- Email: [email protected]
Value exchanges for value-driven health care
PRACTICE PRACTICE STRATEGIES STRATEGIES Value exchanges for value-driven health care
T
he U.S. Department of Health and Human Services (HHS), through its Agency for Healthcare Research and Quality (AHRQ), on May 8, officially requested permission to begin a proposed project: “Chartering Value Exchanges for Value-Driven Health Care’’ (Federal Register: May 8, 2007 [Volume 72, Number 88], Page 26117-26119). “Value exchanges” represent a key component in the HHS’s Value-Driven Health Care Initiative, a plan to improve the quality and curtail the cost of the American health
As part of its Value-Driven Health Care Initiative, the U.S. Department of Health and Human Services is taking the first steps toward the establishment of federally chartered health care value exchanges that could begin organizing local or regional health care quality measurement, electronic health record systems, public provider quality reporting, and pay-for-performance programs as early as next year. Optometrists should be aware of this potentially important development in the nation’s health care infrastructure and begin to consider how value exchanges could affect optometric practice. care system. The value exchanges will be federally chartered, local or regional, multistakeholder health care collaboratives, according to the HHS. The department plans for the local collaboratives to become part of a national health care improvement program to be known as the Learning Network. The value exchanges will work to enhance health care quality and value by measuring the performance and cost of local health care providers, reporting those findings, and then working to improve the quality and cost of care, according to an HHS statement. In addition to participation in the AHRQ-managed Learning Network, chartered value exchanges will be eligible to pool their data with Medicare for broad-based measurement of provider performance and quality outcomes, according to the HHS.
“The Secretary of Health and Human Services has created and is implementing a Value-Driven Health Care Initiative to enhance person and population-centered care by improving the quality of health care services and reducing health care costs,” the AHRQ notice explains. Also being undertaken as part of the initiative are Medicare cost and quality improvement programs, including the Physician Quality Reporting Initiative (PQRI) that began in July and the formation of Medicaid pay-forperformance programs. Goals and objectives for the Value-Driven Health Care Initiative were outlined in a presidential executive order last fall and encompass: (1) promotion of the establishment of health information technology interoperability standards for exchanging price and quality health care data; (2) promotion of the availability and use of transparent, nationally endorsed, consensus-derived quality measures; (3) promotion of the availability and use of transparent, nationally endorsed, consensus-derived measures of price/cost; and (4) promotion of the use of provider and consumer incentives for high-quality and cost-efficient health care. The Value-Driven Health Care Initiative is based on 3 fundamental principles embodying 4 “cornerstones” of value-driven care (see Box 1), according to the AHQR. “The first is that at its core, health care is ‘local’— provided in uniquely constituted cultural and marketbased environments. As such, improving the value of health care requires a critical mass of community stakeholders (public and private purchasers, health plans, providers, and consumers) as well as other relevant community entities (e.g., local information exchange organizations, state data organizations), investing their time and resources toward shared cost and quality-improvement goals. We refer to such representative quality improvement community organizations as local multistakeholder collaboratives. Scattered across the country, there are community collaboratives in various stages of development, ranging from mature multistakeholder collaboratives to communities where only a limited number of organizations within a single stakeholder group or a limited number of stakeholder groups are working together,” the AHRQ explained. The initiative’s second principle is that broad access to accurate, meaningful information will improve the value of health care services by (1) stimulating provider improvement, (2) engaging consumers in provider selection and treatment choices, and (3) enabling large-scale health care purchasers to align consumer and provider incentives.
1529-1839/07/$ -see front matter © 2007 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2007.06.009
422 Box 1
Four ‘cornerstones’ of valuedriven care The Department of Health and Human Service’s (HHS) planned system of value-driven health care system rests on 4 interconnected “cornerstones,” according to the agency. ● Interoperable health information technology (HIT)—A National Health Information Network (NHIN) is being developed to facilitate the use of electronic health records and the collection of health-related data. The HHS hopes to make electronic health records available to all Americans no later than 2014. Standards for the network and the health records are being developed. ● Quality standards—Through organizations such as the AQA (an alliance of health care providers, health plans, employers and other health care stakeholders) and the American Medical Association–led Physician Consortium for Performance Improvement (PCPI), the HHS is working to establish nationally recognized “consensus” standards against which the quality of health care can be measured. Adherence rates are to be made available publicly to aid patients in the selection of health care providers as well as to providers themselves for use in improving care. ● Price standards—Efforts are underway to develop uniform approaches to measuring and reporting price information for the benefit of consumers. In addition, strategies are being developed to measure the overall cost of services for common episodes of care and the treatment of common chronic diseases. Adherence rates are to be made available publicly to aid patients in the selection of health care providers. ● Incentives—the HHS is calling on all parties— providers, patients, insurance plans, and payers—to participate in arrangements that reward both those who offer and those who purchase highquality, competitively priced health care. Such arrangements may include implementation of pay-for-performance methods of reimbursement for providers or the offering of consumer-directed health plan products, such as accountbased plans for enrollees in employer-sponsored health benefit plans.
