• NBCH is actively working to bring about reform too. Starting in 2007, NBCH included in its eValue8 standardized health plan quality improvement instrument twelve key questions related to implementation of the Value-Driven Health Care Initiative's Four Cornerstones.
• NBCH is publicly reporting eValue8 performance results from the Four Cornerstone focused measures.

NBCH Value-Driven Health Care Initiative eValue8 Report

Physician/Hospital/Insurer Performance Measurement, Reporting & Incentives

• NBCH strongly supports formal designation of the (NQF) as the national performance measurement consensus-building entity.
• NBCH strongly supports efforts in Congress and the current administration to reform Medicare physician services that align with quality and are structured to reward high-quality, efficient, patient-centered care.
• NBCH believes that the Physician Quality Reporting Initiative (PQRI) sets an extremely important precedent toward the proliferation — "mainstreaming" — of provider performance quality measures, particularly clinical-based measures.
• NBCH supports recent efforts in Congress, particularly in the Senate Finance Committee, to extend and strengthen PQRI through the "Medicare, Medicaid and SCHIP Extension Act of 2007" (MMSEA).
• NBCH is pleased to see that PQRI goals tie directly to two of the four VDHCI Four Cornerstone priorities for building a value-driven health care system- measuring and publishing quality information, and promoting the quality and efficiency of care.
• NBCH believes that it is essential for public and private health care purchasers to continue to reward quality and efficient health care by incorporating pay-for- performance incentives into their benefit design strategies.

NBCH Commends Senate Finance Committee on Progressive Efforts to Reform Medicare Physician Services

Quality & Cost Transparency/Quality & Safety Improvement

• NBCH believes that meaningful comparisons about provider performance are only possible through large, robust data sources and the Medicare claims database is the single largest source of information about hospitals, physicians, and other providers.
• NBCH believes that despite current data available to the public through such programs as the Performance Measurement and Reporting Initiative (PMRI), greater access is needed to give consumers more complete information about their health care providers. We must replace our search to define perfect measures in favor of a more comprehensive assessment of what the larger national data system should be.
• NBCH supports the August 21, 2006 Executive Order signed by President Bush solidifying the federal government's commitment to improve standardization of health care information transparency and provider quality measurement by harmonizing health care purchasing practices of federal government, state governments and large employers.
• NBCH believes that the key to the success of continuous quality improvement is strong government leadership in setting standards for incentives and resources to providers to improve the efficiency and effectiveness of the care they give.
• NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers, in fact, over thirty of our coalition members are participating in the VDHCI as Community Leaders and Community Value Exchanges (CVEs).
• NBCH supports a stronger voluntary and mandatory medical error and "near miss" reporting system in which providers do not have to fear adverse employment retribution and medical malpractice litigation. Every effort should be made by our federal government to provide a reliable reporting system to learn from mistakes, and make the appropriate systemic changes to prevent repetition of the mistakes in the future.

Health Care Data Access, Quality & Safety Improvement NBCH Policy Statement

Health Care Information Technology Infrastructure

• NBCH believes that successfully transforming our nation's health care information technology capability requires stronger national leadership focused on infrastructure support and development. This would include efforts to create an interoperable electronic medical record system, electronic clinical decision support tools, and electronic claims and payment reimbursement processing.
• Public and private sector-based financial incentives, along with alignment of national quality-based standards and capacity building, should support grassroots-level implementation.
• It is essential that national interoperability strategies include standards for the storage and transmission, including protection of consumer privacy and personal information of health care information.
• NBCH believes there needs to be a change of federal anti-kickback laws to allow hospitals to provide physicians with health IT hardware and software.

NBCH Health Information Technology Position Statement

Health Care Reform & Access to Affordable, Quality Health Care

NBCH Position Statement on Making Affordable, Quality Health Care Accessible to All

NBCH Principles for Responsible Health Benefit Design

Medical Malpractice Reform: NBCH supports health care litigation reform that brings consistency to the current disparate system, controls the costly practice of defensive medicine, reduces malpractice costs and reduces injuries through system-wide reforms rather than by creating a more elaborate punitive legal system. Specifically, NBCH supports reasonable limits on damage awards, the development of a liability system that recognizes the adherence to industry standards, and evidence-based medical protocol as an affirmative defense to medical malpractice. NBCH also supports standardized voluntary and mandatory reporting of medical errors by doctors and hospitals to advance patient safety and quality issues. Reform must promote a medical care environment that encourages and rewards provider accountability and performance but also protects accountable, high performance health care providers from the burdens of undue medical malpractice liability.

NBCH Position Statement on Medical Malpractice Reform

Health Care Administrative Simplification: NBCH supports clear, consistent, standard-based exchange of patient health care information to help simplify and clarify the administrative complexity of the nation's health care system. Improved communication between providers and payers would reduce administrative costs, and make it easier for patients to access more reliable health care information and benefits.

