Three Lessons on Improving Quality of Care in Communities

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

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.

Alliances of all stakeholders fuel change.

To create collective will to make bold changes, you need to gather everyone. For example, in many Aligning Forces communities, doctors, insurers, and employers had never come together to discuss health care quality. When they finally did -- and worked with a reliable convener to forge and meet goals—they gained confidence in their abilities to improve the health care in their communities. In most places, these multi-stakeholder alliances forged through Aligning Forces became trusted agents of change.

Take New Mexico, where health care had traditionally been siloed and lacked collaboration. To address this, the New Mexico Coalition for Healthcare Quality was started under the auspices of Aligning Forces. Working together, Coalition members initiated the first voluntary ambulatory care public reporting website in the state. They spearheaded hospital and ambulatory quality improvement efforts and mounted a campaign to reduce emergency department use. They even provided employers with tools to become real partners with their health plans and care providers. Now the Coalition has transitioned to form the New Mexico Coalition for Healthcare Value to continue to serve as a catalyst for change.

Publicly reported data drives improvement.

When RWJF called for involving local providers in efforts to measure and report the quality of care that they provide, many people said it wouldn’t happen.

But you can’t improve what you don’t measure—and you can’t drive accountability without transparency. So alliances defied the naysayers and went on to develop novel ways to accurately measure the quality of care delivered locally and display it so all could understand. The result? Care improved when performance was publicly reported.

Results in Cincinnati, where the Aligning Forces effort was led by The Health Collaborative, makes the point. Staff at the TriHealth Physician Partners group in West Chester, Ohio, saw that the practice’s scores for the care it provided to patients with diabetes were average. Determined to be above average, the practice manager ran reports several times a week to determine which patients needed to achieve better control of their diabetes. Those in good control were celebrated with certificates, while those who struggled received extra attention, such as nutrition counseling or fitness support. A year later, the practice’s score rose 20 points on five reported measures for diabetes care, the highest improvement rate of any practice reporting in the area.

Consumers must be at the table.

Health and health care is personal, so we can’t improve it without engaging ‘real people’ in it. I don’t mean targeting consumers only as an audience. We need to proactively engage them as equal stakeholders, actively participating and shaping the changes we need to make. Aligning Forces made consumer engagement a priority, ensuring patients were partners in the work. It benefits them and the whole system.

Aligning Forces for Quality in South Central Pennsylvania is one example. The alliance introduced a Patient Partners program to bring patients to the center of decision making at local practices. Patient Partners are people who manage their own chronic condition or have cared for someone with one, so they have personal knowledge of the barriers patients face. The program—36 primary care and specialty practices, with 57 Patient Partners serving more than 125,000 patients—consistently ensured that the patient perspective was considered as practices worked to improve quality.

Lessons learned in these 16 communities are leading the way toward a nationwide transformation in health care at both national and regional levels. When we started on this journey we didn’t know we were on the precipice of the monumental transformation of the U.S. health care system that is now underway. Aligning Forces for Quality has been a tremendous journey, and with our efforts to build a Culture of Health continuing the work, the insights will continue to be used to improve health and health care.

Anne Weiss

Anne F. Weiss, a director for the Robert Wood Johnson Foundation, leads efforts to achieve the highest possible value from our nation’s investments in improving health and health care. Read her full bio