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Chartered Value Exchanges (CVEs) Technical Assistance Needs

The Comprehensive Technical Assistance Request Chart

This document was last revised on July 8, 2008 and contains technical assistance requests from the CVE Learning Network launch meeting, one-on-one calls, baseline interviews, workplans, Project Director Calls, and meetings with AHRQ. The worksheet below contains the technical assistance requests chart. Below is an explanation of what certain references represent within the technical assistance request chart.

With regards to "Source":

1 = Launch meeting requests, one-on-one calls, and baseline interviews.
2 = Workplans.
3 = Project Director Call.

# Date Source Focus Area Category Originator of Request Summary of Technical Assistance Request Technical Assistance Request
1 2/4/08-3/31/08 1 Collaborative Leadership Engaging stakeholders MI-AFH Engaging leaders MI-AFH asked for assistance in communicating and engaging leaders within the Multistakeholder group. In particular, communicating with these local people of influence to provide momentum within the work they are conducting as they are overwhelmed by the complexity of the health care industry and the politics.
2 2/4/08-3/31/08 1 Collaborative Leadership Engaging stakeholders MI-GDAHC/
WA-PSHA		 Maintaining local investment MI-GDAHC requested information on what other communities have done to maintain local investment and ownership (e.g., bringing people to the table). 
3 2/4/08-3/31/08 1 Collaborative Leadership Strategic Planning TN-HMCT Help with strategic planning and setting priorities (2) TN-HMCT requested help with strategic planning and setting priorities. Minnesota CVE requested assistance around planning, such as having an external expert to facilitate discussion and advice on how to pull together.
4 2/4/08-3/31/08 1 Collaborative Leadership Engaging stakeholders MI-GDAHC/
WA-PSHA		 Volunteer effectiveness/ motivating stakeholders within a voluntary structure (2) MI-GDAHC requested assistance in increasing the effectiveness of the CVE's volunteers in terms of time and finances. WA-PSHA asked for assistance in motivating stakeholders to adopt and implement the coalition's recommendations within a voluntary system.
5 2/4/08-3/31/08 1 Collaborative Leadership Strategic Planning ME Catalogue State initiatives  Maine CVE Alliance commented that each of the participating organizations in the CVE is a Multistakeholder group, and it is a challenge to bring about collaboration among the leaders of these organizations because each of them is busy running their own organization and each has its own governance and foci. What might be helpful is cataloguing various initiatives in the State to prevent overlapping efforts and to learn about leadership from other communities. 
6 2/4/08-3/31/08 1 Collaborative Leadership Sustainability/ Funding ME Funding information—Workplans  Maine CVE Alliance requested information on how other CVEs are funding AHRQ work plans. 
7 2/4/08-3/31/08 1 Collaborative Leadership Engaging stakeholders NY-Niagara Assistance addressing site-specific P2 status Niagara Health Quality Coalition remarked that the P2 Collaborative and Niagara both applied for CVE status. However, only Niagara received the CVE status. As a result, those funding the P2 Collaborative experienced some hurt feelings, a natural consequence of competition. Niagara is working through this situation and would appreciate assistance in this area.
8 2/4/08-3/31/08 1 Collaborative Leadership Other OR Information on tested strategies  Oregon Health Care Quality Corporation requested information on the tested and untested strategies in this area.
9 2/4/08-3/31/08 1 Collaborative Leadership Other UT/LA Information on experiences of others  Utah Partnership for Value-driven Health Care (UPV) requested information on the experiences of other communities.
10 2/4/08-3/31/08 1 Collaborative Leadership Engaging stakeholders MI-AFH Offer guidance on communications among stakeholders (2)   Bridget White, Michigan's Alliance for Health, spoke of the need for technical assistance with communications, particularly as they begin reaching out to stakeholder groups. Alliance for Health needs help with communicating across a diverse group of stakeholders "so we don't feel we're speaking Greek." She asked specifically, where communications fits in terms of the seven technical assistance areas outlined by AHRQ. When asked to clarify what she meant by "communications," White pointed out that they have 26 far flung hospitals in their State with many layers of constituents. How can they best reach all those layers of constituents and develop consistent messages?
11 2/4/08-3/31/08 1 Collaborative Leadership Engaging stakeholders MA Offer advice on leveraging stakeholder groups and leadership Massachusetts Healthcare Quality Partners asked for assistance in engaging with State agencies and the State's existing health care reform agenda. In addition, the Massachusetts CVE asked for help in a) working with the National Governors Association, and b) convening meetings with different leadership groups, and leadership players.
