare requires a critical mass of community
stakeholders: Public and private purchasers, health plans, providers,
and consumers, as well as other relevant community entities (e.g.,
local health information exchange organizations, Quality Improvement
Organizations, state data organizations) investing their time and
resources toward shared cost and quality improvement goals. We refer to
such representative community entities as local multi-stakeholder
collaboratives. Scattered across the country there are community
collaboratives in various stages of development ranging from mature
multi-stakeholder collaboratives (defined as ongoing collaboration
among representatives from purchasers, health plans, providers, and
consumers) to communities where collaboration does not include
representatives from all four groups.
The second principle is that broad access to accurate, meaningful
information will improve the value of healthcare services by (1)
stimulating provider improvement, (2) engaging consumers in provider
selection and treatment choices, and (3) enabling purchasers to align
consumer and provider incentives. Generating the information needed to
accomplish this is maximized when performance measures can be
calculated based on all payer data.
The third principle is that establishing a nation-wide learning
network will accelerate market-based health care improvement. Learning
networks are an evidence-based organizational mechanism to achieve
rapid identification, dissemination and adoption of best practices.
They are comprised of individuals or groups focused on achieving common
broad goals.
Based on the above, AHRQ plans to (1) identify and designate
qualified mature community-based multi-stakeholder groups as Chartered
Value Exchanges and establish a nation-wide learning network for them.
Chartered Value Exchanges (CVEs)
AHRQ envisions Chartered Value Exchanges as having four core and
three important non-core functions as described below.
Four (4) Core Functions
Engagement of Stakeholders in Collaboration:
Effectively engaging representatives from all four critical
stakeholders: purchaser, health plan, provider, and consumer
representatives as well as from Health Information Exchanges, Quality
Improvement Organizations, state data organizations and other community
stakeholders in ongoing collaboration is a core CVE function.
Use of Measures:
Getting nationwide consensus based and endorsed performance
measures locally adopted and used is a core CVE function. Developing
new measures is not. Measures could be generated nationally or
generated locally based on clear protocols. Optimally, measures would
be constructed by pooling information from all relevant sources and
would ultimately address all six Institute of Medicine performance
domains of safety, timeliness, effectiveness, efficiency,
equitableness, and patient-centeredness.
Provider Engagement in Improvement:
Directly engaging providers to use performance information is a
core CVE function and is not limited to informing providers of results.
Engagement requires active ongoing dialogue that includes but is not
limited to improving data accuracy and data interpretability. While
provider engagement is anchored locally, CVEs will operate in a
national environment and should encourage involvement, support and
ongoing dialogue between national, regional, and local entities.
Consumer Engagement:
Engaging consumers to use performance information is a core CVE
function and is not limited to reporting of information. This function
may be met, however, by assuring usable information is made available
to other entities that would use and distribute that information to
consumers.
Three (3) Important (Non-core) Functions
Promoting HIT and HIE
The role of the CVE is to: (1) Facilitate the use of interoperable
health information technologies and health information exchange either
directly or through alignment with regional health information networks
and (2) promote the ongoing migration of measure calculation based
solely on aggregated claims data to measure calculation that includes
aggregated electronic clinical data and fosters real time patient care
improvement.
Facilitating Rewards for Better Performance
The role of the CVE is to facilitate or enable the use of
performance measures to reward and foster better provider performance
and consumer behavior. The function may be met by serving as a catalyst
attempting to influence regional or national health plans and
purchasers.
Supporting Knowledge Transfer and Conducting Ongoing Improvement of
Efforts
Sharing discoveries and lessons learned within the CVE community,
the CVE learning network, and interested public at large is an
expectation of how a CVE conducts itself. Likewise, it is an
expectation that a CVE will practice continues quality improvement in
all that it does.
The Chartered Value Exchange designation will be applied to the
collective work occurring within a
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community regardless of how many organizations divide up the work. AHRQ
does not plan, however, to impose a particular definition of community
based on geography or population density. AHRQ recognizes the need to
respect local culture, relationships, and priorities, and will maintain
a flexible and inclusive approach to selection and designation. AHRQ
does not require a Value Exchange to be an incorporated non-profit
entity. AHRQ expects CVEs to adopt nationwide consensus based and
endorsed principles and standards where they exist and as they are made
available. To be eligible, interested parties must first be recognized
by HHS Secretary Michael O. Leavitt as a Community Leader for Value-
driven Healthcare. For additional information on Community Leader
recognition, see http://www.hhs.gov/transparency/communities/communityleaders/communities.html
.
