President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry

Establishing Health Care Quality as a National Prirority

Chapter Five
Creating Public-Private Partnerships

Improving the quality of health care in America must be a national priority that begins with leadership by the President and the Congress and extends to all levels of the health care industry. Uppermost on the national agenda should be initiatives designed to focus attention on specific priorities for improvement and to coordinate the wealth of existing resources in partnership efforts to address those priorities. The first step will be to establish national aims for improving the quality of health care (see Chapter 3). Then core sets of quality measures that relate to the aims and that are applicable to each sector of the health care industry will need to be identified, and a strategy for standardized reporting of the measures defined and implemented (see Chapter 4). These actions will provide the means to track progress in meeting national aims and to generate the comparative information needed to support efforts to improve quality, promote accountability, and make sound public health and policy decisions.

To provide ongoing leadership for these efforts, the Commission recommends creation of two complementary bodies, one lodged in the public sector, the other in the private sector. The first entity, an expert Advisory Council for Health Care Quality, would advance and influence the public agenda with respect to quality of care. The Advisory Council would focus on defining, updating, tracking, supporting, and reporting on national aims for improvement. It also would track the industry's efforts to establish an environment in which quality improvement can occur through full, systemwide implementation of the Consumer Bill of Rights and Responsibilities (see Chapter 9). Complementing the efforts of the Advisory Council would be a Forum for Health Care Quality Measurement and Reporting, a group representing key stakeholders, convened to provide coordination and guidance to the multiple public and private sector parties involved in evaluating health care quality. The Forum's objective would be to develop an effective and efficient way to focus incentives for quality improvement on national priorities while ensuring the public availability of information needed to support the marketplace and oversight efforts.


Principles for Action

Through the Commission's work to assess the current state of health care quality and to identify strategies for improvement, several principles emerged. These principles assisted in defining an effective and efficient approach for undertaking the actions needed to make quality improvement both a national priority and an attainable goal. The Commission determined that, to be successful, its recommended approach would need to:

Proposed Organizational Structures

The Commission has identified an approach for creating stable, predictable mechanisms to serve as a catalyst and an agent for national, systemwide quality improvement. The Commission's recommended approach features a public sector body -- the Advisory Council for Health Care Quality -- that would establish the national quality improvement agenda and a framework for action. It also relies on a private sector body -- the Forum for Health Care Quality Measurement and Reporting -- that would coordinate existing resources and harness market forces toward implementing the Nation's agenda for improvement.

A Two-Entity Approach

The two-entity structure that characterizes the Commission's recommended approach emerged after extensive discussions of various public and private sector models, which resulted in a recognition that each has strengths and weaknesses, advantages and disadvantages. It represents compromises on the part of many, if not most, members of the Commission.

Key to developing the Commission's recommended approach was recognition that there was a strong need for a mechanism by which to provide ongoing national leadership for health care quality improvement. Such a structure would need to be lodged in the public sector to have the high visibility essential for both drawing upon and influencing leaders from across the public and private sectors.

At the same time, the value of establishing standards for quality measurement and reporting through private sector channels was evident. The Commission clearly recognized the progress that private sector organizations have made in developing these types of standards. It sought to identify a mechanism that would further stimulate that effort while ensuring the implementation of a comprehensive quality measurement and reporting framework with core sets of measures applicable to each sector and adhered to by all organizations or providers within that sector. It did not seek to create a new quality oversight organization or to displace the work of existing organizations, but rather to provide a forum in which the work of those groups could be better coordinated and focused on common goals for systemwide quality improvement.

While members of the Commission were united in their support for work under way in the quality measurement field, Commission members held varying degrees of confidence in the likelihood that a purely private sector approach that focused on increasing coordination among the existing groups would yield a fully successful outcome. The decision to provide the Advisory Council with responsibilities for tracking the Forum's influence on the health care industry was made to increase the odds of success and to put the Advisory Council in a position to determine the need for, and timing of, additional interventions.

There are concerns on the part of some about creating too strong a public sector role that could stifle innovation. This clearly is not the Commission's intent. The Advisory Council's role should be limited to one of providing advice and guidance to policymakers, the health care industry, the Forum, and others.

The Commission intends that the two entities would support each other's work and believes that each would be strengthened by the other. Both the Advisory Council and the Forum would have public and private sector participation, and there would be coordination between the activities of the two. These three aspects -- bilocation in the public and private sectors, public and private composition, and coordination and communication between the two entities -- will maximize the effectiveness of public-private partnerships.

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Last Revised: Sunday, July 19, 1998