[Federal Register Volume 72, Number 88 (Tuesday, May 8, 2007)]
[Notices]
[Pages 26117-26119]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-2268]


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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 for participation in a learning 
network of model multi-stakeholder community health care collaboratives 
operated 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 July 9, 2007.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, 540 Gaither Road, Room <greek-i> 5036, 
Rockville, MD 20850.
    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.

SUPPLEMENTARY INFORMATION:

Proposed Project

``Chartering 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) eligibility 
to request Medicare-inclusive multi-payer patient de-identified 
individual physician-level 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 and encompass (1) 
promotion of the

[[Page 26118]]

establishment of health information technology interoperability 
standards for exchanging price and quality healthcare data; (2) 
promotion of the availability and use of transparent, nationally 
endorsed, consensus-derived quality measures; (3) promotion of the 
availability and use of transparent, nationally endorsed, consensus-
derived 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 design is based on three fundamental principles. 
The first is that at its core, 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 information exchange organizations, State data organizations) 
investing their time and resources toward shared cost and quality 
improvement goals. We refer to such representative quality improvement 
community organizations as local multi-stakeholder collaboratives. 
Scattered across the country there are community collaboratives in 
various stages of development ranging from mature multi-stakeholder 
collaboratives to communities where only a limited number of 
organizations within a single stakeholder group or a limited number of 
stakeholder groups are working together.
    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 foster market-based healthcare reform. 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 common broad goals.
    Based on the above, AHRQ plans to establish a nation-wide learning 
network of mature community-based multi-stakeholder healthcare quality 
improvement collaboratives. Goals of the Learning Network include 
facilitating collaborative production of public reports, fostering pay 
for performance, fostering consumer financial incentives, and 
ultimately, improving quality. AHRQ will issue semi-annual public 
Requests for Proposals (RFP) and conduct a selection process 
immediately thereafter to identify and charter mature multi-stakeholder 
collaboratives as Value Exchanges. 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.

Method of Collection

    Each RFP will be posted on the AHRQ public Web site (www.ahrg.gov) 
with a link to the AHRQ site on the OS 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 capacity or plans to develop their capacity to do each 
of the following:
    A. Facilitate collection of provider-level measures across the six 
performance domains identified by the Institute of Medicine (IOM) 
(safety, timeliness, effectiveness, efficiency, equitableness, patient-
centeredness).
    B. Use (or promote the use of) transparent, nationally endorsed, 
consensus-derived performance measures and consumers' cost for public/
consumer reporting.
    C. Use (or promote the use of) transparent, nationally endorsed, 
consensus-derived performance measures to reward and foster better 
performance.
    D. Use (or promote the use of) transparent, nationally endorsed, 
consensus-derived performance measures for improvement by directly 
informing providers of their results.
    E. Foster collaboration across multiple stakeholders (public and, 
private purchasers, health plans, providers, and consumers), as well as 
other relevant community entities (e.g., local information exchange 
organizations, State data organizations) in the community of interest 
and serve as a hub for sharing information and dialogue.
    F. Promote the use of interoperable health information technologies 
for measurement as appropriate and collaborate with health information 
sharing processes and in the adoption of these technologies.
    G. Support knowledge transfer--maintain transparent processes and 
share lessons learned.
    H. Conduct ongoing evaluation and improvement of efforts.
    At a minimum, successful applicants will demonstrate the following:
    A1. For those conducting or overseeing measurement/auditing and 
aggregation of data across multiple payers, the ability to do so.
    A2. For those receiving already aggregated data and calculated 
performance results from a source (e.g., national aggregators), the 
ability to effectively implement the use of these results.
    B. The ability to manage collaborative processes that engage all 
critical stakeholders.
    C. Organizational capacity to meet A.1 or A.2 and B above. At a 
minimum the following organizational characteristics or capacities will 
be required:
    <bullet> Non-profit status.
    <bullet> Staff/consultant arrangements to provide needed expertise.
    <bullet> History of raising funds or in-kind support uom multiple 
stakeholders.
    <bullet> Ability to manage collaborative, multi-stakeholder 
projects and finances.
    <bullet> Ability to track progress in meeting individual 
collaborative goals, which may include, for example, producing public 
reports, or fostering pay for performance or consumer incentives.
    The request for proposals will be open for two months.
    A review committee will be assembled and have the following 
composition:
    <bullet> Three experts representing institutional healthcare 
purchaser stakeholder perspectives.
    <bullet> Three experts representing health plan stakeholder 
perspectives.
    <bullet> Three experts representing individual consumer stakeholder 
perspectives.
    <bullet> Three experts representing providers with at least two of 
the providers being physicians.
    <bullet> AHRQ staff experienced in working with community 
collaboratives.
    Proposals will be reviewed by review teams comprised of at least 
one representative from each stakeholder group listed above and at 
least one AHRQ staff person. All proposals will be reviewed in the 6 
weeks following the closing of the application period.

Estimated Annual Respondent Burden

[[Page 26119]]



                               Exhibit 1.--Estimate of Cost Burden to Respondents
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                                                                                                     Estimated
                                     Number of    Estimated time     Estimated        Average       annual cost
     Data collection effort          estimated    per respondent   total burden     hourly wage      burden to
                                    respondents      in hours          hours           rate         respondents
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Draft narrative response to RFP               50               8             400          $34.67         $13,868
 by Collaborative Manager.......
Narrative reviews by 2 members               100               1             100           57.90           5,790
 of Collaborative executive
 committee......................
Narrative revisions by                        50               8             400           34.67          13,868
 Collaborative Manager..........
Assembly of narrative with any                50               2             100           12.58           1,258
 supporting documents by
 Collaborative Assistant........
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    Total.......................             250  ..............           1,000  ..............          34,784
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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, No additional 
costs to respondents are anticipated, e.g., for capital equipment, 
software, etc.

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: May 1, 2007
Carolyn M. Clancy,
Director.
[FR Doc. 07-2268 Filed 5-7-07: 8:45 am]
BILLING CODE 4160-90-M