Performance Detail: HCQO (continued)
Performance Budget Submission for Congressional Justification, Fiscal
Value Driven Health Care
AHRQ's Value Research focuses on three important areas:�Providers producing greater value, consumers and payers choosing value, and the payment system rewarding value. At present, AHRQ's Value Research priority includes research related to the Value-driven Healthcare Initiative and a new Initiative—the Health Insurance Decision Tool.
Long-Term Objective 1: Consumers and patients are served by healthcare organizations that reduce unnecessary costs (waste) while maintaining or improving quality.
|#||Key Outputs||FY 2004 Actual||FY 2005 Actual||FY 2006�Target||FY 2006�Actual||FY 2007 Target||FY 2007 Actual||FY 2008 Target/Est.||FY 2009 Target/Est.||Out-Year Target|
|1.3.27||Increase the number of� people who are served by community collaboratives that are using evidence-based measures, data and interventions to increase health care efficiency and quality||NA||NA||NA||NA||NA||NA||300,000 people||600,000 people||2016 increase by 1 Million people|
|1.3.28||Increase the # of Chartered Value Exchanges (CVEs)||NA||NA||NA||NA||NA||NA||15||30||2016|
|1.3.29||Increase the number of�States or communities reporting market-level hospital cost data||NA||NA||NA||NA||NA||NA||4||8||2016|
|1.3.30||Increase the number of communities or States with public report cards||NA||NA||NA||NA||NA||NA||5||15||2016|
|1.3.31||Increase the number of new reports, tools, evaluations available for CVEs||NA||NA||NA||NA||NA||NA||5||5||2016|
The goal of the HHS Value-driven Healthcare Initiative is to improve the quality of healthcare services while reducing unnecessary healthcare costs or waste, by increasing the transparency of cost and quality information for consumers, expanding health information technology, and promoting use of provider and consumer incentives for quality and efficiency. In 2009, AHRQ will support this initiative through the development of five measurable goals and interrelated activities:
- Chartered Value Exchanges. Central to the Value-driven Initiative is a new family of Chartered Value Exchanges (CVEs).�CVEs are local collaboratives, consisting of public and private payers, providers, plans and consumers, and in some cases State data organizations, Quality Improvement Organizations, and health information exchanges, who are committed to publicly reporting cost and quality information in their communities, and�working in tandem to improve quality and value.�Twice a year, AHRQ will be soliciting applications from community collaboratives seeking to become Chartered Value Exchanges. The first solicitation opened in October, 2007, and the first CVEs announced in early 2008. This activity supports the measure for increasing the number of CVEs.�CVEs will have access to quality information about physician groups in their area, drawn from Medicare and private plan data. The ultimate aim of CVEs is timely, comparative data on provider quality and some measure of price or efficiency, presented in a consumer-friendly format.
- Measures and data for transparency:� Evidence-based measures and solid, local data on cost and quality are crucial to creation of Value-Driven healthcare.�AHRQ has a long history of development and maintenance of measures and data that the Department, private purchasers, States and providers are using for quality reporting and improvement.�Examples include the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), Quality Indicators (QIs), National Healthcare Quality and Disparities Reports (NHQR/NHDR), Health Information Exchanges, Culture of Safety measures, and the Healthcare Cost and Utilization Project (HCUP).
- Evidence to support reporting, payment and improvement strategies.�A third component of the Value-Driven Healthcare Initiative will be to provide evidence on when and how public reporting strategies are most likely to work, the payment strategies and community approaches most likely to improve value, and the redesign initiatives likely to reduce waste.� This component supports the measure for increasing the number of communities or States with public report cards.
- Coordination forum for public payers. The federal government is the largest purchaser of health care, and therefore value-driven health care can not succeed without the active collaboration of federal payers in this effort. In 2008, AHRQ is establishing a forum to facilitate coordination across public payers, and this work will continue in 2009.
