Many organizations and governmental bodies measure health care quality data, set national benchmarks and help to define quality health care in the United States.
United States Department of Health & Human Services
The US Department of Health and Human Services (HHS) is the main governmental agency to which many well-known organizations report. For example, the following organizations are under the HHS umbrella: CMS or Medicare, the Food and Drug Administration (FDA), National Institutes of Health (NIH), Centers for Disease Control Prevention (CDC) and more.
The United States Department of Health and Human Services is the main agency for protecting the health of all Americans and providing essential human services to the general population.
Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare and Medicaid Services, often referred to simply as CMS or Medicare, is the governmental health care payor for qualifying seniors and lower-income families. CMS provides reimbursement for health care charges and sets the reimbursement benchmark for other payors, such as insurance companies.
CMS also works with the Department of Health and Human Services to set governmental health care policies and quality standards. Recently, CMS developed several quality improvement efforts. For example, CMS now requires hospitals to report data on several key factors, including measures for treatment of heart attack, heart failure, pneumonia and surgery.
National Committee for Quality Assurance (NCQA)
The National Committee for Quality Assurance is a non-profit organization with a mission to improve national health care standards. The organization provides details to evaluate health care plans and network physicians. NCQA developed the Health Plan Employer Data and Information Set (HEDIS®) with standardized performance measures to assess health plans. HEDIS scores can be used to evaluate health plans and individual physicians within the plans. NCQA also developed a health plan report card to ease the health plan evaluation process for consumers.
Health Plan Data & Information Set (HEDIS)
Health Plan Data & Information Set (HEDIS) is a set of standardized performance measures to assess health plans and physician groups. HEDIS measures were developed by the National Committee for Quality Assurance (NCQA), a non-profit organization whose mission is to improve national health care standards. Consumers will begin to see these measures from their health care insurance companies.
Joint Commission on Accreditation of Healthcare Organizations
The Joint Commission, also commonly referred to as TJC, provides accreditation to hospitals that meet a certain baseline of quality standards. The mission of The Joint Commission is to improve the safety and quality of care provided through certified accreditation and related services that support improvement in health care organizations, especially hospitals.
The Joint Commission is a non-profit organization that evaluates and accredits more than 15,000 health care organizations and programs in the United States. IU Health West Hospital has been accredited since January, 2005.
HealthGrades Inc. is a for-profit health care ratings, data and advisory company. HealthGrades assigns ratings for the following areas: cardiac, neuroscience, orthopedics, pulmonary/respiratory, obstetrics and vascular surgery. The score is derived using outcomes for specific procedures in each specialty.
The Leapfrog Group
The Leapfrog Group is an initiative focused on driving breakthrough improvements in quality, affordability and especially safety in health care. Focused on improving patient safety by reducing preventable medical mistakes, The Leapfrog Group works with medical experts throughout the US to identify problems and propose solutions designed to improve hospital systems that could break down and cause harm to patients.
National Quality Forum (NQF)
A private, non-profit membership organization, the National Quality Forum (NQF) was created to improve US health care through establishment of national standards for measurement and reporting on safe, timely, beneficial, efficient, equitable and patient-centered care.
The NQF has members from all aspects of health care, including national, state and regional groups that represent consumers and the general health care system of health plans, hospitals and supporting industries and organizations. The NQF board of directors includes members from two key federal agencies: CMS (Medicare) and the Agency for Health Care Research and Quality. The NQF votes to endorse quality measures for national use and develops a research agenda for quality improvement.
Hospital Quality Alliance (HQA)
The Hospital Quality Alliance: Improving Care Through Information (HQA) is a public-private collaboration to improve the quality of care provided by the nation's hospitals by measuring and publicly reporting on the care they provide. This collaboration includes the Centers for Medicare and Medicaid Services (CMS), the American Hospital Association, the Federation of American Hospitals and the Association of American Medical Colleges.
It is supported by other organizations such as the Agency for Healthcare Research and Quality, the National Quality Forum, the Joint Commission on Accreditation of Healthcare Organizations, the American Medical Association, the American Nurses Association, the National Association of Children's Hospitals and Related Institutions and more.
The goal of the program is to identify a robust set of standardized and easy-to-understand hospital quality measures that would be used by all stakeholders in the health care system in order to improve overall quality of care and the ability of consumers to make informed health care decisions.