Employer Cost Containment

• NBCH supports legislation and market strategies that would allow small businesses to collectively purchase health insurance to spread risk and leverage economies of scale.
• NBCH supports small employer tax incentives to provide health care benefits.
• NBCH supports reasonable exemptions from state coverage mandates for small employers.
• NBCH supports greater flexibility to allow families to use SCHIP dollars to enroll in employer-sponsored benefit programs.
• NBCH supports state reform initiatives which combine a mix of approaches to find a real solution for access to affordable quality health care for the uninsured and underinsured citizens.
• NBCH believes pro-consumer reforms must be in balance with maintaining a strong employer-based system that is accessible and cost-efficient.
• NBCH is working with other like-mind organizations to educate members of Congress about the importance of preserving ERISA to maintain uniform health and retirement benefits across the country.

Population Health Improvement

• NBCH believes there is a significant and urgent need for meaningful strategies to improve the health status of our country's population. There are many intervention strategies that can be integrated into both public and private health care coverage to change people's behavior and help them make better decisions about diet, exercise and managing chronic conditions.
• NBCH supports access to preventive health care needs and that this access needs to be a basic, fundamental component of our public and private health care systems.
• NBCH supports economic incentives as an effective way to influence the behavior of health care consumers. In addition, if individuals fail to meet goals or attain positive results, it makes sense that they pay a greater share of their medical costs.
• NBCH supports greater consumer responsibility for their own health, but also believes there needs to be a system-wide, multi-stakeholder approach with doctors, employers, insurers and government work together to provide the support and high-quality care necessary.
• NBCH supports the evidence-based benefit design that includes coverage for preventive services and chronic conditions.
• NBCH supports the development and use of incentives for health care professionals to provide necessary health education and coaching support
• NBCH supports the development and sustainability of local leaders and community health partnerships, including business and health coalitions, for improving the population health using evidence-based tools and information.
• NBCH supports the use of common metrics to measure population health improvement.

Comparative-Effectiveness Research

• NBCH believes that a robust national CER program is a vital element of comprehensive, effective health care reform to control spending, improve quality and expand consumer and employer access and choice.
• NBCH supports the establishment of a national CER institute which receives stable funding through both pubic and private support, and is directed by a multi-stakeholder committee which is representative of both public and private sector interests.
• NBCH believes that to protect the integrity of a national CER program, the conduct of clinical research needs to be distinctly separate from the practical application of the research findings, particularly in terms of health care coverage determination and recommendations.
• NBCH believes that a national CER program should include a condition-specific research agenda that is fair and balanced based on patient needs, and that takes into account national health care expenditures. The research agenda should cover the full spectrum of health care treatment options- medical and surgical procedures, pharmaceuticals, as well as medical devices.
• NBCH believes it is essential to establish fair, comprehensive stakeholder input throughout the CER process, including a transparent research process, as AHRQ has been doing. Transparency of the CER processes is essential to establish research priorities, to conduct and validate the research and to disseminate the results.

Patient-Centered Care/Medical Home

• NBCH believes that a strong primary care system is the foundation of high quality, efficient care that is consistent and comprehensive.
• NBCH believes the medical home is a complementary approach to value-based purchasing, as both work to improve the quality and reduce the cost of health care.
• NBCH supports an increased role of the federal and state governments in experimenting in communities around the country through demonstration programs with the medical home concept, particularly with regard to physician payment incentives and reimbursement.
• NBCH supports continued public and private purchaser collaboration and partnership in strengthening awareness and understanding of this concept around the country, as well as support for medical home as part of any national wide health care reform proposal.
• NBCH supports federal government initiatives to support and encourage the primary care field of practice through educational grants and loans.
• NBCH is very pleased to be a member of the Patient-Centered Primary Care Collaborative, a coalition of major employers, provider groups, consumer groups, and other stakeholders to develop and advance the patient-centered medical home. (http://www.pcpcc.net).

Medicare Program Reform

• NBCH believes that the Centers for Medicare and Medicaid Services (CMS) plays a vital leadership role in setting the national agenda for innovation, experimentation and progress toward a safer, quality health care system. Medicare's leadership should continue to be transformative, as well as aggressive.
• NBCH supports value-based benefit design, and though this model has become widespread among private sector employers, it needs the leadership and extensive implementation that only the federal government can provide, namely through the Medicare program.
• NBCH believes our nation's health care system needs to be organized to focus on how health benefit design can increase the probability that individual consumers receive evidence-based care resulting in improved health outcomes and decreased direct and indirect health care costs.
• NBCH supports the use of evidence-based benefit design by CMS for all populations.
• NBCH believes it is fundamental to quickly connect evidence-based resources and recommendations to benefit coverage and provider payment policies.

Department of Health and Human Services Funding

*Given the unique needs of the coalitions' members, and of the individual employers that comprise each coalition's own membership, NBCH does not claim that each of its member coalitions, or their payer members, endorses each of the aforementioned statements.