12 4/16/08 3 Collaborative Leadership Strategic Planning AHRQ Help creating synergies  Help creating synergies with any new CVE applicants in markets where CVEs already exist. 
13 2/4/08-3/31/08 1 Collaborative Leadership Sustainability/ Funding MI-GDAHC/LA/
WA-PSHA/OR/ MI-AFH		 Help make the business case and help build a sustainable funding model (5) Greater Detroit Area Health Council asked AHRQ to "help us make the business case for collaboration on quality, efficiency and value to better and more broadly engage the purchasers and other stakeholder leadership. Sustainability tools." In a similar vein, Louisiana Health Care Quality Forum asked for a business model for financial sustainability. Oregon Health Care Quality Corporation noted that "we will save money by cutting some sectors' revenue. How do we anticipate implication at a shared table?" Michigan's Alliance for Health requested business planning around a sustainable funding model and help building a local and national infrastructure. Puget Sound Health Alliance requested information/research on sustainability and collaborative financing over time.
14 2/4/08-3/31/08 1 Collaborative Leadership Other LA/
MI-GDAHC		 Assist with Electronics Health Records (EHR) demonstration application/Clarify communications regarding EHR Demonstration application (2) Shannon Robshaw, Louisiana Health Care Quality Forum, stated on day one of the meeting that her organization is listed as the primary organization under that State's CVE. She requested technical assistance around preparation of an application for the EHR demonstration. She noted that as the primary organization, the community is looking to them as a convener in putting together an application and bringing stakeholders together. Robshaw reiterated her request on day two, during the final technical assistance session, where she specifically asked for assistance around the application process for the demonstration.

                                                                                                                                               Janice Whitehouse, Greater Detroit Area Health Council, asked that AHRQ clarify expectations regarding communications between CVEs and HHS. She noted that they have not received their second call regarding the EHR demonstration. She also requested clarification regarding HHS' request that her organization identify a consumer to share his/her personal experience with an electronic medical record. 
15 2/4/08-3/31/08 1 Collaborative Leadership Strategic Planning MI-GDAHC Determine CVE role Greater Detroit Area Health Council noted that it is addressing the question of "what is our best, most impactful role?"  We don't have the resources to lead direct interventions. We do pilots and try to spread learnings and organize learning networks. What else can we do in a very large, very complex community with very progressive health systems, health plans and multiple universities where we have pretty significant collaborations and a history of collaboration but also strong competitive forces?
16 2/4/08-3/31/08 1 Collaborative Leadership Other GDAHC Use of resources  Greater Detroit Area Health Council requested information on how to have the biggest impact with its resources, the largest resources being the organizations involved in the CVE.
17 05/08 N/A Collaborative Leadership Governance N/A Information on governance workgroup Information on governance workgroup
18 05/08 2 Collaborative Leadership Governance NYQA Develop voting rights The New York Quality Alliance would like to see successful models for developing structure for adding new members with voting rights. 
19 05/08 2 Collaborative Leadership Sustainability/ Funding NYQA Examples of sustainability models  Examples of sustainability models and business plans. 
20 05/08 2 Collaborative Leadership Governance NYQA Samples of by-laws and fee structures Samples of by-laws and fee structures. 
21 05/08 2 Collaborative Leadership Governance NYQA Assistance with developing membership groups and leadership structures Assistance with developing membership groups and leadership structures. 
22 05/08 2 Collaborative Leadership Governance NYQA Examples of successful models of governance structures Examples of successful models of governance structures. 
23 05/08 2 Collaborative Leadership Sustainability/ Funding WA-PSHA Advice on sustainable funding models.  Washington—Puget Sound Health Alliance requested advice on sustainable funding models.
24 05/08 2 Collaborative Leadership Engaging stakeholders WA-PSHA Advice on how to fully engage organizations in light of free rider issues Washington—Puget Sound Health Alliance requested advice on how to fully engage organizations and regional coalitions in light of "free rider" issues and competing interests at the national or international levels.
25 05/08 2 Collaborative Leadership Sustainability/ Funding WA-PSHA Information on benefits/risks of government funding  Washington—Puget Sound Health Alliance requested advice on benefits and risks of relying on legislated funding (local, county, State, and/or Federal), and information about federal legislation, if any, that may be of particular interest to CVEs.
