Grants to bolster local quality improvement efforts

Sixteen communities across the country received a $1.3 million boost to continue testing innovative ways to improve health care quality and efficiency.

The grants from the Robert Wood Johnson Foundation will help the local health care collaboratives develop and test payment models as part of the foundation's Aligning Forces for Quality initiative.

The program, which began in 2006, brings together physicians, hospitals, payers and consumer groups in participating communities to collaborate on improving health care delivery in their area. The communities are comprised of a city, such as Boston and Cleveland; a region, such as western Michigan and Puget Sound, Wash.; or an entire state, such as Minnesota and Oregon.

A main goal of the grant money, now totaling $300 million, is to provide examples of quality improvement for communities across the country, particularly as they look to adapt to health system reform, said Robert Graham, MD. He is director of the AF4Q national program office at George Washington University in Washington, D.C.

The Patient Protection and Affordable Care Act "is largely an attempt to rationalize and reform the financing and infrastructure of U.S. health care system and a lot of pieces talk about quality. But all health care is really local," Dr. Graham said.

The collaboratives are working toward similar objectives of improving care quality, system efficiency, transparency and patient engagement, but using a community-based approach.

For example, some have had success in getting physicians to publicly report clinical performance data so that other doctors, patients and hospitals can benefit from information sharing. The move also has helped encourage higher participation by patients in their own care, Dr. Graham said.

Other regions are focusing on health information technology as a way to transform care quality.

Better Health Greater Cleveland has made headway in encouraging electronic medical records adoption and implementation among participating physician practices.

A study of the program released in January revealed that 51% of diabetes patients in EMR practices received all the recommended care compared with only 7% in practices with paper records. Forty-four percent of diabetes patients in EMR practices were able to effectively manage their condition, compared with 16% in paper-based offices.

With the latest grants, program participants will take the next step of "trying to figure out ways to create more innovative payment systems to reinforce the activities we believe increase quality and value," Dr. Graham said, adding that the current fee-for-service system often has led to overutilization and poor care coordination.

Some of the ideas likely to be tested include bundled payments and accountable care organizations.

Details of the AF4Q initiative are online (link).