Memorandum on Establishment of the Quality Interagency Coordination Task Force

Memorandum for the Secretary of Defense, the Secretary of Labor, the Secretary of Health and Human Services, the Secretary of Veterans Affairs, the Director of the Office of Personnel Management

Subject: Establishment of the Quality Interagency Coordination Task Force

Last November, I endorsed the "Patient Bill of Rights" recommended by the Advisory Commission on Consumer Protection and Quality in the Health Care Industry (the "Quality Commission"). On February 20, 1998, after receiving your encouraging reports from the Vice President about the degree to which your agencies are in compliance with these rights, I directed you to take all administrative actions under your authority to come into compliance.

As a result of my February 20 memorandum and your commitment to implement the Patient Bill of Rights, the Federal Government will be taking the lead in ensuring patient protections. By holding the Federal Government accountable, we are strengthening our call on the Congress to pass patient rights legislation that exceeds these protections to all Americans.

Yesterday, in their report to me through the Vice President, the Quality Commission took the next logical step. Building on the Patient Bill of Rights, which is explicitly designed to ensure quality, the Commission's final report includes recommendations that I am confident will actually improve quality care. Specifically, the Commission called for the development of national health care quality improvement goals and the use of measurement standards that will empower consumers and businesses to make informed purchasing decisions based on health plans' quality performance records.

The Quality Commission recommends establishing "two complementary entities, one public and one private, to provide ongoing national leadership in health care quality improvement." The Commission recommends the creation of a broadly represented, publicly administered "Advisory Council for Health Care Quality" and a privately administered "Forum for Health Care Quality Measurement and Reporting." The Commission's approach represents a creative balance to achieve constructive involvement from all the parties that have important expertise and experience in this area.

It is my strong belief that we must ensure that all relevant agencies within the Federal Government build on their leadership role in health care quality. As the Quality Commission report makes clear, the lack of coordination and uniform quality standards in both the public and private sectors has created conditions that fall "short of fully meeting users' needs, and often are duplicative and unduly burdensome on health care providers, plans, and others." To that end, the Federal Government must use improved standards and goals to better inform and empower health care consumers and purchasers under Federal jurisdiction. Moreover, we must do a better job of collaborating within and across the Federal Government to most efficiently and effectively ensure we achieve the national goal of improving quality and health outcomes.

Therefore, I am directing the Secretary of Health and Human Services to immediately establish a "Quality Interagency Coordination" (QuIC) task force to ensure better coordination among the executive agencies with jurisdiction over health programs. I hereby direct you to take the following actions consistent with your authority and the mission of your agency to meet or exceed the recommendations of the Quality Commission.

First, I direct that all participating agencies shall have equal standing on the QuIC task force.

Second, I direct the task force to, wherever feasible, collaborate on goals, models, and timetables that are consistent with the Quality Commission's six "National Aims for Improvement": reducing the underlying causes of illness, injury, and disability; reducing health care errors; ensuring the appropriate use of health care services; expanding research on effectiveness of treatments; addressing oversupply and undersupply of health care resources; and increasing patient participation in their care.

Third, I direct the Secretary of Health and Human Services to serve as the convener of the QuIC task force and to schedule the first task force meeting to order by no later than March 27, 1998.

Fourth, I direct the task force to improve cooperation by the participating agencies on the development and utilization of quality measurement mechanisms for public sector programs; these efforts should be flexible enough to respond to changing needs, technology, and information, while being sufficiently standardized to be comparably measured.

Fifth, I direct the task force to work to increase the development and dissemination of evidence-based health care information to help guide practitioners' actions in ways that will improve quality and potentially constrain costs.

Sixth, I direct the task force to consult with health care workers and their representatives, as well as other affected parties, in developing models for quality improvement.

Seventh, I direct the task force to enhance efforts to develop user-friendly information for both consumer and business purchasers that facilitates meaningful comparisons of quality performances of plans, facilities, and practitioners.

Eighth, I direct all participating agencies, where feasible and appropriate, to seek to avoid inefficient duplication of ongoing quality improvement efforts and resources.

Finally, I direct the task force, to every extent possible, to endeavor to coordinate the Federal programs' quality reporting and compliance requirements to reduce administrative burdens on private entities who administer, oversee, or participate in the Nation's Federal health programs.

WILLIAM J. CLINTON