26 05/08 2 Collaborative Leadership Sustainability/ Funding WI Information on CVE funding structures  The Wisconsin Healthcare Value Exchange would like information on funding structures of other CVEs.
27 05/08 2 Collaborative Leadership Engaging stakeholders WI Developing consensus on measurement and reporting The Wisconsin Healthcare Value Exchange requested, with regards to achieving consensus on a strategy for addressing the issues of physician-level measurement and reporting, information on if, and if so, how other communities or initiatives are reporting at a physician level (dealing with small volume, etc.).
28 2/4/08-3/31/08 1 Public At-large Engagement AHRQ Resources LA Access to AHRQ tool Louisiana Health Care Quality Forum requested access to the AHRQ community inventory tool. 
29 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools ME Messaging/Funding (Social marketing) Maine CVE Alliance requested assistance in issues of funding and developing high quality messaging for a broad population (e.g., developing the media, story, and what would be communicated). 
30 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools NY-Niagara/
PA-PRHI		 Activities and best practices from other coalitions & communities (2) Niagara Health Quality Coalition requested information on effective activities that other coalitions are conducting. Pittsburgh Regional Health Initiative made a similar request, asking for best practices based on other communities' experiences, such as those of Health Care For All.
31 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools OR Tested materials Oregon Health Care Quality Corporation requested tested materials, particularly in the area of consumer engagement.
32 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools MI-AFH Social marketing strategies Alliance for Health asked for effective social marketing strategies for consumers.
33 2/4/08-3/31/08 1 Public At-large Engagement Other OR Evaluation design Oregon Health Care Quality Corporation requested assistance in designing an evaluation around the work it is doing with grassroots organizations and securing the funds to carry out the evaluation.
34 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools PA-PRHI Assistance from Sofaer Pittsburgh Regional Health Initiative asked for Assistance from Shoshanna Sofaer in presenting information in the most effective ways.
35 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools PA-PRHI Tools & training materials Pittsburgh Regional Health Initiative asked for tools (e.g., training materials) to educate consumers and information on how to identify consumers that would be active in leading others.
36 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools UT Research data on consumers UPV asked for research data on what consumers are looking at.
37 2/4/08-3/31/08 1 Public At-large Engagement Cultural competency/ Literacy TN-HMCT/
WA-PSHA		 Consumer education information that is aimed at racial and/or ethnic subpopulations (2) Rev. Kenneth Robinson, Healthy Memphis Common Table, asked AHRQ for assistance in tailoring messages to African American consumers. What specific assistance could AHRQ offer to CVEs in this area? Have we given up on doing printed messages at the fourth grade level (Lazar mentioned the need for more verbal communication)? What about educational materials that are tailored to racial and/or ethnic consumer subpopulations? Are there different media or messages that have been found to be more/less effective with these subpopulations? For example, is cable more effective in reaching these subpopulations than radio? Robinson also asked that Allan Lazar share lessons learned from the study he referred to in his presentation on targeting and tailoring educational messages to these consumer subpopulations.

Washington—Puget Sound Health Alliance noted the diversity of the many ethnic and cultural groups in their region, which can be overwhelming. How can they engage with cross-cultural communication with non-mainstream ethnic groups (e.g. recent immigrants, native Americans, all varieties of Asian groups)?
38 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools PA-PRHI Engage consumers on improving quality Pittsburgh Regional Health Initiative asked for assistance in educating consumers on meaning of value-based health care and consumers' role in quality improvement.
39 2/4/08-3/31/08 1 Public At-large Engagement Cultural competency/ Literacy TN-Memphis Harness local heritage for advocacy  Healthy Memphis Common Table asked for ways to use churches and civil rights heritage of Memphis to increase advocacy and demand for information and medical home.
40 2/4/08-3/31/08 1 Public At-large Engagement Other N/A Identify local consumer organizations Please note that Jennifer Sweeney, National Partnership for Women and Families, promised to provide a list of organizations that CVEs can work with in their local communities.
41 2/4/08-3/31/08 1 Public At-large Engagement AHRQ Resources PA-PRHI Access to AHRQ's commercials (over time of one year) Pittsburgh Regional Health Initiative specifically requested access to "commercials."
