To make the
process transparent for becoming a Chartered
Value Exchange, these common questions, the Scoring Form, Guide to Scoring, and the Application are available.
Contents
Why become a Chartered Value Exchange?
What are the specific benefits of becoming a Chartered Value
Exchange?
What is the timeline for 2008 applications and announcement of
chosen value exchanges?
Where can I get a copy of the application?
How is the application structured?
Are letters of support required?
Is there a word limit for the application?
What is the application review process and who are the reviewers?
How are applications scored?
Are certain stakeholder groups required to be collaborative members in order to qualify as a Chartered Value Exchange?
Should consumer representation come from randomly selected consumers of health care or consumer advocacy organizations?
How long does the Chartered Value Exchange designation last?
Can there be two Chartered Value Exchanges designated in the same community?
Can Chartered Value Exchanges lose their designation before the 3-year period ends?
Who do I contact with additional questions or concerns?
Questions
and Answers
Question
1: Why become a Chartered Value Exchange?
Answer: There
is growing recognition that improving the value of U.S. health care will
require aligning stakeholder efforts within and among communities. Critical to
that alignment is the generation and use of standard performance information
for:
- Improvement
directly by providers.
- Public
reporting and more informed consumer decisionmaking.
- Effective
public policies, payment policies, and consumer incentives that reward or
foster better performance.
Becoming
a Chartered Value Exchange brings a local multistakeholder collaborative into a
community of like-minded communities all striving to achieve greater health
care value and improve population health.
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Question 2: What are the specific benefits of becoming a Chartered Value Exchange?
Answer: Chartered
Value Exchanges will receive Medicare claims-based physician group performance
results calculated in such a way that the results may be combined with private
sector claims. In addition, Chartered Value Exchanges will automatically join
an Agency for Healthcare Research and Quality (AHRQ)-sponsored Learning Network
that provides:
- Peer-to-peer
learning through facilitated meetings, both face to face and virtual.
- Tools,
access to experts, and a shared Web-based knowledge management system.
- A
channel for raising issues to be addressed by national consensus-building
organizations.
- A
channel for informing and participating in national goal setting for quality
improvement.
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Question
3: What is the timeline for 2008 applications and announcement of chosen value
exchanges?
Answer: AHRQ
accepts applications twice a year, in April and October. The next application
period is April 19 through June 19. All applications will be reviewed after the
application period ends. Results will be announced 6 weeks later.
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Question
4: Where can I get a copy of the application?
Answer: The
application, this document, the scoring form, and reviewer evaluation guide are
all accessible on the AHRQ Web site. To obtain the application, go to: http://www.ahrq.gov/qual/value/cveapp2008.htm
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Question
5: How is the application structured?
Answer: Part I of the application
describes the demographics of the community (population, providers, plans, and
employers). Part II describes the collaborative membership, who makes
decisions and how they are made, and the capacity the collaborative has to
carry out its proposed Chartered Value Exchange activities and plans. Part III
describes the collaborative current activities and/or plans to address the
following seven functions:
- Engaging stakeholders in
collaboration.
- Obtaining or generating
standard performance information.
- Engaging providers to
improve.
- Facilitating consumer
decisionmaking.
- Promoting policies and
incentives for better performance.
- Promoting health
information technology and health information exchange.
- Supporting transparency and
conducting ongoing improvement of efforts.
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Question 6: Are letters of
support required?
Answer: We are now requiring one
letter of support from each of the following collaborative stakeholder groups:
- Private or public
purchasers.
- Health plans.
- Providers.
- Consumer advocacy
organizations.
In addition, although not
required, letters from a variety of stakeholders such as health information
exchanges, State data organizations, and quality improvement organizations that
reflect broad support will be viewed more favorably than several letters of
support from one stakeholder group.
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Question
7: Is there a word limit for the application?
Answer: The cover page and Part I of
the application (community demographics) are not counted in a word limit.
Parts II and III (collaborative membership, activities and plans to address
Chartered Value Exchange functions) have a combined 3,000-word limit. Letters
of support and appendices are not counted in the word limit.
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Question 8: What is the
application review process and who are the reviewers?
Answer: A peer-review process is used
to review and score applications. Reviewers are identified from the Quality
Alliance Steering Committee membership and supplemented as needed to make three
to four six-member review teams. Reviewers are assigned to teams so that each
team is comprised of one purchaser representative, one health plan
representative, one provider representative, one consumer advocacy organization
representative, one non-AHRQ Federal employee, and one person with expertise in
community coalition building. Each team is supplemented as needed to include
quality improvement organization and health information exchange expertise.
Conflicts of interest are minimized through application assignment to specific
teams.
Reviewers individually score
their assigned applications and then discuss each assigned application via a
conference call. During that call, the team's final average scores for each
application are determined and submitted to AHRQ. Results for all applicants are
presented to a combined committee consisting of all review teams for discussion
and recommendation. Committee recommendations are subsequently presented to
the AHRQ Executive Leadership Team to make final decisions of how many and
which applicants will be chartered. Attempts are made to maximize geographical
and population diversity.
