[Federal Register Volume 72, Number 149 (Friday, August 3, 2007)]
[Notices]
[Pages 43274-43277]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-3814]


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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 
<a href="/cdn-cgi/l/email-protection#46090f1407193533242b2f35352f292806292b246823293668212930"><span class="__cf_email__" data-cfemail="4d02041f0c123e382f20243e3e2422230d22202f6328223d632a223b">[email protected]</span></a> (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 
<a href="/cdn-cgi/l/email-protection#3b5f5449524815575e5d50544c524f417b5a53494a15535348155c544d"><span class="__cf_email__" data-cfemail="35515a475c461b5950535e5a425c414f75545d47441b5d5d461b525a43">[email protected]</span></a>.

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

[[Page 43276]]

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:
    <bullet> Excellent (5 points): Clear demonstration of activity 
already in progress.
    <bullet> Very Good (4 points): Activity partially in progress and 
effective plan to further mature articulated.
    <bullet> Average (3 points): Effective plan articulated.
    <bullet> Fair (2 points): Attempts to address but hasn't 
effectively articulated plan or success.
    <bullet> 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..........
                                                ----------------------------------------------------------------
    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.

[[Page 43277]]

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


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