“Generating the information needed to accomplish this is maximized when performance measures can be calculated based on all payer data,” the AHQR adds. The initiative’s third guiding principle is that establishing a nationwide health care learning network will foster mar-
Practice Strategies Box 2
Health and Human Services recognizes 31 local valuedriven health projects In a key step toward the establishment of its planned national “value-driven” health system, the U.S. Department of Health and Human Services (HHS) has officially recognized 31 “community leader” coalitions around the nation. Established to improve health care quality and reduce health care costs in their respective areas, the coalitions are multistakeholder organizations (representing health care purchasers, plans, providers, and consumers) that are attempting to develop regional or local value-driven health care systems. Those local value-driven health systems are to include: ● Public reporting of health provider quality and cost information. ● Regional health information organizations (RHIOs) to facilitate the use of electronic health records (EHRs) in health quality and cost data collection. ● Incentive programs for the utilization of providing of quality care (such as pay-for-performance programs). The AOA Advocacy Group urges optometrists to become actively involved in local value-driven health care efforts. Seattle’s Puget Sound Health Alliance on January 3 became the first community leader coalition to be recognized by the HHS. The Puget Sound coalition represents nearly 130 health care provider and business entities including Starbucks Coffee, Microsoft, Premera Blue Cross, Aetna, the Washington Roundtable (a leading business group) and the Association of Washington Business. Georgia’s Center for Health Transformation, headed by former House Speaker Newt Gingrich, has been designated a community leader coalition by the HHS. So has the Integrated Healthcare Association, California’s largest pay-for-performance program. Markets with HHS-recognized coalitions range from New York City to rural areas in Iowa and upstate New York. A total of 4 coalitions have been recognized by the HHS in Iowa. Under its Value-Driven Health Care Initiative, the HHS is actively encouraging the development of local health coalitions and plans to eventually make them part of a national network of government-chartered “value exchanges.” Continued on following page.
Practice Strategies Box 2 (continued)
423 Box 3
Health and Human Services recognizes 31 local valuedriven health projects
Health and Human Services– designated “community leader” organizations
To gain HHS acceptance as value exchanges, health coalitions must meet a set of 15 criteria covering a range of issues from organizational structure to specific requirements for the health care improvement functions to be undertaken. Once chartered as value exchanges, the coalitions would be invited to participate in a nationwide “Learning Network,” sponsored and maintained by the HHS’s Agency for Healthcare Research and Quality. The Learning Network would provide access to expert faculty offering lessons on successful health quality improvement and consumer health data reporting programs. In addition, the network would also offer resources to assist with “relationship management” and coalition building, according to the HHS. Chartered value exchanges will also qualify to pool their data with Medicare for broad-based measurement of provider performance and quality outcomes, according to the HHS. The HHS is expected to post calls for organizations to apply for chartered value-exchange status on a semiannual basis. For additional information on the HHS’s ValueDriven Health Care Initiative, see the related article in this issue of Optometry. AOA members wishing assistance in contacting or joining local health coalitions may contact Jodi Chappell, AOA associate director of federal relations, by calling (703) 837-1348 or e-mailing [email protected].
