Building organizational capacity: a cornerstone of health system reform.

The U.S. health care delivery system is in need of overhaul. Care is fragmented, unsafe, and inefficient. Achieving higher levels of performance requires organizational capacity, including information technology (IT) and specialized expertise, not present in most settings. Organizational capacity is fortified through the benefits of larger scale and clinical integration. The evolution of new organizational structures will open up opportunities to redesign payment programs and invest capital toward building high-performing systems. A comprehensive policy agenda is needed to encourage growth in organizational capacity, including national priorities and goals, performance measurement and reporting, payment reform, community leadership, IT, and public education.

Balancing the nation's health care scorecard: the National Healthcare Quality and Disparities Reports.

BACKGROUND: In January 2005, the U.S. Agency for Healthcare Research and Quality (AHRQ) released the congressionally mandated reports on the United States health care system--the 2004 National Healthcare Quality and Disparities Reports (NHQR and NHDR). They are intended to summarize the current state of the science of health care quality and disparities for a broad audience, including providers, consumers, researchers, and policy makers. BALANCING THE HEALTH CARE SCORECARDS: The NHQR and NHDR are designed as balanced scorecards, yet measure imbalance is evident with respect to relative attention to the quality dimensions, condition/clinical areas, and priority population. For example, heart disease and nursing home/home health each represent more than 20 measures of the total of 179 measures, whereas mental health and HIV/AIDS care are tracked with a total of six. USING THE SCORECARD FOR QUALITY IMPROVEMENT (QI): The measures making up the scorecards are derived directly from current national initiatives aimed at improving specific performance measures in hospitals, nursing homes, and home health agencies, which facilitates performance benchmarking at different levels of the health care system. CONCLUSION: Much work remains to be done if these reports are to be used to their fullest potential as balanced scorecards for the United States.

How the national healthcare quality and disparities reports can catalyze quality improvement.

BACKGROUND: The purpose of the National Reports on Healthcare Quality and Disparities is to enhance awareness of quality and health care disparities, track progress, understand variations, and catalyze improvements in health care. OBJECTIVES: The objective of this paper is to propose a model that will facilitate a user's progression from knowledge to action and to show how the reports, its data warehouse, associated products, and Agency for Healthcare Research and Quality resources are integrated and focused on a comprehensive campaign to improve health care quality. DESIGN: The design of the paper is to present a conceptual model and to show how implementation strategies for the reports fit the model. FINDINGS: The authors propose a quality improvement supply chain model to help elucidate the links of the process, corresponding developmental stages that potential users need to master and progress through, and "just-in-time" supply chain inputs at each of the corresponding stages, and populate the model with examples. CONCLUSION: The traditional ways of disseminating knowledge derived from science through reports and conferences are inadequate to the humbling need for vast improvements in the US health care system. Our model suggests the need for a wide variety of information, packaged in a diverse ways, and delivered just in time and on demand. It encourages the alignment of decision makers and researchers, along with information intermediaries and innovation brokers, to make the information production cycle more efficient and effective. Future iterations of the reports will improve relevance, meaning, and distribution of information to facilitate its uptake by potential users.

Do consumer-directed health benefits favor the young and healthy?

This paper demonstrates through a simulation and demographic analysis of consumers' out-of-pocket payments for premiums and medical care that the young and healthy are potential winners with consumer-directed health benefits (CDHBs), and the moderately sick are the losers. However, benefit design constraints and job tenure realities limit the savings opportunities for the young. As employee cost sharing continues unabated, one potential remedy is to cap expenses as a percentage of income, thereby placing a limit on the burden to the sick and ensuring that all Americans share the burden equally according to ability to pay.