'The Unfinished Work Of Health Care Reform: Aligning Forces For Quality' by Barbra Rabson

While Massachusetts is way ahead of the rest of the country in health care reform, we certainly haven't reached the finish line. At best, we've made it up Heartbreak Hill, with a lot of tough miles ahead. What's been accomplished in three years is pretty amazing – 430,000 more people insured and a rate of uninsured that's the lowest in the U.S. by far – but unless we address the urgent need to tame health care costs while also improving quality of care, the state's gains in access and coverage will be in severe jeopardy.

Fortunately, the law's success has generated a great deal of momentum and good will, and a quick glance across the health care landscape shows that numerous groups, agencies and institutions are already working on various pieces of the cost and quality puzzle. But the fragmented nature of the health care marketplace and delivery systems, plus the natural desire of groups to focus on their own best interests, can make it difficult for them to act quickly in concert with one another. That's where Aligning Forces for Quality comes in.

Aligning Forces for Quality (AF4Q) is a comprehensive effort designed by the Robert Wood Johnson Foundation to lift the overall quality of health care in targeted communities across the country, and Greater Boston has just been chosen to participate.

As a result, RWJF will provide technical support and a planning grant to a local coalition of more than three dozen organizations and agencies representing consumers, providers, health plans, employers, and state and local government. The goal is for the members of the coalition to develop a joint plan of action for bringing about concrete and long-lasting health system changes.

Many of the same organizations that have joined the Greater Boston Aligning Forces Initiative, including my own, are deeply involved in trying to make health care more effective, safe and efficient. What's unique and exciting about the AF4Q approach is that it challenges us to create a model of community-wide consensus-building around our priorities and brings people and organizations together to focus on how we can make the most of the many activities already in place. It forces us to ask, “What is the one goal, the one aim, that will accomplish the most for the health of the community?”

Once a high-level goal is agreed upon, we can channel the great work that is already being done in so many areas – provider payment reform, delivery system restructuring, community and public health investments, value-based benefit design, electronic health information exchanges, administrative simplification, and consumer activation, to name a few – into a concerted, community-wide effort. AF4Q will give us the resources, expertise and training we need to establish goals, priorities, action plans, and measures of success.

Our progress will be tracked using more than a dozen standards such as whether providers' quality performance and patients' assessments of their care experiences are measured and publicly reported; the number of hospitals enrolled in collaboratives to reduce racial and ethnic health disparities or to make care more patient-centered; and the number of local initiatives with approved plans to educate and engage consumers.

AF4Q is already up and running in 15 other communities across the country so we have models to look to (and they will be looking to us) to make this happen. The Greater Boston initiative will bring added clarity, focus and energy to the process of reform and it can help get us much closer to the goal of making high-quality, affordable health care available to everyone in Massachusetts.

Barbra Rabson
Co-chair of the Greater Boston Aligning Forces for Quality Initiative

This program aired on June 15, 2009. The audio for this program is not available.

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Martha Bebinger Reporter
Martha Bebinger covers health care and other general assignments for WBUR.



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