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
ket-based health care reform. “Learning networks are an evidence-based organizational mechanism to achieve rapid identification, dissemination, and adoption of best practices. They are comprised of individuals or groups focused on common broad goals,” the AHQR explained. Based on those principles, the AHRQ plans to establish a nationwide learning network of mature community-based multistakeholder health care quality improvement collaboratives, the agency’s notice concludes. Goals of the Learning Network include facilitating collaborative production of public reports, fostering pay-for-performance programs, fostering consumer financial incentives, and ultimately, improving quality. To develop its network, the AHRQ plans to issue semiannual public requests for proposals (RFP) and conduct a selection process immediately to identify and charter “mature” multistakeholder collaboratives that qualify as value
Alabama Quality Assurance Foundation Alliance, The (Milwaukee, Wisconsin) Arkansas Foundation for Medical Care Cedar Rapids (IA) Healthcare Alliance Center for Health Transformation (Georgia) Colorado Business Group on Health Greater Detroit Area Health Council Health Action Council of Northeastern Ohio Health Policy Corporation of Iowa Healthy Memphis Common Table Indiana Employers Quality Health Alliance Inland Northwest Health Services (Spokane, Washington) Integrated Healthcare Association (California) Iowa Health Buyers Alliance Iowa Healthcare Collaborative Maine Health Management Coalition Kansas City Quality Improvement Consortium Louisiana Health Care Quality Forum Advisory Workgroup Memphis Business Group on Health Nevada Partnership for Value-Driven Health Care New York Business Group on Health Niagara Health Quality Coalition Oregon Health Care Quality Corporation Partnership for New York City Puget Sound Health Alliance (Seattle, Washington) Quality Health Network (Colorado) Utah Partnership for Value-Driven Health Care South Carolina Business Coalition on Health Virginia Business Coalition on Health Wisconsin Health Information Organization
exchanges (see Box 2). To be eligible, a collaborative must first be recognized by the HHS as a Community Leader for Value-driven Health Care (see Box 3). To qualify as a value exchange, a community leader organization must demonstrate the capacity (or have plans to develop capacity) to: A. Facilitate collection of provider-level measures across 6 performance domains identified by the Institute of Medicine (IOM) (safety, timeliness, effectiveness, efficiency, equitableness, and patient-centeredness). B. Use (or promote the use of) transparent, nationally endorsed, consensus-derived performance measures and consumer cost data for public or consumer reporting.
424 C. Use (or promote the use of) transparent, nationally endorsed, consensus-derived performance measures to reward and foster better performance. D. Use (or promote the use of) transparent, nationally endorsed, consensus-derived performance measures for improvement by directly informing providers of their results. E. Foster collaboration across multiple stakeholders (public and private purchasers, health plans, health care providers, and consumers), as well as other relevant entities (e.g., local information exchange organizations, state data organizations) in the community of interest and serve as a hub for sharing information and dialogue. F. Promote the use of interoperable health information technologies for measurement, as appropriate, and collaborate with health information sharing processes and in the adoption of these technologies. G. Support “knowledge transfer” by maintaining transparent processes and sharing lessons learned. H. Conduct ongoing evaluation and improvement of efforts. Successful applicants for charter as value exchanges will also have to demonstrate the ability to manage collaborative processes so all critical stakeholders are engaged. Those planning to conduct data collection will have to demonstrate the ability to do so. Those receiving aggregated health care performance results data from a source (such as national data aggregators) must demonstrate the ability to effectively implement the use of these results. Values exchanges must have nonprofit status and staff or consultants who can provide needed expertise. Successful applicants must have a history of raising funds or in-kind support from multiple stakeholders. They must demonstrate the ability to manage collaborative, multistakeholder projects and finances. They must also be able to track progress in
Practice Strategies meeting “individual collaborative goals, which may include, for example, producing public reports or fostering pay-forperformance or consumer incentives.” The AHRQ is requesting permission to proceed with the project from the federal Office of Management and Budget (OMB) under terms of the federal Paperwork Reduction Act. A public comment period was to close in early July. Federal agencies often act within 90 days after the required comment period, meaning the OMB may issue permission to proceed with the chartering of value exchanges as early as October. Once the project is approved, the AHRQ plans to twice annually post a public call for parties interested in becoming chartered as Value Exchanges for Value-Driven Health Care. The AHRQ will post requests for proposals on its Web site (www.ahrq.gov). Each request for proposals will be open for 2 months. A new AHRQ review committee—representing institutional health care purchasers, health plans, health care consumers, and health care providers (with at least 2 being physicians) will review the proposals. All proposals will be reviewed in the 6 weeks after the closing of the application period. That means the first federally chartered local or regional health care value exchanges could be approved and ready to organize local health care quality measurement, electronic health record systems, public provider quality reporting, and pay-for-performance programs as early as the spring of 2008. “Optometry must be represented in these collaboratives,” said David Cockrell, O.D., American Optometric Association (AOA) Board of Trustee liaison to the AOA Federal Relations Committee. The AOA Washington office will work with state optometric associations to ensure proper representation for optometry on the state collaboratives. AOA-affiliated state optometric associations seeking assistance should contact AOA Associate Director of Government Relations Jodi Chappell ([email protected]) at the AOA Washington office.
