An Engine for Collective Impact

AF4Q Alliances facilitated “collective impact” in their communities by providing backbone support to stakeholders committed to this common agenda. Alliances did this by serving as an independent body providing all stakeholders with access to comprehensive, trusted data on health care cost and quality; creating a unified, effective set of measures; driving an aligned vision for quality improvement; and creating a transparent mechanism to hold stakeholders accountable for accomplishing established goals.

Public Access to Comprehensive and Trusted Data Sets

Measuring and reporting the quality of care that doctors and hospitals deliver is a cornerstone of regional health care improvement. To do this, multi-stakeholder Alliances collected and aggregated data across multiple sources for use in public reporting, quality improvement, and payment reform. Alliances analyzed the data and made findings available via consumer-friendly report cards that illustrated the variation in performance, quality, cost, and patient experience. Alliances also gave providers feedback and benchmarking reports.

Many Alliances were formed around this portfolio of work with the understanding that data are power. Data are the raw material that post-Affordable Care Act (ACA) health care systems need to rebuild care and payment systems that deliver value, rather than volume. Data are what engaged consumers use to make informed decisions about their care, what payers and purchasers use to design value-based benefit packages, and what government and public health entities use to make policy decisions. All of these players need access to uniform, actionable data in order to effect change.[1] But data alone are not valuable. Value comes from aggregating data across payers and systems and from analyzing the data to facilitate quality improvement and payment reform strategies.

In most communities, information on health care quality was available from national data sets, or in the form of multiple data streams from various providers, payers, and other data vendors. Often, these data were held as proprietary business intelligence and are not available publicly. When the data were made public, others rarely trusted them because of the lack of transparency in data collection processes and measurement methodology, and suspicion about motivation. Multi-stakeholder Alliances, as independent conveners had the ability to create robust, trusted data sets by collecting and aggregating clinical and claims data from multiple payers using a transparent, inclusive process.  These data were a powerful catalyst for action by providing a more complete picture of health care quality and costs. Aggregated data also improved measure validity and reliability. All together, these factors allowed Alliances to push for population-level improvements in quality and cost that could not  be achieved without collaboration across payers and providers.

Employers and purchasers, also, needed a robust multi-payer source of information on health care quality and value to make the best possible decisions about health benefits for employees. Currently, most of the information employers can access comes from health plans and is generally single-payer data, limiting employers’ ability to benchmark against other local or national employers and purchasers. Finally, consumers and physicians may regard data aggregated by a neutral third party as more trustworthy than reports produced by an individual health plan or system.

[1] Toussaint, J., Shortell, S., and Mannon, M. (2014). Improving the value of healthcare delivery using publicly available performance data in Wisconsin and California. The Journal of Delivery Science and Innovation, 2(2):85-89.