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AQA Invitational Meeting Summary
Carolyn Clancy, Agency for Healthcare Research and Quality (AHRQ)
Carolyn Clancy opened the meeting
by welcoming participants and noting that there were a record number of people
(over 160, representing 100 stakeholders) in attendance. Clancy said that the
increase was due in part to the fact that there were representatives present
from the organizations involved in the pilot programs.
Review of AQA Governance
John Tooker, American College of Physicians
John Tooker provided an overview of the AQA. He stressed that the AQA employs
a collaborative process that includes consumers, health insurance plans,
physicians, purchasers, and other key stakeholders. He also reiterated that
the quality improvement movement is voluntary, and that it involves a series
of interlocking groups working together.
Tooker briefly reviewed the AQA's governance model, which he said has
no formal structure and relies on the voluntary commitment and collaborative
spirit of the multiple stakeholders. He noted that there have been at least
three open meetings annually, and that the steering committee (made up of
representatives from consumer groups, health insurance plans, physicians,
and other participants) meets before every meeting and occasionally otherwise.
Between meetings, each of the three workgroups meets regularly.
The AQA uses a consensus process for getting work done, continued
Tooker. At the same time, he emphasized that there was a balancing act between
the need for urgency and the desire to take advantage of opportunities. On
the latter subject, he pointed out that new challenges are constantly providing
opportunities that the AQA needs to take advantage of in a timely manner.
The AQA is really focused on implementation and adoption of measures in
the field, said Tooker. As a result, there is a need to coordinate with organizations
that are developing performance measures. Tooker added that the intent is
to develop a robust series of measures for all areas and then to implement
them in the field. In addition, he stressed that there needs to be an orderly
process from development to implementation and then the principles must be
The principles must be workable in the field, stressed Tooker,
and hence there are six pilot projects underway to evaluate whether measures
can be adopted in the field.
Tooker also noted that it was clear that performance
measures must be implemented in coordination with the work being done by
the HQA. As a result, he said, an AQA/HQA Quality Alliance Steering Committee
has been established in order to look at how to expand the pilot projects
and how to establish a health quality network in the United States.
Tooker took a minute to talk about the AQA's communications philosophy.
The AQA is a transparent process, he said, and all its meetings and agendas are
posted on a public Web site. At the same time, because the AQA is not a formal
entity the AQA Steering Committee has agreed that it is not appropriate for the
AQA to provide formal public comment on its activities. Rather, the steering
committee believes that it is more appropriate for individuals representing their
own companies to do so.
Following Tooker's remarks, Carolyn Clancy reiterated
that that the AQA process is highly transparent, and that the goal of the
process is better health care.
One participant said that she wanted the opportunity
for all participants to at least listen in on workgroup activities, something
that has not been done. Clancy responded that this was a very good point
and promised that the AQA Steering Committee would discuss the matter. Kevin
Weiss (who chairs the workgroup on performance measurement) said the problem
stemmed from the way the cost-of-care subgroup had started. He and others
learned from that process that it was important to bring more people into
the room and into the conversation.
There also was a question about the voting process. Clancy responded that
the AQA generally takes an up/down vote, although there have been times that
an item has been sent back to a workgroup for further discussion.
Finally, one participant expressed concern that the direction taken by
a workgroup often depends on who is participating in any given conference
call or meeting. He said that he was sometimes uncomfortable that the process
was moving very fast without adequate representation from all parties.