Learning Network
Goals of the Learning Network will be to facilitate sharing of CVE
experiences and lessons learned; identify and share promising practices
that improve healthcare value; identify gaps where innovation is
needed; raise issues to be addressed by national consensus-building
organizations; and provide on-the-ground perspective to inform and
participate in setting national priorities for healthcare quality and
cost improvement. The Learning Network will provide technical
assistance in such areas as collaborative production of public reports,
effective pay for performance, and use of consumer incentives, and will
ultimately work with CVEs to implement a core measure set derived from
nationwide consensus based and endorsed measures.
Method of Collection
Each RFP will be posted on the AHRQ public Web site (http://www.ahrq.gov
) with a link to the AHRQ site on the HHS transparency Web
site as well. The RFP instructions will direct interested parties to
electronically submit narrative information (maximum 3000 words) to
AHRQ that describes their current activities and/or plans to perform
the four core functions and three important non-core functions. In
addition, applicants will be asked to describe their staff/consultant/
in-kind resource arrangements to provide needed expertise; their
ability to raise funds or in-kind support from multiple stakeholders;
and their ability to manage projects and finances as indications of
their organizational capacity to accomplish the four core functions.
Review teams comprised of purchaser, health plan, provider, consumer,
and federal representatives will be assembled. Review teams will
include experts from Health Information Exchanges and the Quality
Improvement Organization community. Each enrollment period will be open
for two months. Applications will be assigned and scored as they are
received at AHRQ. AHRQ staff will screen the application for Community
Leader status, then distribute it to each member of the 5 member review
team. The application will be individually scored by each of the review
team members within two weeks. The completed scoring forms will be
returned to AHRQ who will then generate the team's average scores per
function for that applicant. The Scoring Form uses the following rating
scale and definitions to guide the evaluations:
Evaluation Guide: To standardize the interpretation of the rating
sale, 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.
Minimum average scores have been set for each function, and are
weighted to reflect the importance of the particular function.
Engagement of critical stakeholders has a minimum average score of 4.5
while engagement of others, use of performance measures, provider
engagement and consumer engagement each have minimum average scores set
at 3.0. Non-core functions including promotion of HIT and HIE,
facilitation of rewards for better performance, participation in
knowledge transfer, and ongoing improvement of efforts each have
minimum average scores set at 2.0. Organizational capacity requires a
minimum average score of 2.0 also. Individual application scores can
range from a possible high of 27 to a low of 10, but the acceptance of
any applicant will be based on meeting the minimum average score
required for each function as well as organizational capacity. A grid
of all applicants' average scores by function will be presented to the
AHRQ Executive Leadership Team to make final decisions on how many and
which applicants will be chartered at the end of the first month and at
the close of the enrollment period. Attempts will be made to maximize
geographical and population diversity. Successful applicants will be
notified within one month of review.
Estimated Annual Respondent Burden
Exhibit 1.--Estimate of Cost Burden to Respondents
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Estimated Estimated Estimated
Number of time per total Average annual cost
Data collection effort estimated respondent burden hourly wage burden to
respondents in hours hours rate respondents
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Draft narrative response to RFP by 50 8 400 $34.67 $13,868
Collaborative Manager.........................
Narrative reviews by 1-2 members of 75 1 75 57.90 4,342.50
Collaborative executive committee.............
Narrative revisions by Collaborative Manager... 50 8 400 34.67 13,868
Assembly of narrative with any supporting 50 2 100 12.58 1,258
documents by Collaborative Assistant..........
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Total...................................... 225 ........... 950 ........... 33,336.50
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This information collection will not impose a cost burden on the
respondent beyond that associated with the above estimates of the time
needed to provide the application-requested information. There will be
no additional substantial costs to respondents anticipated, e.g. for
capital equipment, software, computer services.
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Estimated Costs to the Federal Government
The total cost to the government for its proposal review activity
is estimated to be $500,000 annually.
Request for Comments
In accordance with the above-cited legislation, comments on the
AHRQ's information collection are requested with regard to any of the
following: (a) Whether the proposed collection of information is
necessary for the proper performance of health care improvement and
information dissemination functions of AHRQ, including whether the
information requested will have practical utility; (b) the accuracy of
AHRQ's estimate of burden (including hours and costs) of the proposed
collection(s) of information; (c) ways to enhance the quality, utility,
and clarity of information to be collected; and (d) ways to minimize
the burden of the collection of information upon the respondents,
including the use of automated collection techniques or other forms of
information technology.
Comments submitted in response to this notice will be summarized
and included in the request for OMB approval of the proposed
information collection. All comments will become a matter of public
record.
Dated: July 30, 2007.
Carolyn M. Clancy,
Director.
[FR Doc. 07-3814 Filed 8-2-07; 8:45 am]
BILLING CODE 4160-90-M