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How Public Health Sharing Arrangements Fit Into the Value Equation

Oct 6, 2015, 11:05 AM, Posted by Meshie Knight

In recent years, cross-jurisdictional sharing has been a focus for policymakers and public health officials wishing to increase effectiveness and efficiency in the delivery of public health services. Measuring its impact is next.

public health nursing banner

Well-functioning, high-value public health departments are critically important to ensuring the conditions for good health in communities. In recent years, however, health departments have been faced with exceptional financial challenges mostly in the form of repeated reductions in state and local funding for public health budgets. At the same, expectations for their roles and responsibilities-- as monitors and chief health strategists for communities and as partners within and beyond the health sector—are growing.

In 2012, RWJF launched a program to investigate a potential strategy for strengthening health departments that could be especially effective in times of financial or administrative hardship, and importantly, could also help to augment the capabilities of health departments serving particularly small or rural jurisdictions: cross-jurisdictional sharing (or more simply, publicly authorized sharing of public health services across jurisdictions). The Center for Sharing Public Health Services (CSPHS) was designed to help build the evidence for how cross-jurisdictional sharing (CJS) arrangements can be planned for and implemented in different environments.

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Three Lessons on Improving Quality of Care in Communities

Sep 15, 2015, 10:16 AM, Posted by Anne Weiss

Aligning Forces for Quality not only transformed care in 16 communities, but it provided insights to help shape efforts building a national Culture of Health through high value care.

In a Culture of Health, how can communities improve the quality and value of health care? What happens when people who get, give, and pay for health care locally work together? In 2007, the Robert Wood Johnson Foundation (RWJF) set out to answer these questions when it launched Aligning Forces for Quality with an audacious goal: To transform the quality, equality, and value of regional health care markets.

Along the way, we explored what happens when the people who get, give, and pay for health care locally, work together. Our investment sparked deep and meaningful change in 16 very different communities across America, and important lessons learned in each and every one. But three lessons in particular helped drive success and can be applied to our work to build a national Culture of Health.

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Three Things the United States Can Learn About Public Health From Around the World

Jul 23, 2015, 10:45 AM, Posted by Najaf Ahmad

When it comes to bridging health and health care delivery, the U.S. has an opportunity to learn from global innovations that link the public health, social services, and health care systems.

Globe Image via Joseph Li

It started with three hundred Boy Scouts from across Uganda being trained as “social monitors”. They were tasked with reporting the conditions of their communities to Uganda’s Ministry of Health through their mobile phones. In less than a year, these “U-reporters” grew to over 89,000. The U-report itself is a free SMS-based system that allows young Ugandans to share what’s happening in their communities and work with community leaders and government to affect positive change. The information gathered is disseminated through radio, TV, websites, youth events, community dialogue and other ways.

This system of real time surveillance is a vital new development for the world’s fifth-fastest growing country. Reliable health information in Uganda can mean the difference between life and death. As has been seen recently, epidemics like Ebola or West Nile thrive on information delays. Furthermore, U-reports are empowering Ugandans to share responsibility for creating healthier conditions within their communities.

The U-report is just one of the many exciting global innovations highlighted in a report by the Robert Wood Johnson Foundation (RWJF) and AcademyHealth. Written by Margo Edmunds and Ellen Albritton at AcademyHealth, the report showcases innovations that link public health, social services, and health care systems. These initiatives serve as examples of bridging otherwise disparate elements of health and health care delivery. The authors deliberately selected racially, ethnically and economically diverse regions around the world to ensure that their innovations were applicable to and reflected the diversity of the United States. A Google Hangout also convened several experts to discuss the report’s findings.  

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How Can We Measure High Value Care? Consider the Patient Point of View

Jun 29, 2015, 4:43 PM, Posted by Anne Weiss

Health care is centered around human relationships, which is why it's so important the voices of the people the system is designed to help—patients and their families—are heard by those defining and measuring care.  

Summer has come at last! Along with all the usual endings and beginnings that come with this time of year, there’s an important new opportunity for those of us who are passionate about improving health care. The Medicare Access and CHIP Reauthorization Act of 2015 threw out Medicare’s old rules for paying physicians and substituted a new system, one that’s  supposed to reward physicians for delivering high quality, high value care. This is a game-changer many years in the making, but as with any complex new law, the details matter. How will Medicare define and measure high quality, high value care? We can get some hints from CMS’ new strategic vision for physician quality reporting.

If I were granted just one wish by the people who are going to define and measure high value care, I know what I’d say: listen to our voices, the voices of patients and families, the ultimate health care consumers. Listening to patient voices and providing care that is patient-centered can improve clinical outcomes, reduce “waste” in health care by reducing unnecessary testing, and increase the overall care experience for both patients and providers. Health care is centered around human interactions and relationships—it is critically important that those defining and measuring care truly hear the voices of the people the system is designed to help—patients and their families.

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Expanding Opportunities for Rural Communities to Get Quality Care

Jun 9, 2015, 4:58 PM, Posted by Susan Hassmiller

Initiatives like the Future of Nursing and Project ECHO are expanding opportunities for more communities to get quality health care and lead healthier lives regardless of ZIP code.

Buncombe Farm Land

I read recently in The New York Times about Murlene Osburn, a cattle rancher and psychiatric nurse, who will finally be able to start seeing patients now that Nebraska has passed legislation enabling advanced practice nurses to practice without a doctor’s oversight.