Health Insurance Decision Tools (HIDT)
|#||Key Outputs||FY 2004 Actual||FY 2005 Actual||FY 2006|
|FY 2007 Target/|
|FY 2007 Actual||FY 2008 Target/|
|FY 2009 Target/Est.||Out-Year Target/Est.|
|1.3.32||Produce nationally representative estimates of health plan benefits, costs, and consumer behavior on coverage decisions||NA||NA||NA||NA||NA||NA||NA||Develop draft specifications for estimation weights that will produce national estimates||2010|
Nationally representative estimates of health plan benefits, costs, and consumer behavior on coverage estimates
|1.3.33||Produce model to inform plan benefit structure||NA||NA||NA||NA||NA||NA||NA||Initial modeling of change in behavior of use of services based on acquisition of coverage||2011|
Plan benefit structure model
|1.3.34||Produce decision tools to facilitate specification of plan benefit structure.||NA||NA||NA||NA||NA||NA||NA||Initiate data collection and abstraction||2011|
Decision tools to facilitate specification of plan benefit structure
|1.3.35||Data Products by 2010: Medical Expenditure Panel Survey (MEPS) Public Use file on health plan benefits||NA||NA||NA||NA||NA||NA||NA||Collection of data on health plan benefits and costs in MEPS|
Produce MEPS Public Use Files with health benefits data
|1.2.2||Tool Development by 2011:|
Microsimulation model to estimate take-up, use of services and cost of coverage for basic coverage plans.
Develop interim version of tool
Generate State specific estimates of eligible uninsured population; model utilization and expenditure behavior; estimates of plan costs
Develop the microsimulation model and interactive decision tool
Tool Deployment by 2011:
At least 5 States use HIDT to design health insurance plan
|NA||NA||NA||NA||NA||NA||NA||Meet with leaders from 5 States to prioritize HIDT content||2011|
Provide HIDT to at least 5 States to use to design health insurance plan
The Health Insurance Decision Tool initiative will provide an integrated set of decision tools to assist States in the development of innovative programs which are consistent with the President's goal to provide access to basic health insurance at an affordable price. The success of health insurance coverage initiatives will depend in large part on each State's ability to design a health insurance plan or plans for its particular population that is affordable in terms of both State outlays and target families' incomes.�To accomplish these efforts, States need tools that will provide them the information necessary to design plans that will meet these objectives. There are two areas critical to health insurance coverage initiatives for which national information is currently not available. These are information on the benefit provisions of plans currently held by, and available to, the privately insured, and information on what factors consumers consider in making decisions with respect to their choice of plans. In addition, a more sophisticated knowledge of the benefit design of these insurance plans and individual selection preferences is of specific importance in the design of reasonably-priced State-specific plans.
AHRQ is uniquely positioned to fill these gaps because of its ongoing data collection efforts in the Medical Expenditure Panel Survey (MEPS) and the Consumer Assessment of Health Plans Survey (CAHPS®).�Government and non-governmental entities currently rely upon existing MEPS data to evaluate health reform policies, the effect of tax code changes on health expenditures and tax revenue, and proposed changes in government health programs such as Medicare. The data AHRQ collects through its surveys, which includes the individual and group markets, provides a starting point for filling these identified gaps. The health plan booklets that will be obtained from household participants in the MEPS through this initiative will provide the data necessary for analyses of what characteristics of health plans influence the choices consumers make in selecting among plans and their benefit provisions. Similarly, CAHPS information on consumers' satisfaction with plans, with the addition of new information collected in self-administered questionnaire on plan selection criteria would provide the necessary data for determining what factors consumers find most important in choosing a plan.�The emphasis in data development and analysis will include developing a more nuanced understanding of the content of the plans in the individual and group market and those factors that cause consumers to choose one such plan over another. The required data on health benefits and consumer behavior will be collected in MEPS in 2009, resulting in the production of public use files that contain the essential data necessary to develop the Health Insurance Decision Tool. The use of this information in concert with the existing MEPS data will facilitate the development of a microsimulation model to estimate plan take-up, use of services and cost of coverage associated with the design of health plans that provide basic coverage. (Go to Output table.)
This initiative will facilitate the development and implementation of State-specific affordable health plans for low income individuals in the U.S., and will provide State decisionmakers with the tools and information they need to design effective programs for reducing the numbers of uninsured Americans.�It will also provide Federal decisionmakers with the information they need for evaluating States' proposals, and could assist in understanding the impacts of other Federal initiatives, for example, consumer driven health plans, on the overall U.S. healthcare system.�The Health Insurance Decision Tool will also serve to assist HHS in evaluating the proposals made by States regarding estimates of the eligible target population; take up rates within the eligible target population; utilization patterns of individuals newly covered under the plan, and plan costs for both the States and covered families. Without the development of these decision tools, programs will be designed that are less effective than they could be, or produce unanticipated adverse consequences.