1. Chartered Value Exchanges (CVEs) September 2008 CVEs may wish to tailor this slide deck for use with stakeholders in your community.

2. U.S. Department of Health and Human Services The Secretary Administration for Children and Families (ACF) Agency for Healthcare Research and Quality (AHRQ) Centers for Disease Control and Prevention (CDC) Agency for Toxic Substances and Disease Registry (ATSDR) Program Support Center (PSC) Substance Abuse and Mental Health Services Administration (SAMHSA) National Institutes of Health (NIH) Indian Health Service (IHS) Health Resources and Services Administration (HRSA) Food and Drug Administration (FDA) Centers for Medicare & Medicaid Services (CMS) Administration on Aging (AoA)

3. AHRQ’s Mission Improve the quality, safety, efficiency and effectiveness of health care for all Americans

4. Quality of care in US – Medical accidental deaths outnumber others Source: To Err is Human: Building a Safer Health System, Institute of Medicine, 1999.

5. 2001 IOM Report, Crossing the Quality Chasm Scientific review documents the scale and gravity of quality problems Scientific review documents the scale and gravity of quality problems More than 70 publications cite quality problems More than 70 publications cite quality problems …between the health care we have and the care we could have lies not just a gap, but a chasm.

6. Patients’ care often deficient, study says. Proper treatment given half the time. On average, doctors provide appropriate health care only half the time, a landmark study of adults in 12 U.S. metropolitan areas suggests. Medical Care Often Not Optimal Failure to Treat Patients Fully Spans Range of What Is Expected of Physicians and Nurses Study: U.S. Doctors are not following the guidelines for ordinary illnesses The American healthcare system, often touted as a cutting-edge leader in the world, suddenly finds itself mired in serious questions about the ability of its hospitals and doctors to deliver quality care to millions. Medical errors corrode quality of healthcare system

7. RAND study – Doctors provide appropriate health care only about half the time Percentage of time Alcohol dependence Hip fracture Peptic ulcer Diabetes Low back pain Prenatal care Breast cancer Cataracts 11% 23% 33% 45% 69% 73% 76% 79% E. McGlynn, S. Asch, J. Adams, et al., The Quality of Health Care Delivered to Adults in the United States, N Engl J Med, 2003.

8. Transformational Goal of CVEs: Improved Quality and Efficiency Low High LowHigh Quality Efficiency

9. What Will This Take? Good measures and data Good measures and data Strong local coalitions Strong local coalitions Evidence-based reporting, payment strategies Evidence-based reporting, payment strategies Evidence, tools, strategies for improvement Evidence, tools, strategies for improvement Collaboration across sites Collaboration across sites

10. Focus of AHRQ Learning Network for CVEs Technical assistance content spans contemplation, design and implementation decisions across the following activities identified by user/stakeholders as high priority: 1.Collaborative leadership & sustainability 2.Public at-large engagement 3.Quality & efficiency measurement 4.Public reporting 5.Provider incentives 6.Consumer incentives 7.Capacity for improving quality 8.HIT/HIE

11. AHRQ Learning Network Builds on Secretary’s Value-Driven Health Care Principles 1. All health care is “local” 2. Transparency – accurate meaningful information on quality and cost – is key to provider improvement and consumer engagement 3. Collaboratives involving key stakeholder groups – public and private payers, providers, plans and consumers* – hold promise to foster requisite reforms *and in some cases State data organizations, Quality Improvement Organizations, and health information exchanges

12. Improving Quality The need for leadership has never been greater. The need for leadership has never been greater. All public and private health care constituencies must commit to a shared agenda that can raise the quality of health care for all. All public and private health care constituencies must commit to a shared agenda that can raise the quality of health care for all. -- 2001 IOM Report, Crossing the Quality Chasm