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 of AF4Q's Oregon Alliance.

Oregon Health Care Quality Corporation (Q Corp), leader of the AF4Q initiative in Oregon, is at the forefront of improving transparency in health care. The foundation of this work is gathering and analyzing data. Over the years, Q Corp has developed a comprehensive claims database that includes information from Oregon’s largest health plans, the Oregon Health Authority Division of Medical Assistance Programs (Medicaid Fee-for-Service) and the Centers for Medicare and Medicaid Services (Medicare Fee-for-Service through the Qualified Entity Program). Q Corp has also developed a provider directory that attributes patients to the appropriate provider, clinic, and medical group for reporting.

With this data infrastructure, Q Corp is able to report on more than 20 measures of quality and utilization for a variety of audiences. Q Corp’s quality and utilization reports have become an integral part of health care transformation efforts. For example, its focus on data and reporting has led it to become a critical partner working with multiple state agencies on health care reform metrics. 

Q Corp also provides public reports of care quality and utilization on the website www.PartnerforQualityCare.org. With this information, Oregonians can compare care performance in their area and learn more about the health care services they should be receiving.

Building on its efforts to gather and analyze data, Q Corp is now working to add health care costs to its reports. The goal is to analyze data about the costs of care to help identify methods for reducing costs and unnecessary care. As an initial step, Q Corp began measuring the costs and utilization of care for lower back pain. A study it conducted found that in 2011, Oregonians spent more than $11.5 million on treating lower back pain. With its partners, Q Corp then developed and launched an informational campaign to urge people with lower back pain to stay active and avoid unnecessary treatments.

Q Corp also began 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. In fall 2014, the March of Dimes and Q Corp launched the Oregon Perinatal Collaborative Subcommittee on Data for Measurement and Improvement. The subcommittee’s members include policymakers, payers, hospitals, employers, consumers, and public health officials, who meet monthly. “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.”

In Oregon, Q Corp has begun to examine the impact of social determinants on health. The Equity Atlas 2.0, a joint project of Q Corp and the Coalition for a Livable Future, allows users to overlay disease incidence rates with social factors, like walkability of neighborhoods and access to grocery stores, for the four counties in the Portland metro region. The combination of information can help inform policymakers as well as urban planners to plan for roadways, bike paths, and bus routes to improve flow and accessibility. Other counties in Oregon are asking how they, too, can create an equity atlas.

“Many of the important factors that determine health are not within the health care system but are a combination of where we live, work, and recreate,” said Mylia Christensen, executive director of Q Corp. “At the beginning of the Aligning Forces for Quality program, Q Corp reported information aimed at improving the quality of health care. This is the other end of the spectrum—working with new partners and examining population health.”