Over the past decade, many organizations and health care leaders have coalesced around a vision of creating a national system to measure the quality and cost of health care in the United States, and to use this information to improve care. While a variety of complementary efforts are underway, the nation is still working toward the ultimate goal of efficiently delivering timely, consistent information about the quality and cost of health care to:

• give patients and consumers the information they need to make informed decisions about health care services; and
• provide comprehensive, meaningful information to physicians, nurses and other health care professionals to improve patient care.

This effort requires three important steps:

1. Development of broadly supported, valid measures of quality and cost that can be used consistently nationwide.
2. Collection of data for endorsed quality measures so that stakeholders can gain a comprehensive picture of providers, and a better grasp of patient experiences, for the purposes of improving care.
3. Use of these measures locally by patients, consumers, employers, health care providers and payers, who are in the best position to work together to improve quality.

Why is quality measurement of health care so important?
Experience has shown that measurement and public reporting foster improvements in individual practice and the systems that are needed to support better quality. While physicians, nurses, clinics and hospitals work to deliver high-quality care, they need sufficient information to help them identify areas to target for their quality improvement efforts.

In order for consumers and purchasers to get better care at a lower cost, they too need and want useful information. Information on the quality and cost of health care will empower consumers to make informed decisions about their health care. Therefore, it is imperative that the information patients, consumers and their families receive is accurate, clear and relevant to them.

What has been achieved with quality measurement at a national level?
There have been a number of significant advances in the effort to improve health care quality.

The National Quality Forum (NQF), in conjunction with the state and federal governments, sets national priorities for measuring and improving the quality and value of health care services in America. NQF, with public and private resources, including significant funding from the Robert Wood Johnson Foundation (RWJF), endorses standard measures that can be used nationally to assess the quality and cost of the health care services that patients receive.

Hundreds of quality measures have been developed by numerous prestigious organizations including the Centers for Medicare & Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), National Committee for Quality Assurance, the Joint Commission, the American Medical Association and other professional organizations. These measures were reviewed, accepted and endorsed by a broad range of health care stakeholders represented in NQF's process, which has resulted in major advances in the capacity for performance measurement to improve health care. A majority of these measures assess single points in the health care experience (e.g., did a heart attack patient receive an aspirin upon arrival at the hospital) which provides an important foundation for the development of measures that give a broader perspective on patient care.

The AQA alliance, founded in 2004, is a broad-based national coalition of more than 125 organizations working together on a strategy to measure, report on and improve physician performance. In the past two years, the alliance has adopted 144 NQF-endorsed measures in 22 areas of medical practice, becoming a major force behind the concepts of measurement, public reporting and evidence-based medicine, and advancing these concepts into practice.

Many recognized that the nation needed an overall framework to promote the use of standard quality and cost measures nationwide. As a result, in 2006 two established quality alliances—the AQA alliance and the Hospital Quality Alliance—and other stakeholders formed the Quality Alliance Steering Committee (QASC) to coordinate efforts to measure and report on the quality of health care that is provided in physician offices and hospitals across America.

What is the Quality Alliance Steering Committee?
QASC is a collaborative effort among government, physicians, nurses, hospitals, health insurers, consumers, accrediting agencies and foundations to dramatically improve the quality of health care across the United States. Together, all of these stakeholders are working to ensure that quality measures are constructed and reported in a clear and consistent way that informs both consumer and employer decision-making, as well as the efforts of practitioners to improve.

What is the vision of QASC?
The vision of QASC is to advance high-quality, cost-effective, patient-centered health care through the coordination of the various groups that are working to promote public reporting of health care provider information for:

• improvement directly by providers;
• consumer decision-making; and
• effective policies, payment policies and consumer incentives that reward or foster better provider performance.

Why was QASC formed?
Many different private- and public-sector groups have designed models for assessing performance and reporting data. However, the proliferation of multiple, uncoordinated and sometimes conflicting initiatives has significant unintended consequences for different stakeholders—unnecessarily burdening physicians, nurses, clinics and hospitals; creating confusion among consumers; and detracting from efforts by employers to design programs that meet the needs of their employees.

