Application to Participate in Healthcare Transparency Innovators Forum: “50 percent by 2020”

Thank you for your interest in the Center for Healthcare Transparencyand the goal of makingmeaningful and actionable information on the relative cost and quality of healthcare services available to 50 percentof the U.S. population by 2020.

If you would like to be selected as a transparency innovator to participate in the Collaborative Planning meeting in San Francisco on October 8 and 9, 2015, please respond to the questions below. Brevity is encouraged and appreciated. This information will not be shared and will be used exclusively for purposes of attendee selection and Center for Healthcare Transparency implementation planning. The Center for Healthcare Transparency will cover travel, hotel and related costs for participants selected to attend the Forum.

Please submit your application by Wednesday, July 1st.We will notify selected participants by July 10.

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  1. Organization name:
  2. Organization website:
  3. Contact person name and email
  4. Geographic areacovered by your organization or initiative:
  5. Estimated number oflives covered by your current data sources
  6. Cost data:
  7. Quality data:
  8. Patient experience data:
  9. Is your organization a CMS-approved Qualified Entity with access to Medicare data? YesNo (circle one)
  1. In the chart below, add an “X” for each capability that your organization and/or its active stakeholder partners currently has or is planning to have by 2020.

Core Capability / Current / Planned
Multi-stakeholder collaboration – purchasers
Multi-stakeholder collaboration – consumers
Multi-stakeholder collaboration – providers
Multi-stakeholder collaboration – other (briefly specify)
Public reporting – quality
Public reporting – cost
Public reporting – patient experience
Public reporting – other (briefly specify)
  1. In the chart below, add an “X” for each capability that your organization and/or its active stakeholder partners currently has or are planning to have by 2020 and a brief description ofrelevant details.

Core Capability / Current / Planned / Brief Description(for example, data sources & volume)
Collection and/or aggregation –clinical data
Collection and/or aggregation – claims data
Collection and/or aggregation – patient experience data
Collection and/or aggregation – other data (briefly specify)
Core Capability / Current / Planned / Brief Description( For example, type of reports and reporting level)
Analysis and reporting of measures for use in payment reform
Analysis and reporting of measures for use inclinical quality improvement
Analysis and reporting of measures for use inconsumer engagement
Analysis and reporting of measures for other uses
  1. Optional: Please feel free to note or attach otherinformation thatshould be considered, such as notable innovation,governance structure, capacity or perspectives that your organization would bring to the discussion, and or to helping meet CHT’s 50 percent by 2020 goal
  1. In most cases, CHT expects to select one individual from an applicant organization; however, an additional person may also be selectedbased on the need for that person’s perspective.Foreach individual applicant, please provide the following information:

Applicant One

  1. Name:
  2. Title and description of role: [50 word limit]
  3. Particular skills and experience: [50 word limit]

Applicant Two (optional)

  1. Name:
  2. Title and description of role: [50 word limit]
  3. Particular skills and experience: [50 word limit]

Please see responses to Frequently Asked Questionhere. The FAQs will be updated periodically as additional questions are asked.For additional information, please contact .

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The planning phase of the Center for Healthcare Transparency is funded by

The Laura & John Arnold Foundation.