T
he U.S. Department of Health and Human Services (HHS), through its Agency for Healthcare Research and Quality (AHRQ), on May 8, officially requested permission to begin a proposed project: “Chartering Value Exchanges for Value-Driven Health Care’’ (Federal Register: May 8, 2007 [Volume 72, Number 88], Page 26117-26119). “Value exchanges” represent a key component in the HHS’s Value-Driven Health Care Initiative, a plan to improve the quality and curtail the cost of the American health
As part of its Value-Driven Health Care Initiative, the U.S. Department of Health and Human Services is taking the first steps toward the establishment of federally chartered health care value exchanges that could begin organizing local or regional health care quality measurement, electronic health record systems, public provider quality reporting, and pay-for-performance programs as early as next year. Optometrists should be aware of this potentially important development in the nation’s health care infrastructure and begin to consider how value exchanges could affect optometric practice. care system. The value exchanges will be federally chartered, local or regional, multistakeholder health care collaboratives, according to the HHS. The department plans for the local collaboratives to become part of a national health care improvement program to be known as the Learning Network. The value exchanges will work to enhance health care quality and value by measuring the performance and cost of local health care providers, reporting those findings, and then working to improve the quality and cost of care, according to an HHS statement. In addition to participation in the AHRQ-managed Learning Network, chartered value exchanges will be eligible to pool their data with Medicare for broad-based measurement of provider performance and quality outcomes, according to the HHS.
“The Secretary of Health and Human Services has created and is implementing a Value-Driven Health Care Initiative to enhance person and population-centered care by improving the quality of health care services and reducing health care costs,” the AHRQ notice explains. Also being undertaken as part of the initiative are Medicare cost and quality improvement programs, including the Physician Quality Reporting Initiative (PQRI) that began in July and the formation of Medicaid pay-forperformance programs. Goals and objectives for the Value-Driven Health Care Initiative were outlined in a presidential executive order last fall and encompass: (1) promotion of the establishment of health information technology interoperability standards for exchanging price and quality health care data; (2) promotion of the availability and use of transparent, nationally endorsed, consensus-derived quality measures; (3) promotion of the availability and use of transparent, nationally endorsed, consensus-derived measures of price/cost; and (4) promotion of the use of provider and consumer incentives for high-quality and cost-efficient health care. The Value-Driven Health Care Initiative is based on 3 fundamental principles embodying 4 “cornerstones” of value-driven care (see Box 1), according to the AHQR. “The first is that at its core, health care is ‘local’— provided in uniquely constituted cultural and marketbased environments. As such, improving the value of health care requires a critical mass of community stakeholders (public and private purchasers, health plans, providers, and consumers) as well as other relevant community entities (e.g., local information exchange organizations, state data organizations), investing their time and resources toward shared cost and quality-improvement goals. We refer to such representative quality improvement community organizations as local multistakeholder collaboratives. Scattered across the country, there are community collaboratives in various stages of development, ranging from mature multistakeholder collaboratives to communities where only a limited number of organizations within a single stakeholder group or a limited number of stakeholder groups are working together,” the AHRQ explained. The initiative’s second principle is that broad access to accurate, meaningful information will improve the value of health care services by (1) stimulating provider improvement, (2) engaging consumers in provider selection and treatment choices, and (3) enabling large-scale health care purchasers to align consumer and provider incentives.
1529-1839/07/$ -see front matter © 2007 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2007.06.009
422 Box 1
Four ‘cornerstones’ of valuedriven care The Department of Health and Human Service’s (HHS) planned system of value-driven health care system rests on 4 interconnected “cornerstones,” according to the agency. ● Interoperable health information technology (HIT)—A National Health Information Network (NHIN) is being developed to facilitate the use of electronic health records and the collection of health-related data. The HHS hopes to make electronic health records available to all Americans no later than 2014. Standards for the network and the health records are being developed. ● Quality standards—Through organizations such as the AQA (an alliance of health care providers, health plans, employers and other health care stakeholders) and the American Medical Association–led Physician Consortium for Performance Improvement (PCPI), the HHS is working to establish nationally recognized “consensus” standards against which the quality of health care can be measured. Adherence rates are to be made available publicly to aid patients in the selection of health care providers as well as to providers themselves for use in improving care. ● Price standards—Efforts are underway to develop uniform approaches to measuring and reporting price information for the benefit of consumers. In addition, strategies are being developed to measure the overall cost of services for common episodes of care and the treatment of common chronic diseases. Adherence rates are to be made available publicly to aid patients in the selection of health care providers. ● Incentives—the HHS is calling on all parties— providers, patients, insurance plans, and payers—to participate in arrangements that reward both those who offer and those who purchase highquality, competitively priced health care. Such arrangements may include implementation of pay-for-performance methods of reimbursement for providers or the offering of consumer-directed health plan products, such as accountbased plans for enrollees in employer-sponsored health benefit plans.
