Agency Information Collection Activities Proposed Collection; Comment Request, 43274-43277 [07-3814]
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43274
Federal Register / Vol. 72, No. 149 / Friday, August 3, 2007 / Notices
Copies of the proposed collection
plans, data collection instruments, 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.
SUPPLEMENTARY INFORMATION:
Proposed Project
‘‘Voluntary Customer Surveys Generic
Clearance for the Agency for Healthcare
Research and Quality’’
In response to Executive Order 12962,
the Agency for Healthcare Research and
Quality (AHRQ) plans to conduct
voluntary customer surveys to assess
strengths and weaknesses in agency
program services. Customer surveys to
be conducted by AHRQ may include
readership surveys from individuals
using AHRQ automated and electronic
technology databases to determine
satisfaction with the information
provided or surveys to assess effect of
the grants streamlining efforts. Results
of these surveys will be used in future
program planning initiatives and to
redirect resources and efforts, as
needed, to improve AHRQ program
services. The current clearance will
expire January 31, 2008. This is a
request for a generic approval from
OMB to conduct customer surveys over
the next three years.
Methods of Collection
The data will be collected using a
combination of methodologies
appropriate to each survey. These
methodologies include:
• Evaluation forms;
• Mail surveys;
• Focus groups;
• Automated and electronic
technology (e.g., e-mail, Web-based
surveys, instant fax, AHRQ Publication
Clearinghouse customer feedback) and,
• Telephone surveys.
ESTIMATED ANNUAL RESPONDENT BURDEN
No. of
respondents
Type of Survey
Average
hour burden/response
Total hours
of burden
Mail/Telephone Surveys ..........................................................................................................................
Automated/Web-based ............................................................................................................................
Focus Groups ..........................................................................................................................................
51,200
52,000
200
0.15
0.163
1.0
7,680
8,476
200
Totals ................................................................................................................................................
103,400
NA
16,356
This information collection will not
impose a cost burden on the
respondents beyond that associated
with their time to provide the required
data. There will be no additional costs
for capital equipment, software,
computer services, etc.
mstockstill on PROD1PC66 with NOTICES
Estimated Annual Costs to the Federal
Government
The mail and telephone surveys and
focus groups will in some cases be
carried out under contract. Assuming
the contract cost per survey is $50,000–
$100,000, and for each focus group is
$20,000, total contract costs could be
$720,000 per year.
Request for Comments
In accordance with the above-cited
Paperwork Reduction Act legislation,
comments on 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
AHRQ health care research and health
care information dissemination
functions, including whether the
information 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 the
information to be collected; and (d)
ways to minimize the burden of the
collection of information upon the
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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 Agency’s subsequent
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. 07–3813 Filed 8–2–07; 8:45 am]
BILLING CODE 4160–90–M
‘‘Chartering Value Exchanges for Valuedriven 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.
Comments on this notice must be
received by September 4, 2007.
DATES:
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, Department of health and
Human Services.
ACTION: Notice.
AGENCY:
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:
SUMMARY:
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Written comments should
be submitted to: Karen Matsuoka by fax
at (202) 395–6974 (attention: AHRQ’s
desk officer) or by e-mail at
OIRA_submission@omb.eop.gov
(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.
ADDRESSES:
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ, Reports
Clearance Officer, (301) 427–1477, or by
e-mail at doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
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Federal Register / Vol. 72, No. 149 / Friday, August 3, 2007 / Notices
Proposed Project
mstockstill on PROD1PC66 with NOTICES
‘‘Charting Value Exchanges for Valuedriven 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 AHRQmanaged 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
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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 multistakeholder 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,
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43275
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
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Federal Register / Vol. 72, No. 149 / Friday, August 3, 2007 / Notices
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 nonprofit 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
https://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 consensusbuilding organizations; and provide onthe-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 (https://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:
• Excellent (5 points): Clear
demonstration of activity already in
progress.
• Very Good (4 points): Activity
partially in progress and effective plan
to further mature articulated.
• Average (3 points): Effective plan
articulated.
• Fair (2 points): Attempts to address
but hasn’t effectively articulated plan or
success.
• 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
Number of
estimated
respondents
Data collection effort
Estimated
time per
respondent
in hours
Estimated
total burden
hours
Average
hourly wage
rate
Estimated
annual cost
burden to
respondents
mstockstill on PROD1PC66 with NOTICES
Draft narrative response to RFP by Collaborative Manager ...................
Narrative reviews by 1–2 members of Collaborative executive committee ....................................................................................................
Narrative revisions by Collaborative Manager .........................................
Assembly of narrative with any supporting documents by Collaborative
Assistant ...............................................................................................
50
8
400
$34.67
$13,868
75
50
1
8
75
400
57.90
34.67
4,342.50
13,868
50
2
100
12.58
1,258
Total ..................................................................................................
225
....................
950
....................
33,336.50
This information collection will not
impose a cost burden on the respondent
beyond that associated with the above
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estimates of the time needed to provide
the application-requested information.
There will be no additional substantial
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costs to respondents anticipated, e.g. for
capital equipment, software, computer
services.
