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Quality Improvements Infrastructure: AARP is pleased that the committee proposes to support the development of an infrastructure to sustain quality improvements throughout the system by directing the Secretary of DHHS to first identify national priorities for improvement and then to pursue the realization of these priorities through performance measurement and public reporting. AARP already participates in multi-stakeholder activities through consensus organizations (such as the National Quality Forum and the National Priorities Partners) in pursuit of quality improvement, and we agree that the Secretary should help bolster these nascent, but increasingly important, collaborative initiatives through a variety of consultative opportunities identified in the draft legislation. The capacity to evaluate performance throughout the health care system is integral to several features of a reformed health care system, such as improvement in the delivery of chronic are, reduction in disparities among racial and ethnic minorities, and aligning payment with desired outcomes.

It will be important to ensure that priorities are harmonized and made consistent to achieve maximum benefit from resources devoted to quality improvement activities. We note that the draft legislation would require the Secretary to receive recommendations on priorities for performance improvement from a qualified consensus-based entity (section 204(d)(1) while section 399LL (b)(4) identifies 9 specific areas that the Comptroller General would be required to evaluate. Although we believe the identified areas are worthy, there may be some inconsistency in requiring input from the consensus body on the one hand and establishing specific priorities on the other. Similarly, section 213 that provides grants to implement medication management services in the treatment of chronic disease would allow the Secretary to fund (via grants or contracts) the development of performance measures to assess the use and effectiveness of medication management services. Here again, although we think medication management programs offered by pharmacists have merit to promote safety and encourage greater patient adherence, measures to evaluate performance in this area should be consistent with the requirements applicable to all performance measures specified in section 204 (i.e., that they be evidence-based, consistent with national goals and priorities, and endorsed by a national consensus body.)

We are very pleased to see the committee’s implicit recognition of the fact that performance measurement in support of quality improvement and decision support should be considered a public good. AARP agrees that providing the federal resources to support measure development, research, dissemination of information on best practices, and the provision of technical assistance is necessary.

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