“Generating the information needed to accomplish this is maximized when performance measures can be calculated based on all payer data,” the AHQR adds. The initiative’s third guiding principle is that establishing a nationwide health care learning network will foster mar-
Practice Strategies Box 2
Health and Human Services recognizes 31 local valuedriven health projects In a key step toward the establishment of its planned national “value-driven” health system, the U.S. Department of Health and Human Services (HHS) has officially recognized 31 “community leader” coalitions around the nation. Established to improve health care quality and reduce health care costs in their respective areas, the coalitions are multistakeholder organizations (representing health care purchasers, plans, providers, and consumers) that are attempting to develop regional or local value-driven health care systems. Those local value-driven health systems are to include: ● Public reporting of health provider quality and cost information. ● Regional health information organizations (RHIOs) to facilitate the use of electronic health records (EHRs) in health quality and cost data collection. ● Incentive programs for the utilization of providing of quality care (such as pay-for-performance programs). The AOA Advocacy Group urges optometrists to become actively involved in local value-driven health care efforts. Seattle’s Puget Sound Health Alliance on January 3 became the first community leader coalition to be recognized by the HHS. The Puget Sound coalition represents nearly 130 health care provider and business entities including Starbucks Coffee, Microsoft, Premera Blue Cross, Aetna, the Washington Roundtable (a leading business group) and the Association of Washington Business. Georgia’s Center for Health Transformation, headed by former House Speaker Newt Gingrich, has been designated a community leader coalition by the HHS. So has the Integrated Healthcare Association, California’s largest pay-for-performance program. Markets with HHS-recognized coalitions range from New York City to rural areas in Iowa and upstate New York. A total of 4 coalitions have been recognized by the HHS in Iowa. Under its Value-Driven Health Care Initiative, the HHS is actively encouraging the development of local health coalitions and plans to eventually make them part of a national network of government-chartered “value exchanges.” Continued on following page.
Practice Strategies Box 2 (continued)
423 Box 3
Health and Human Services recognizes 31 local valuedriven health projects
Health and Human Services– designated “community leader” organizations
To gain HHS acceptance as value exchanges, health coalitions must meet a set of 15 criteria covering a range of issues from organizational structure to specific requirements for the health care improvement functions to be undertaken. Once chartered as value exchanges, the coalitions would be invited to participate in a nationwide “Learning Network,” sponsored and maintained by the HHS’s Agency for Healthcare Research and Quality. The Learning Network would provide access to expert faculty offering lessons on successful health quality improvement and consumer health data reporting programs. In addition, the network would also offer resources to assist with “relationship management” and coalition building, according to the HHS. Chartered value exchanges will also qualify to pool their data with Medicare for broad-based measurement of provider performance and quality outcomes, according to the HHS. The HHS is expected to post calls for organizations to apply for chartered value-exchange status on a semiannual basis. For additional information on the HHS’s ValueDriven Health Care Initiative, see the related article in this issue of Optometry. AOA members wishing assistance in contacting or joining local health coalitions may contact Jodi Chappell, AOA associate director of federal relations, by calling (703) 837-1348 or e-mailing [email protected].
