In 2003 the Institute of Medicine called on health plans to collect data on their members' race and ethnicity as a foundation for improving the quality of care and reducing disparities. We describe the progress made toward collecting these data, the most commonly used data collection methods, and the challenges plans have encountered. We found that from 2003 through 2008, the proportion of plans that collected members' data on race and ethnicity doubled in the commercial market to 60 percent. It increased even more sharply to 94 percent and 83 percent, respectively, for plans covering Medicaid and Medicare Advantage enrollees. However, the scope of data collection varied greatly across plans, and data collection was an organizationwide initiative in a minority of plans. To fulfill the goals of recent legislation, including the Affordable Care Act, health plans will need to expand their efforts. Among other steps, plans and other key stakeholders should agree on uniform race and ethnicity categories, modify information systems to capture these data, and increase members' trust so that self-reported data-the most accurate data on race and ethnicity-can be gathered. R esearchers have documented racial and ethnic disparities in the use and quality of health care for more than two decades. In a landmark report, the Institute of Medicine recommended a comprehensive, multilevel approach to address disparities.1 A key recommendation was that health plans collect and report data on members' race and ethnicity as a necessary foundation for improving the quality of care and reducing disparities. 2 The collection of such data is uniquely important because, in contrast to health care providers, plans can obtain information about members who do not frequently use the health care system.

In recent years there has been a significant expansion in the use of provider performance measures for quality improvement, payment, and public reporting. Using data from a survey of health plans, we characterize the use of such performance measures by private payers. We also compare the use of these measures among selected private and public programs. We studied twenty-three health plans with 121 million commercial enrollees-66 percent of the national commercial enrollment. The health plans reported using 546 distinct performance measures. There was much variation in the use of performance measures in both private and public payment and care delivery programs, despite common areas of focus that included cardiovascular conditions, diabetes, and preventive services. We conclude that policy makers and stakeholders who seek less variability in the use of performance measures to increase consistency should balance this goal with the need for flexibility to meet the needs of specific populations and promote innovation. D uring the past two decades there has been substantial growth in the availability and use of performance measures. The National Quality Forum, a nonprofit organization that establishes consensus standards for measuring performance, has endorsed more than 700 measures.1 The use of provider performance measures for quality improvement, payfor-performance, and public reporting purposes has become commonplace.Performance measures increasingly play an integral role in assessing the achievement of high-quality, efficient care in new health plan and Medicare payment and delivery models such as accountable care organizations, patient-centered medical homes, and bundled and global payment.2,3 Understanding performance measures and their use is vital to ensuring the availability of reliable performance information. 4 Information on measures that are used to assess providers' performance in Medicare is publicly available through the federal rule-making process. In contrast, we are aware of only a few reports that examine the use of performance measures in the private sector. The primary focus of these reports has been the use of measures endorsed by the National Quality Forum across a cross section of users, including community collaboratives, accrediting organizations, a few health plans, and the public sector.1,5 The National Quality Forum also has catalogued the performance measures used by the Aligning Forces for Quality communities. This existing body of work provides only a limited understanding of the measures used by health plans to assess providers' performance. Consequently, little is known about how performance measures used by health plans compare with those used in public-and other privatesector programs.To address this gap in knowledge, we conducted a study with the primary purpose of gaining a better understanding of health plans'

Since 2008, collection and use of REL data continues gradually to increase among health plans, demonstrating the industry's commitment to address racial/ethnic gaps in care.

RESULTS:In 2008, almost all enrollees (99.8%) represented in the survey were in health insurance plans that used Advisory Committee on Immunization Practices (ACIP) recommendations to determine coverage. The vast majority (Ն99.0%) of enrollees were in plans covering all ACIP-recommended child and adolescent vaccines in Ն75% of the health insurance product lines offered, and Ն16.5% of enrollees were in plans covering these vaccines in all products. The majority of enrollees (Ն83.3%) were in plans covering ACIP-recommended pediatric and adolescent vaccines without cost-sharing. Plans covering 95.5% of enrollees updated benefits to reflect changes in vaccine recommendations within Յ3 months, compared with 60.0% in 2005. In 2008, 96.7% of enrollees were in plans that could reimburse providers for vaccines within 3 months once the vaccines were included in benefit designs, compared with 59.2% in 2005. CONCLUSION:The survey shows widespread private health insurance plan coverage of vaccines, consistent with, or better than, the coverage levels reported in the AHIP 2005 survey. Pediatrics 2009;124:S532-S539