The 16 communities and people who make up AF4Q challenge health care's status quo. They are testing new ideas—reimagining how we pay for, receive, and provide health care. They've come far already but know that that by bringing all stakeholders to the table, they can evolve even further. Explore all 16 of these initiatives.

Patients without the skills to manage their health care can incur costs up to 21 percent higher than those of patients who are highly engaged in their care, according to recent research published in Health Affairs. Patient engagement begins with giving patients the tools they need; at its most advanced, it also can mean that patients work directly with providers to provide feedback and strive to improve quality.

Patient Partners is an advanced form of consumer engagement where patients volunteer to join their ambulatory care practice’s quality improvement leadership team (QILT). With the Patient Partners program, one or two patients take a behind-the-scenes look at the health care practice and give feedback to doctors. More than just advisors, Patient Partners are active members of their practices’ QILTs and contribute the patient viewpoint to practice-level redesign work as the providers strive to achieve patient-centered medical home recognition and improve health outcomes for their entire patient panels. 

The Institute of Medicine estimates that up to 30 percent of the $2 trillion in annual health care spending in the United States is duplicative or unnecessary. Increasing prices for treatments and overall costs also have troublingly little relationship to good health care outcomes. 

Q Corp now is working on improving the quality and costs of maternity care, including a goal to reduce the overall rate of Cesarean sections in Oregon by two percent. “We are developing a statewide data center with information about the quality and utilization of maternity care in Oregon,” said Meredith Roberts Tomasi, program director with Q Corp. “Once we have measures and the data center, we can look for payment reform opportunities, which will help improve quality and affordability.”

Q Corp was chosen by the Network for Regional Healthcare Improvement (NRHI) as one of five communities to develop total cost of care and total resource use reports. This program, called the Healthcare Cost Measurement and Transparency Project, seeks to break new ground by producing health care cost information and benchmarks. This information will allow communities to better understand health care cost variation across their own regions and provider groups, and also make comparisons on cost to other regions across the country.

The Wisconsin Collaborative for Healthcare Quality (WCHQ) has spurred quality improvement by bringing together workgroups to enhance health care quality. “We look to the health care organizations to provide the expertise, and we facilitate a peer-to-peer relationship,” said Cindy Schlough, director of strategic partnerships for WCHQ.
 
WCHQ has experienced tremendous growth, with more than 60 percent of physicians in the state now submitting data to WCHQ. These stakeholders gather for bimonthly meetings to share best practices, and this open dialogue has been a lynchpin of its success.
 
To clearly illustrate areas for improvement, WCHQ creates “scorecards” that put an organization’s publicly reported data in context with red, yellow, and green “stoplight” markers for each measure. This helped challenge some of the assumptions inherent in each organization.
 
WCHQ has also leveled the playing field when it comes to accessing the publicly reported data. WCHQ creates reports to show the most current results on all of the measures for each organization. Anyone, not just health care organizations with sophisticated data analysts, can download clear and simple spreadsheets. For the health care organizations, the measures summary reports highlight data variations and further encourage better performance.