42 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools N/A HC101 training for consumer representatives A technical assistance request was made for training that would offer a health care "101" perspective, and that would educate consumer representatives as to the various acronyms and players in the health care arena.
43 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools NY-Niagara/
ME/
MI-GDAHC/UT		 Creating a compelling Web site (2) Vernice Anthony, Greater Detroit Area Health Council, mentioned public at large engagement as one of this Michigan CVE's technical assistance needs in the context of remarks she gave as a reactor during the day two breakout sessions, "How CVEs Can Engage Consumers in their Communities?" She did not provide further detail other than to describe the difficulties of creating a compelling Web site that will drive consumers to use the site for information. UPV made a similar request, asking for assistance with developing its Web site to meet consumer needs.
44 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools N/A Consumer storytelling tools While participants did not articulate specific technical assistance requests at the breakout session on consumer engagement, there was considerable discussion around the best approaches for engaging consumer advocacy groups. One approach that received interest from the audience is the use of "storytelling" as a means of group consensus building. Nancy Clarke, Oregon Health Care Quality Corporation, mentioned the importance of "stories" in working to encourage consumer advocacy groups to expand their goals from access alone to incorporating quality and accountable care.
45 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools MI-GDAHC Designing effective outreach Greater Detroit Area Health Council asked for help in effective outreach to better engage consumers and consumer advocates, and helping them become equal partners in the collaborative. Messaging that works to help the public at large move forward in the quality improvement, public reporting journey.
46 2/4/08-3/31/08 1 Public At-large Engagement Best practices/ Research/ Tools TN-HMCT Educate consumers on value of EHRs Healthy Memphis Common Table asked for help in educating consumers on the value of EHR/EMR so that they prefer physicians and data that employ electronic information.
47 2/4/08-3/31/08 1 Public At-large Engagement Engaging stakeholders MA Offer advice on leveraging stakeholder groups and leadership Massachusetts Healthcare Quality Partners asked for assistance in engaging with State agencies and the State's existing health care reform agenda. In addition, the Massachusetts CVE asked for help in a) working with the National Governors Association, and b) convening meetings with different leadership groups, and leadership players. 
48 2/4/08-3/31/08 1 Public At-large Engagement Other PA-PRHI Provide appropriate feedback Pittsburgh Regional Health Initiative asked assistance in providing feedback that is appropriate, reliable and actionable to employers, providers, and consumers. How do we determine what they need and when they need it? 
49 05/08 2 Public At-large Engagement Sustainability/ Funding LA Resources for public relations campaigns  Resources for public relations campaigns. 
50 05/08 2 Public At-large Engagement Other MN Assistance to better engage consumers in the employer setting.  Assistance to better engage consumers in the employer setting. 
50 05/08 2 Public At-large Engagement Other MN Assistance to better engage consumers in the employer setting.  Assistance to better engage consumers in the employer setting. 
51 05/08 2 Public At-large Engagement Best practices/ Research/ Tools NYQA Best practices for consumer use and understanding of measurement and reporting Best practices for consumer use and understanding of measurement and reporting. 
52 05/08 2 Public At-large Engagement Best practices/ Research/ Tools NY-Niagara Best practices in presenting information.  New York—Niagara Health Quality Coalition requested best practices in presenting information to various audiences: consumers, employers, health plans and providers.
53 05/08 2 Public At-large Engagement AHRQ Resources NY-Niagara Continuation of involvement from AHRQ on use of AHRQ databases Continuation of involvement from AHRQ on use of AHRQ databases. 
54 05/08 2 Public At-large Engagement Other NY-Niagara Media training Media training. 
55 05/08 2 Public At-large Engagement Other WA-PSHA National discussion on quality variations and performance reports Washington—Puget Sound Health Alliance requested, with regards to raising awareness of quality variations and performance reports, advice and support in raising the discussion in national publications, in ways that recognize and support regional collaborative work. 
56 05/08 2 Public At-large Engagement Cultural competency/ Literacy WA-PSHA Engaging those with language/cultural barriers.  Washington—Puget Sound Health Alliance requested advice on effective ways to engage with patients who have limited English proficiency and/or for whom there are perceived racial or ethnic barriers. 
57 05/08 2 Public At-large Engagement Best practices/ Research/ Tools WI Literature on consumer engagement.  The Wisconsin Healthcare Value Exchange requested assistance with identifying current literature on consumer engagement.