E:\FR\FM\03AUN1.SGM
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Federal Register / Vol. 72, No. 149 / Friday, August 3, 2007 / Notices
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
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
Food Safety and Security Monitoring
Project—Radiological Health;
Availability of Cooperative Agreements
Under a Limited Competition; Request
for Applications: FD07–005; Catalog of
Federal Domestic Assistance Number:
93.448
AGENCY:
Food and Drug Administration,
HHS.
mstockstill on PROD1PC66 with NOTICES
ACTION:
Notice.
I. Funding Opportunity Description
The Food and Drug Administration
(FDA), Office of Regulatory Affairs
(ORA), Division of Federal-State
Relations, is announcing the availability
of cooperative agreements for
equipment, supplies, personnel,
training, and facility upgrades to Food
Emergency Response Laboratory
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18:17 Aug 02, 2007
Jkt 211001
Network (FERN) radiological
laboratories of State, local, and tribal
governments. The cooperative
agreements are to enable the analyses of
foods and food products in the event
that redundancy and/or additional
laboratory surge capacity is needed by
FERN for analyses related to
radiological terrorism or other
emergency situations. These cooperative
agreements are also intended to expand
participation in networks to enhance
Federal, State, local, and tribal
governmental food safety and security
efforts. This notice supersedes the
request for applications that published
in the Federal Register of August 24,
2006 (71 FR 50068).
A. Background
ORA is the primary inspection and
analysis component of FDA and has
approximately 1,600 investigators,
inspectors, and analysts who cover the
country’s approximately 95,000 FDAregulated businesses. These
investigators inspect more than 15,000
facilities per year and ORA laboratories
analyze several thousand samples per
year. ORA conducts special
investigations, conducts food inspection
recall audits, performs consumer
complaint inspections, and collects
samples of regulated products.
Increasingly, ORA has been called upon
to expand the testing program that
addresses the increasing threat to food
safety and security through intentional
radiological terrorism events. Toward
this end, ORA has developed
radiological screening and analysis
methodologies that are used to evaluate
foods and food products in such
situations. However, in the event of a
large-scale emergent incident, analytical
sample capacity in ORA field
laboratories has a finite limit.
Information from ongoing relationships
with State partners indicates limited
redundancy in State food testing
laboratories; both in terms of analytical
capabilities and analytical sample
capacity. Several State food testing
laboratories lack the specialized
equipment to perform the analyses, and/
or the specific methodological expertise
in the types of analyses performed for
screening foods and food products
involving radiological terrorism events.
The events of September 11, 2001,
reinforced the need to enhance the
security of the U.S. food supply.
Congress responded by passing the
Bioterrorism Act, which President
George W. Bush signed into law on June
12, 2002. The Bioterrorism Act is
divided into the following five titles:
Title I—National Preparedness for
Bioterrorism and Other Public
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43277
Health Emergencies,
Title II—Enhancing Controls on
Dangerous Biological Agents and
Toxins,
Title III—Protecting Safety and
Security of Food and Drug Supply,
Title IV—Drinking Water Security and
Safety, and
Title V—Additional Provisions.
Subtitle A of the Bioterrorism Act,
‘‘Protection of Food Supply,’’ section
312, ‘‘Surveillance and Information
Grants and Authorities,’’ amends part B
of Title III of the Public Health Service
Act to authorize the Secretary of Health
and Human Services to award grants to
States and Indian tribes to expand
participation in networks to enhance
Federal, State, and local food safety
efforts. This may include meeting the
costs of establishing and maintaining
the food safety surveillance, technical,
and laboratory capacity needed for such
participation.
FDA will support the projects covered
by this document under the authority of
section 312 of the Public Health
Security and Bioterrorism Preparedness
and Response Act of 2002 (the
Bioterrorism Act) (Public Law 107–188).
This program is described in the Catalog
of Federal Domestic Assistance under
number 93.448.
B. Program Research Goals
The goal of ORA’s cooperative
agreement program is to complement,
develop, and improve State, local, and
Indian tribal food safety and security
testing programs. This will be
accomplished through the provision of
equipment, supplies, personnel, facility
upgrades, training in current food
testing methodologies, participation in
proficiency testing to establish
additional reliable laboratory sample
analysis capacity, analysis of
surveillance samples, and, in
cooperation with FDA, participation in
method enhancement activities
designed to extend analytical
capabilities. In the event of a large-scale
radiological terrorism event affecting
foods or food products, the recipient
may be required to perform selected
radiological analyses of domestic and
imported food samples collected and
supplied to the laboratory by FDA or
other Federal agencies through FDA.
These samples may consist of, but are
not limited to, the following: Vegetables
and fruits (fresh and packaged), juices
(concentrate and diluted), grains and
grain products, seafood and other fish
products, milk and other dairy products,
infant formula, baby foods, bottled
water, condiments, and alcoholic
products (beer, wine, scotch).
E:\FR\FM\03AUN1.SGM
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]]>Agencies
[Federal Register Volume 72, Number 149 (Friday, August 3, 2007)]
[Notices]
[Pages 43274-43277]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 07-3814]
-----------------------------------------------------------------------
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.
-----------------------------------------------------------------------
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
OIRA_submission@omb.eop.gov (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
doris.lefkowitz@ahrq.hhs.gov.
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 https://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 (https://
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:
Excellent (5 points): Clear demonstration of activity
already in progress.
Very Good (4 points): Activity partially in progress and
effective plan to further mature articulated.
Average (3 points): Effective plan articulated.
Fair (2 points): Attempts to address but hasn't
effectively articulated plan or success.
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
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
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