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
ket-based health care reform. “Learning networks are an evidence-based organizational mechanism to achieve rapid identification, dissemination, and adoption of best practices. They are comprised of individuals or groups focused on common broad goals,” the AHQR explained. Based on those principles, the AHRQ plans to establish a nationwide learning network of mature community-based multistakeholder health care quality improvement collaboratives, the agency’s notice concludes. Goals of the Learning Network include facilitating collaborative production of public reports, fostering pay-for-performance programs, fostering consumer financial incentives, and ultimately, improving quality. To develop its network, the AHRQ plans to issue semiannual public requests for proposals (RFP) and conduct a selection process immediately to identify and charter “mature” multistakeholder collaboratives that qualify as value
Alabama Quality Assurance Foundation Alliance, The (Milwaukee, Wisconsin) Arkansas Foundation for Medical Care Cedar Rapids (IA) Healthcare Alliance Center for Health Transformation (Georgia) Colorado Business Group on Health Greater Detroit Area Health Council Health Action Council of Northeastern Ohio Health Policy Corporation of Iowa Healthy Memphis Common Table Indiana Employers Quality Health Alliance Inland Northwest Health Services (Spokane, Washington) Integrated Healthcare Association (California) Iowa Health Buyers Alliance Iowa Healthcare Collaborative Maine Health Management Coalition Kansas City Quality Improvement Consortium Louisiana Health Care Quality Forum Advisory Workgroup Memphis Business Group on Health Nevada Partnership for Value-Driven Health Care New York Business Group on Health Niagara Health Quality Coalition Oregon Health Care Quality Corporation Partnership for New York City Puget Sound Health Alliance (Seattle, Washington) Quality Health Network (Colorado) Utah Partnership for Value-Driven Health Care South Carolina Business Coalition on Health Virginia Business Coalition on Health Wisconsin Health Information Organization
exchanges (see Box 2). To be eligible, a collaborative must first be recognized by the HHS as a Community Leader for Value-driven Health Care (see Box 3). To qualify as a value exchange, a community leader organization must demonstrate the capacity (or have plans to develop capacity) to: A. Facilitate collection of provider-level measures across 6 performance domains identified by the Institute of Medicine (IOM) (safety, timeliness, effectiveness, efficiency, equitableness, and patient-centeredness). B. Use (or promote the use of) transparent, nationally endorsed, consensus-derived performance measures and consumer cost data for public or consumer reporting.
424 C. Use (or promote the use of) transparent, nationally endorsed, consensus-derived performance measures to reward and foster better performance. D. Use (or promote the use of) transparent, nationally endorsed, consensus-derived performance measures for improvement by directly informing providers of their results. E. Foster collaboration across multiple stakeholders (public and private purchasers, health plans, health care providers, and consumers), as well as other relevant entities (e.g., local information exchange organizations, state data organizations) in the community of interest and serve as a hub for sharing information and dialogue. F. Promote the use of interoperable health information technologies for measurement, as appropriate, and collaborate with health information sharing processes and in the adoption of these technologies. G. Support “knowledge transfer” by maintaining transparent processes and sharing lessons learned. H. Conduct ongoing evaluation and improvement of efforts. Successful applicants for charter as value exchanges will also have to demonstrate the ability to manage collaborative processes so all critical stakeholders are engaged. Those planning to conduct data collection will have to demonstrate the ability to do so. Those receiving aggregated health care performance results data from a source (such as national data aggregators) must demonstrate the ability to effectively implement the use of these results. Values exchanges must have nonprofit status and staff or consultants who can provide needed expertise. Successful applicants must have a history of raising funds or in-kind support from multiple stakeholders. They must demonstrate the ability to manage collaborative, multistakeholder projects and finances. They must also be able to track progress in
Practice Strategies meeting “individual collaborative goals, which may include, for example, producing public reports or fostering pay-forperformance or consumer incentives.” The AHRQ is requesting permission to proceed with the project from the federal Office of Management and Budget (OMB) under terms of the federal Paperwork Reduction Act. A public comment period was to close in early July. Federal agencies often act within 90 days after the required comment period, meaning the OMB may issue permission to proceed with the chartering of value exchanges as early as October. Once the project is approved, the AHRQ plans to twice annually post a public call for parties interested in becoming chartered as Value Exchanges for Value-Driven Health Care. The AHRQ will post requests for proposals on its Web site (www.ahrq.gov). Each request for proposals will be open for 2 months. A new AHRQ review committee—representing institutional health care purchasers, health plans, health care consumers, and health care providers (with at least 2 being physicians) will review the proposals. All proposals will be reviewed in the 6 weeks after the closing of the application period. That means the first federally chartered local or regional health care value exchanges could be approved and ready to organize local health care quality measurement, electronic health record systems, public provider quality reporting, and pay-for-performance programs as early as the spring of 2008. “Optometry must be represented in these collaboratives,” said David Cockrell, O.D., American Optometric Association (AOA) Board of Trustee liaison to the AOA Federal Relations Committee. The AOA Washington office will work with state optometric associations to ensure proper representation for optometry on the state collaboratives. AOA-affiliated state optometric associations seeking assistance should contact AOA Associate Director of Government Relations Jodi Chappell ([email protected]) at the AOA Washington office.