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Question 9: How are
applications scored?
Answer: Scoring is based on the
following scale definitions:
- 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 purchasers,
health plans, providers, and consumer advocacy organizations has a minimum average score of 4.5.
- Engaging health information
exchanges, quality improvement organizations, and others,
obtaining/generating standard performance information, engaging providers
to improve, facilitating consumer decisionmaking, promoting policies and
incentives for better performance, promoting health information exchange,
and having capacity to achieve functions each require a minimum average score of 3.0.
- Supporting transparent
processes and conducting ongoing improvement of efforts requires an average score of 2.0.
- Individual application
scores can range from a possible high of 45 to a low of 9, but the
acceptance of any applicant will be based on meeting the minimum average
score required for each function as well as the capacity to achieve
the functions.
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Question 10: Are certain
stakeholder groups required to be collaborative members in order to qualify as
a Chartered Value Exchange?
Answer: Yes. At a minimum an
applicant must show that the collaborative has representation from public or
private purchasers, health plans, providers, and consumer advocacy
organizations, and that all four of these stakeholders participate in making
decisions and guiding the work of the applicant/collaborative. Ideally, each
stakeholder group would have an equal voice. If the applicant has a board of
directors, that board must have representation from all four stakeholder
groups. If the applicant is an informal collaborative with a committee guiding
the work of the applicant, that committee must have representation from all
four stakeholder groups.
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Question 11: Should
consumer representation come from randomly selected consumers of health care or
consumer advocacy organizations? Exactly what constitutes adequate consumer
stakeholder participation?
Answer: At a minimum,
adequate consumer stakeholder participation means that the collaborative
priority setting and decisionmaking involves purchasers, plans, providers, and
representation from a consumer advocacy organization. A consumer advocate is an
individual who pleads the case of the consumer and calls attention to issues
that concern the customer. We believe professional consumer advocates have the
system knowledge and skills to provide meaningful ongoing representation with
purchaser, health plan, and provider colleagues. Examples of acceptable
consumer advocacy organizations include senior organizations,
disease groups, broad-based consumer groups, and health care consumer
organizations. Non-national community-based advocacy
organizations are also acceptable. While unions are important partners, they
are not sufficient to serve as the only consumer advocacy organization.
The collaborative is also
encouraged, although not required, to seek input from routine consumers of
health care. Routine consumers of health care often provide stark reality
checks about progress occurring and priorities to be addressed. As the
ultimate customer of health care, it is best if they reflect the population
served by the collaborative. Possible ways to engage routine health care
consumers include participation on Chartered Value Exchange committees,
periodic focus groups, interviews, or surveys.
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Question
12: How long does the Chartered Value Exchange designation last?
Answer: The
designation is awarded for 3 years contingent on the Chartered Value Exchange's
demonstrating ongoing effort to achieve the seven functions listed in Question
5, above.
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Question
13: Can
there be two Chartered Value Exchanges designated in the same community?
Answer: A
Chartered Value Exchange designation will not be awarded to two collaboratives
requesting designation for the same geographic area. There can, however, be
more than one Chartered Value Exchange within a State or region. For example,
there can be two or more Chartered Value Exchanges within a State where each
Chartered Value Exchange covers a separate geographic area within the State.
There can also be Chartered Value Exchanges that cross State boundaries. An
example would be a metropolitan statistical area whose boundaries encompass
counties of two or more States. It is also acceptable to have a Chartered
Value Exchange designation for a broad geographic area, such as an entire State
or region, and also have a Chartered Value Exchange designated for a collaborative
that covers a subset of the State or region. The applicant is responsible for
justifying the need to have a second Chartered Value Exchange if the first
Chartered Value Exchange already exists. The responsibility for the
justification is on both applicants if applying concurrently. The critical
evaluation point is to describe how the Chartered Value Exchanges will
coordinate, complement, and prevent public confusion about their activities.
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Question
14: Can Chartered Value Exchanges lose their designation before the 3-year
period ends?
Answer: Yes.
If one of the four critical stakeholder groups (purchaser, plan, provider,
consumer advocacy organization) drops out of the collaborative after the
collaborative is designated a Chartered Value Exchange, the Chartered Value
Exchange will be given 3 months to re-secure the stakeholder group membership.
If that does not occur, the Chartered Value Exchange designation will be
rescinded.
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Question
15: Who do I contact with additional questions or concerns?
Answer:
Nancy
Wilson, M.D., M.P.H.
Senior
Advisor, Value-driven Health Care
E-mail: nancy.wilson@ahrq.hhs.gov
Phone: (301)
427-1310
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Current as of April 2008
Internet Citation:
Becoming a Chartered Value Exchange: Frequent Questions. April 2008. Agency for
Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/value/cvefaq.htm