EXHIBIT 1.

How different levels of the US health care system could use quality measurement to improve diabetes care Levels of the US health

care system	Possible uses of quality measurement to improve diabetes care
Governmenta	Allocate funding and prioritize resources and investments to underperforming regions based on measures to narrow gaps and disparities in care delivery and health outcomes Facilitate cross-sector collaborations and partnerships
Large employerb	Identify and select employee health plans based on performance with respect to diabetes care quality measurement Invest in health promotion programs for people with diabetes that demonstrate improved health outcomes (including less disability and absenteeism), lower cost of care, and better quality of life
Payerc	Support competitive contract negotiations and selection of in-network providers to incentivize higher quality of care Reduce costs of care and health care use
Health care provider organizationd	Launch quality improvement initiatives to improve performance in the quality of diabetes care Support competitive contract negotiations with payers to incentivize higher quality of care Improve population health and narrow disparities in care and health outcomes Reduce costs of care and health care use
Clinician	Launch quality improvement initiatives to improve performance in diabetes care quality Engage in professional development and improvement efforts to address performance in diabetes care quality
Patient	Select and monitor hospital and clinician performance with respect to diabetes care quality

SOURCE Authors’ analysis.

^aCounty, state, and federal governments.

^bApplicable large employers under the Affordable Care Act, which defines large employer as a company with more than 50 full-time employees.

^cOrganization that pays for an administered health service, such as Medicare, Medicaid, and private insurance companies.

^dAny organization that provides health services to patients