Quality/Equality
The Robert Wood Johnson Foundation is committed to ensuring that all Americans receive quality health care.
We are working to help communities across the country set and achieve ambitious goals to improve the quality of health care in ways that matter to patients and their families, including patients from specific racial and ethnic backgrounds that often experience lower-quality care. To achieve these goals, stakeholders must work on fundamental, highly challenging steps—like measuring and reporting on the quality of health care in ways that can ultimately drive real, measurable improvements in care.
Aligning Forces for Quality: The Regional Market Project (Aligning Forces) is the Foundation’s core initiative to improve the quality of health care for all Americans. Launched in 2006 the program supports teams—representing those who give care, get care and pay for care—in 14 communities throughout the United States to set and achieve ambitious goals to improve the quality of their health care. Aligning Forces is based on the overwhelming evidence that the current ways we deliver health care are inefficient, costly and sometimes downright dangerous. Aligning Forces requires stakeholders at the table to step beyond their entrenched perspectives and work together to create better health care systems.
Measuring and publicly reporting health care is not a new proposition. Almost all major industries are governed by standards and regulations, to serve broader public interests like safety and accountability. But in health care, this issue has become increasingly complex and challenging. Health care providers, like physicians, are anxious that any measurement efforts be fair, objective, and do not carry any unintended consequences, like creating incentives for physicians to treat only the healthiest patients. Meanwhile, most people understand far more about choosing schools, restaurants and cars than they do about what constitutes good care versus bad care. Finally, we are faced with a proliferation of measures from a variety of accreditation and health care organizations. The resulting cacophony of measurement efforts is easy to ignore and hampers efforts to drive real, lasting changes in health care.
What role is RWJF playing in the measurement landscape? We need greater collaboration at the federal and local levels to standardize measurement and reporting activities and create measures that are meaningful to patients, providers, businesses, plans, payors and other stakeholders. At the national level, we are investing in efforts by major organizations to set and act upon priorities for measurement and public reporting. And at the local level, under our Aligning Forces initiative, we are requiring that all Aligning Forces communities measure and report on the performance of primary care physicians by February 2010.
We have set an expectation that 11 out of the current 14 Aligning Forces communities will meet this goal by 2010. At the end of 2008 six of the communities issued public reports on physician performance: Cleveland, Kansas City, Maine, Minnesota, Wisconsin and Seattle. The other Aligning Forces communities are on track to meet this goal by the end of 2009.
The challenges to this public reports is formidable. The Aligning Forces teams face technical challenges, like where to obtain the data, how to aggregate it, and whether to focus the reports on particular diseases, like diabetes. They also face political challenges—like how to keep certain stakeholders like physician societies and businesses engaged, as well as communications challenges in how to make the reports user-friendly for patients and consumers, and findable.
Even for communities that have issued public reports already, some of these challenges remain unsolved. And we know that measurement and reporting alone will not solve our problems with health care quality. We need to develop better measures. For example, many of the quality measures now in use by health insurance plans and government agencies only capture whether single, process-oriented events happen in the course of a patient’s treatment, like whether a patient with diabetes gets an eye exam. Developing measures that capture full episodes of care will help us understand where we need to improve care, and how. In addition, measurement needs to be aligned and coordinated with other efforts—like payment reform that rewards physicians for providing good care, or helping physicians and nurses learn how to improve. However, the act of actually hitting the measurement and public reporting milestone—for the six communities that have issued their reports, and the others to follow—has already put our Aligning Forces communities at the cutting edge of a growing number of efforts to deliver high-quality care and better meets the needs of patients and families.
For additional information about our initiatives and objectives, visit www.rwjf.org/qualityequality.
Progress of Aligning Forces for Quality Communities on Public Reporting
Source: Aligning Forces for Quality Evaluation Team and Center for Health Improvement, 2008.