QASC will help coordinate and build the initial components of an infrastructure to collect health care quality and cost data nationwide.

Who leads QASC?
The Quality Alliance Steering Committee is co-chaired by Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality (AHRQ), and Mark McClellan, M.D., Ph.D., former CMS administrator, who is now senior fellow and director of the Engelberg Center for Health Care Reform at the Brookings Institution and a visiting scholar at the American Enterprise Institute.

How is QASC related to other quality initiatives currently underway?
In the past several years of trying to improve the quality of health care, there have been overlapping and sometimes competing efforts to measure and report on health care quality. The QASC is providing a catalyst for measuring and publicly reporting health care information about the overall patient experience. As QASC works to help stakeholders fill these gaps in achieving a high-quality health care system, it will also continue to integrate its efforts with the ongoing critical activities of the other organizations involved in quality improvement, particularly NQF.

What barriers exist to getting better information on health care quality?
One roadblock to measuring and reporting of performance at the provider level has been that past efforts have been conducted on a piecemeal basis. Different plans and payers have measured the quality of health care covered by various public and private programs separately, often against different sets of measures.

To help improve care, consumers, providers and employers need a more complete picture of providers.

What has already been accomplished through QASC over the last year?
For the past year, pilots at six sites supported by funding from CMS and AHRQ, under the auspices of the AQA alliance, have begun to test approaches to combining data from the public and private sectors and ways to measure and report on physician practice in a meaningful and transparent way for consumers and purchasers of health care.

What are the next steps for QASC?
Next, with substantial funding from RWJF, QASC will begin to test approaches to combining summary provider information from Medicare and private health plan data at the national level, offering a more complete picture of providers. These provider-level measures will be available to regional collaborations to use in improving the quality of health care. The RWJF-funded work also recognizes the impact of racial and ethnic health care disparities on quality improvement efforts and will ensure that these new efforts to create measures from large, national sets of data report these measures in ways that identify important racial and ethnic disparities.

Who is involved in the QASC?

Quality Alliance Steering Committee Co-Chairs
Carolyn Clancy, Agency for Healthcare Research and Quality
Mark McClellan, Brookings Institution

Principals
Bruce Bradley, General Motors
Janet Corrigan, National Quality Forum
Robert (Bob) Dickler, Association of American Medical Colleges
Pam French, Boeing
Karen Ignagni, America's Health Insurance Plans
Clarion Johnson, Exxon Mobil
Chip Kahn, Federation of American Hospitals
Allan Korn, Blue-Cross/Blue Shield of America
Peter Lee, Pacific Business Group on Health
John Lumpkin, Robert Wood Johnson Foundation
Brian Marcotte, Honeywell
Debra Ness, National Partnership for Women & Families
Nancy Nielsen, American Medical Association
Peggy O'Kane, National Committee for Quality Assurance
Dennis O'Leary, Joint Commission
Frank Opelka, American College of Surgeons
Jeffrey Rich, Society of Thoracic Surgeons
Gerry Shea, AFL-CIO
Barry Straube, Centers for Medicare & Medicaid Services
John Tooker, American College of Physicians
Rich Umbdenstock, American Hospital Association
Andy Webber, National Business Coalition on Health

Workgroup Chairs
Vision Workgroup
Carmella Bocchino, America's Health Insurance Plans
Robert (Bob) Dickler, Association of American Medical Colleges

Cost-Price Transparency Workgroup
Bruce Bradley, General Motors
Debra Ness, National Partnership for Women and Families

Measure Harmonization Work Group
Janet Corrigan, National Quality Forum

Efficiency-Episodes of Care Workgroup
Kevin Weiss/Gregg Meyer
Massachusetts General Physicians Organization

Infrastructure Support Workgroup
Chris Queram
Wisconsin Collaborative For Health Care Quality

Expansion Workgroup
Peter Lee
Pacific Business Group on Health