Osburn earned her graduate degree to become a psychiatric nurse after becoming convinced of the need in her rural community, but she found it impossible to practice. That’s because a state law requiring advanced practice nurses to have a doctor’s approval before they performed tasks—tasks they were certified to do. The closest psychiatrist was seven hours away by car (thus the need for a psychiatric nurse), and he wanted to charge her $500 a month. She got discouraged and set aside her dream of helping her community.

I lived in Nebraska for seven years, and I know firsthand that many rural communities lack adequate health services. As a public health nurse supervisor responsible for the entire state, I regularly traveled to small, isolated communities. Some of these communities did not have a physician or dentist, let alone a psychiatric nurse. People are forced to drive long distances to attain care, and they often delay necessary medical treatment as a result—putting them at risk of becoming even sicker, with more complex medical conditions.

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We Went to Oxford and Got Schooled in Primary Care

Apr 23, 2015, 9:00 AM, Posted by Maryjoan Ladden, Susan Mende

As other countries continue to spend far less on health care but perform better on measurable health outcomes, there's opportunity to learn what works abroad and apply those lessons stateside.

Oxford University

It’s a hard notion for many Americans to accept—although we spend more money on health care than any other country in the world, we are far from having the best health outcomes. When you look at measures that include life expectancy, infant mortality rates and preventable illness, other countries that spend far less than the U.S. perform better. But in many of these countries people of all ages and socio-economic status are able to easily access primary care that is comprehensive, patient-centered and rooted in local communities.

One of our goals as program officers at RWJF is to look beyond our borders to identify promising practices that might be incorporated into America’s health care system. Last fall we traveled to Oxford, England, to learn first-hand about promising primary care practices in Chile, England, the Netherlands and Canada—all high and middle income countries that spend less on health care yet have better outcomes than the U.S. We attended a conference organized by the Training and Research Support Centre (TARSC), an organization supported by Charities Aid Foundation of America through a grant from the RWJF Donor-Advised Fund. TARSC provides support and training to government and civic health organizations, and the conference was the next step after its report, “Strengthening primary care in the USA to improve health: Learning from high and middle income countries.” We came away with a lot of insights from both, but were struck by several themes that were constant throughout.

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Three Key Lessons from the Health Care Transparency Summit

Apr 16, 2015, 1:36 PM, Posted by Anne Weiss, Susan Dentzer

A magnifying glass lies on top of money. (Image via taxrebate.org.uk)

“There is no single more powerful concept” in transforming health care than transparency—that is, accurate information for everybody about the costs, quality, and other aspects of health care—according to former US Senate Majority Leader and Robert Wood Johnson Foundation Board Member Bill Frist at the Second National Summit on Transparency in Health Care Costs, Prices, and Quality. Not only is shining the spotlight on costs and quality the key to making health care markets work, Frist said, but it’s also central to delivering the vaunted Triple Aim of better health, better health care, and lower costs. Here are our key takeaways reflecting how much transparency discussions have advanced since the first RWJF sponsored summit in 2013:

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Let's Keep the Payment Reform Momentum Going

Mar 31, 2015, 10:22 AM, Posted by Andrea Ducas

Recent advancements in payment reform have been massive and exciting. It's time to sustain the momentum and transform how we pay for and deliver care.

A hundred dollar bill. Modified image. Original photo by Ervins Strauhmanis.

When it comes to how health care providers are paid, change is in the air. I’m probably more excited than most people about trying to make sure our financial incentives are flowing the right way within the health care system. Here’s why.

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Looking Back, Looking Ahead: Banding Together to Fight for Health Care Value

Feb 13, 2015, 5:06 PM, Posted by Anne Weiss

L1032033_JHW Key health care stakeholders have joined forces to work toward improved quality of health care available to the rural, low-income population of Humboldt and Del Norte Counties, Calif. (AF4Q)

Sometimes it feels like we take one step forward, two steps back when it comes to making sure that we are getting the best quality health care for the tremendous amount our society invests in it. Maybe sometimes it’s one step forward, three steps back.

But then I think about Aligning Forces for Quality—RWJF’s signature initiative to lift the quality and equality of care in 16 regions around the country—and my hope returns. While progress is slow, it is still progress.

More than 10 years ago, RWJF’s leadership suggested to me that we change course in our health care quality improvement strategy. Instead of testing single interventions in widely scattered sites, they asked, why not focus on a limited number of target communities where we could go deep with multiple approaches? We knew health care is essentially local, though shaped by state and federal policy.

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How Not to Flip Out: Flip the Clinic

Jan 27, 2015, 4:38 PM, Posted by Beth Toner

Flip the Clinic San Francisco January 2015 Hard at work at the first regional Flip the Clinic meeting in San Francisco

“If you’ve been waiting more than 15 minutes, please see the receptionist.”

That’s the sign that was posted on a bulletin board in the radiology clinic where I was waiting for an MRI earlier this month. The funny thing? It was so lost amid the other postings around it screaming for attention that I only saw it on my way out, as I waited for a copy of the disk with my MRI on it. It struck me as odd, and a little concerning; did that mean I should be worried the clinic staff might have forgotten about me if I’d been waiting more than 15 minutes?

Don’t get me wrong: I understand that unpreventable delays happen. For me, the most frustrating aspect of signs like this is that they take the power away from the patient. 

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