- Enable better access to all-payer claims and clinical data to enable Regional Health Improvement Collaboratives to do quality/cost measurement and reporting. Most Collaboratives have sophisticated programs to assemble and analyze data from health insurance claims and clinical data sources to help providers identify where there are opportunities to improve the quality and cost of care and to help patients choose the highest-value providers. Many members operate multi-payer or all-payer claims databases and several collect clinical data or serve as Health Information Exchange. Of the 12 Qualified Entities in the U.S. eligible to receive identified Medicare data for public reporting, 11 are NRHI members. Although many receive commercial claims through voluntary participation, many Collaboratives have been unable to obtain timely access to all fee-for-service claims data in a usable format. NRHI members urge that CMS expand access to Medicaid and Medicare claims data to Regional Health Improvement Collaboratives so that they can help communities identify high-value care, help providers in their community identify successful strategies for redesigning care, test alternative payment models, test innovative measures and also develop other innovative payment and delivery reforms that CMMI can support.
- Establish an explicit priority at the Center for Medicare and Medicaid Innovation (CMMI) for payment and delivery system demonstration projects developed by or in coordination with Regional Health Improvement Collaboratives. NRHI members believe that the most successful, high-impact demonstration projects will be those which address the most important quality issues in a particular community, which have support from both consumers and a broad range of healthcare providers, which have participation by payers other than Medicare, and which have effective local mechanisms of monitoring implementation and resolving problems. Announcing an explicit priority at CMMI for projects developed by or in coordination with Regional Health Improvement Collaboratives would ensure that CMMI is building on the extensive work that the Collaboratives have already done to build consensus on healthcare improvement strategies in their communities as well as encourage the creation of additional multi-stakeholder efforts across the country. See letter from Dr. James Madara, Executive Vice President of AMA, comments on the SGR Repeal and Reform Proposal.
Support Needed From the Agency for Healthcare Quality and Research (AHRQ)
- Provide Operating Funds for Regional Health Improvement Collaboratives. Despite the critical role that Regional Health Improvement Collaboratives have played and will continue to play in improving healthcare quality and reducing costs in their communities, there has been no federal financial support for their work to date. Even though the federal government has recognized the important role that Collaboratives play through the HHS/AHRQ Chartered Value Exchange program, there is no federal funding support to help Collaboratives carry out any of their existing programs, much less to implement additional efforts to accelerate progress in improving quality and reducing healthcare costs. The Collaboratives rely primarily on contributions from local healthcare stakeholders to support the quality measurement and quality improvement programs they operate, and it has been increasingly difficult for Collaboratives to obtain adequate support from these stakeholders, due to factors ranging from the national recession to federal policies such as cuts in Medicare reimbursements to doctors and hospitals and minimum standards for medical loss ratios of health insurers. Although many Collaboratives have been successful in obtaining project-specific grants from AHRQ and other federal agencies, these grants are typically intended to support “new initiatives” rather than the ongoing operations of the Collaboratives. Successfully reforming local healthcare delivery systems will require many years of persistent effort by these Collaboratives, and so reliable, multi-year funding will be needed to support their efforts. NRHI members urge that a dedicated federal funding program be created to support the core operations of Regional Health Improvement Collaboratives.
- Give Priority to Applications from Regional Health Improvement Collaboratives in Federal Funding Programs. A number of federal programs, such as the Beacon Communities program, the HIT Regional Extension Center program, and AHRQ’s Comparative Effectiveness grant programs, have been created and significant amounts of funding have been distributed with little or no effort to build on or coordinate with the multi-stakeholder initiatives already underway in many communities. At best, this misses an opportunity to leverage federal funds with local initiatives for greater impact; at worst, it creates confusion and competition for resources and time that can slow progress across the board. NRHI members believe that in regions where Regional Health Improvement Collaboratives exist, it is important that federal programs build on the work of those Collaboratives, rather than duplicate, compete with, or conflict with them. Many of the programs established under the federal Patient Protection and Affordable Care Act (ACA) explicitly point to the types of programs operated by Regional Health Improvement Collaboratives. For example, Section 3015 requires collection and reporting of quality data and provides for grants to “multi-stakeholder entities that coordinate the development of methods and implementation plans for the consistent reporting of summary quality and cost information,” which is precisely the role that many Regional Health Improvement Collaboratives play in their communities. Section 3501 authorizes federal funding for local quality improvement collaboratives to provide technical support to health providers to improve the quality of care they deliver, which is again one of the key roles that Regional Health Improvement Collaboratives play in their communities. NRHI members urge that wherever possible in federal funding programs designed to support local quality improvement initiatives, HHS and other federal agencies give priority to applications from Regional Health Improvement Collaboratives or to applications which have been endorsed by such Collaboratives as being consistent with the priorities and goals established in those communities.
- Provide federal funding to support the measurement and reporting programs of Regional Health Improvement Collaboratives. It is impossible to know where opportunities exist for improvements in the quality of healthcare and for reductions in healthcare costs or whether progress is being made on those opportunities without effective ways to measure the quality and cost of healthcare. Consequently, measurement and reporting will play a key role in achieving national health reform goals. However, the best, fastest, and most cost-effective approach to measurement and reporting is not to try to do it nationally, but to build on the extensive quality measurement and reporting infrastructure which has already been developed in many regions around the country by Regional Health Improvement Collaboratives. This was recognized in the creation of QECP that shares medicare data with regional entities to publicly report performance. See GAO Report -Medicare Certain Physician Feedback Reporting Practices of Private Entities Could Improve CMSs Efforts. NRHI members urge that AHRQ and HHS provide the financial support needed for Regional Health Improvement Collaboratives to implement these types of effective systems for quality measurement and reporting.