Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the quality of health care in 16 diverse communities, reduce racial and ethnic disparities and provide models for national reform. AF4Q brings together people who get care, give care and pay for care to work together toward the shared goal of better health and health care.

Today's issue of Spotlight features the work and successes of AF4Q's Cleveland Alliance.

AF4Q in Cleveland, led by Better Health, is setting an example of the potential of meaningful collaboration. The Alliance’s public reports, which use quality data provided from electronic health records of eight health systems, show that partnerships among competitors are paying off in northeast Ohio. Care and outcomes for diabetes, high blood pressure, and heart failure have improved, as Better Health documents gaps and gains in quality across the region and shares and cheers members’ successful interventions twice a year. Better Health’s efforts to improve primary care for patients with these common conditions also are reducing hospitalizations in northeast Ohio. Because it reports data from clinical records rather than insurance claims, Better Health captures data on uninsured and underserved populations that include racial and ethnic minorities, whose health care and outcomes historically have not been measured, particularly in doctors’ offices and other primary care sites. The information can contribute to efforts to reduce disparities in care, advocates say. Get the details and learn more about Better Health’s work here. 

How do you save $13 million in three years? AF4Q Cleveland has programs and processes to help primary care practices improve their care for common and costly conditions.  Better care leads to better health and lower costs. “We consider it shortening the path, but it’s really a bright spot in the region to do something that is meaningful,” said Randall D. Cebul, MD, president and director of Better Health Greater Cleveland. Since its start in 2007, the mainstay of Better Health’s improvement efforts in primary care have been diabetes, high blood pressure, and heart failure, all common cardiovascular conditions that can be well controlled with care delivered outside a hospital. The data suggest that an estimated 1,928 hospitalizations for these conditions and more than $13 million in costs were averted in Cuyahoga County, OH, from 2009 to 2011, the three years after Better Health’s activities began. Read about AF4Q Cleveland’s secret to shortening the path here.

High blood pressure usually has no symptoms and can affect the brain, heart, and kidneys, increasing the risk of stroke and heart attack. Thirty-five percent of African-American adults like Albert Brooks have high blood pressure, which accounts for 20 percent of the African-American deaths in the United States—twice the percentage of deaths among Caucasians with the condition. The disparity is well documented, longstanding, and stubborn. So when Better Health Greater Cleveland’s Data Center found that 10 primary care practices from Kaiser Permanente Ohio (now HealthSpan Physicians)had the highest percentage of patients with high blood pressure under good control in 2011—and that six of them had improved the most of all practices in the region—its analysts dug deeper. Both black and white patients were benefitting. What had Kaiser practices been doing? See what Better Health discovered and what they did about it here.