Activity

Activity Description

The purpose of this project was to identify options for redesigning performance measures, provider payment policies, and performance improvement programs in ways that would encourage and reward improvements in health and health care delivery.  The primary focus was on the Medicare program, but the findings and recommendations will likely have broad applicability to all public and private insurance programs.

To develop these reports, the staff and committee chair organized the committee into three subcommittees.

The Subcommittee on Pay for Performance served a 12-month term ending approximately January 2006. The subcommittee assisted the main committee in its efforts to identify and analyze options for aligning Medicare payment policies with provider performance in the original fee-for-service program (under parts A and B of title XVIII of the Social Security Act), the new Medicare Advantage program (under Part C), and other programs (under Title XVIII). 

The Subcommittee for the Evaluation of the Quality Improvement Organizations (QIO)  served a 21-month term, ending approximately May 2006. The subcommittee advised the primary committee and prepared draft sections of the report mandated by Section 109 of the Medicare Modernization Act of 2003. The subcommittee focused on selected aspects of the evaluation of the Medicare Quality Improvement Organization Program and on the oversight of the program conducted by the Centers for Medicare and Medicaid Services. The committee looked to the subcommittee, particularly for assistance with evaluation methodologies, to assess the extent to which the program improves the quality of care enjoyed by Medicare beneficiaries.

The Subcommittee on Performance Measures advised the Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs and prepared draft sections of the report. This subcommittee identified a conceptual framework to guide the selection of performance measures for use in assessing community and provider performance; identify leading measurement sets from which subsets of measures will be selected; establish criteria for selecting measures to be used for payment, public reporting and quality improvement; and address methodological issues (e.g., small sample sizes associated with small practice settings). All reports for this project were authored by the main committee. Subcommittees were functioning in an advisory capacity and did not author reports.