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AQA Invitational Meeting Summary

HHS Transparency Initiative

Andrew Croshaw, Transparency Health Care Initiative, U.S. Department of Health and Human Services (HHS)

Andrew Croshaw discussed HHS's Transparency Health Care Initiative. The initiative is based on the idea that building a value-driven health care system requires four cornerstones:

  • Connecting the system—the need to identify standards so that all health information systems can quickly and securely communicate and exchange data.
  • Measuring and publishing quality—the need to define benchmarks for what constitutes quality care.
  • Measuring and publishing price—the need to reach agreement on what procedures and services are covered in each episode of care.
  • Creating positive incentives—the need to create incentives to reward both those who offer and those who purchase high-quality, competitively priced health care.

Croshaw indicated that a large number of companies (and one major labor union) have signed statements of support for the four cornerstones, including approximately 50 of the top 200 companies in the United States. In addition, about a half-dozen States have either signed a statement of support or crafted their own executive orders to begin to move forward on the four cornerstones. Croshaw said the hope was to get to a tipping point so that purchasers all around the United States are asking that the four cornerstones be implemented.

Croshaw said that he was pleased to see that the Quality Alliance Steering Committee had come up with some criteria for how to take standards and measures and implement them locally. He said that HHS has developed a Community Leader for Value in Health Care credential to identify organizations that are working to achieve the four cornerstones at the local level.


Opening the discussion, Carolyn Clancy asked how strong the commitment was of the groups who are signing on to the initiative. Croshaw responded that the commitment wasn't legally binding but was a public statement of an organization's commitment to work toward the four cornerstones of a value-driven health care system. He added that he believed it is important to signal to the market that companies are increasingly engaged in this effort.

Another participant asked what would happen when a new administration takes office in 2 years. How do we ensure the legacy of this important work? In response, Croshaw said that he believed the work being done was of interest to a broad range of stakeholders and not limited to one political party.

One participant spoke about the need for national aggregation standards. He pointed out that health plans are facing the prospect of having to respond to as many as 35 separate State aggregation measures. In response, Croshaw noted that the States are generating a number of innovative solutions. As part of that process, he said, the Federal Government will have an opportunity to influence the States. He added that the goal is to continue to focus on quality improvement and value—to promote innovation while also ensuring that we are aligning with the four cornerstones.

Another participant asked whether the HHS transparency initiative offered an opportunity to highlight and start to address health disparities. Croshaw indicated that the Robert Wood Johnson Foundation has been very focused on quality-of-care initiatives, and has been working to align its efforts with others in order to speak with one voice. Clancy added that AHRQ is looking for opportunities to align with the Robert Wood Johnson Foundation. She also indicated that AHRQ is trying to integrate quality improvement assessment initiatives with the goal of reducing health disparities.

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