58 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Sustainability/ Funding MI-AFH Developing a business case for data aggregation Alliance for Health asked for assistance in developing a business case for aggregating performance data from multiple data sources for the purposes of quality improvement, standardized performance measurement, public reporting, consumer engagement, and payment reform. 
59 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Sustainability/ Funding MI-AFH Creating a sustainable infrastructure Alliance for Health asked for information on how to create a sustainable infrastructure for this work. 
60 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Database/Data warehouse development LA Assistance with multi-payer data warehouse Louisiana Health Care Quality Forum requested best practices on how to get its multi-payer data warehouse rolled out and sustainable (e.g., marketing and promoting it to increase participation in it). 
61 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Database/Data warehouse development LA Building multi-payer databases  Louisiana Health Care Quality Forum requested resources and conversations for best practices and lessons learned in building multi-payer databases, working with vendors, publishing data from the database, and marketing it as a research tool to help its funder. 
62 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Efficiency/ Cost ME/MN/OR/
WA-PSHA/LA		 Technical assistance with efficiency measures (5) Maine CVE requested the assistance of someone who is knowledgeable about different ways of measuring efficiency to help explain the positive and negative aspects of each strategy. The CVE currently has different health plans measuring efficiency in different ways and it would like to avoid having dueling efficiency measures in the community. The CVE would like to see this as part of a national initiative. Minnesota CVE requested support on cost/efficiency measures and specialty measures. Oregon Health Care Quality Corporation asked to be kept current on decisions by NQF and the area of efficiency measures to ensure that the CVE is on the cutting edge of efficiency. Puget Sound Health Alliance asked "what works in efficiency measurement? How to do it." Puget Sound noted the critical triage of which measures are relevant to which audience. Recommendations for prioritization and focus would be helpful. LHCQF asked for provider quality and cost efficiency measures.
63 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Alignment MA Aligning community databases Massachusetts CVE asked for best practices on those who have effectively aligned all the databases within their communities. 
64 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Depression MN Support for pilot depression measures Minnesota CVE requested support with depression measures. The CVE is currently working on pilot depression measures and wants to make sure that it can obtain NQF endorsement. 
65 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Database/Data warehouse development NYQA Vendor data standardization  New York Quality Alliance requested assistance with the vendor on data standardization and assuring that its data runs meet with appropriate specifications.
66 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Database/Data warehouse development NYQA Data validation/ Claims data accuracy. New York Quality Alliance requested help with issues of data validation and ensuring that methodology is sound through the vendor.
67 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Database/Data warehouse development NYQA Claims data accuracy New York Quality Alliance requested best practices for physicians to provide the CVE with feedback on the accuracy of claims data.
68 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Data presentation PA-PRHI Assistance with local report cards Pittsburgh Regional Health Initiative asked for assistance in conducting local report cards. The CVE currently does not have good benchmark data as available data is often around two years old.
69 4/16/08 3 Quality & Efficiency  Measurement Physician attribution   Physician attribution Updates on methdologies for physician attribution.
70 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Other PA-PRHI Measures that make a difference Puget Sound Health Alliance noted that with hospitals being so overburdened with public reporting, it may be helpful to differentiate among measures which are the ones to retire and which are likely to make a difference.
71 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Data presentation TN-Memphis Data presentation at physician group level (PR) Healthy Memphis Round Table asked for data presentation for physician group reporting, which is expected to be publicly reported in 2009—making data consumer friendly.
72 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Engaging stakeholders TN-HMCT Political help with hospital discharge data Healthy Memphis Round Table requested political help in working with the State, hospital association, and other parties when rolling out hospital discharge data.
73 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Other UT Information on health insurance transparency UPV asked AHRQ information for health insurance transparency in areas such as scales of return, rates of denial, and efficiency claims operation in terms of errors. Consumer measures of effectiveness would also be helpful because it plays out better in terms of politics.
74 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Best practices/ Research/ Tools UT Information on consumer transparency UPV asked information on consumer transparency from AHRQ and other communities that have comprehensive experience in this field. This could pertain to information on consumers in the areas of substance abuse, drug seeking behavior. This would be valuable to clinicians.
75 2/4/08-3/31/08 1 Quality & Efficiency  Measurement Data presentation WI Help with disseminating data Wisconsin Collaborative for Healthcare Value Exchange assistance in coordinating, presenting, and disseminating data so that the data can produce meaningful change.

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