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 Wisconsin Alliance.

Bundled payment models hold the promise of driving down health care costs while improving health care quality. As pilot projects have been conducted in the field, common barriers and themes have emerged, including administrative implementation hurdles, data and technology challenges, new emphasis on engaging patients in their care, and questions of whether true costs savings can realistically be achieved.

 

“Fee-for-service has eroded the patient-doctor relationship. With [the total knee replacement bundled payment pilot program], we saw a strong relationship emerge again, one with shared decision-making.”

The Wisconsin Collaborative for Healthcare Quality (WCHQ), leader of the AF4Q initiative in Wisconsin, has improved its preventive screening rates from 68 percent in 2009 to 75 percent in 2012. In 2012, more than half a million Wisconsinites received appropriate screening. To ensure continuing gains, WCHQ has established performance target goals for each of its 21 reporting member organizations. The ultimate goal is a 70 percent or higher screening rate for all patients.

 

WCHQ spurred change by engaging clinician leaders to identify best practices. A project team, including a dozen physicians and nurses, worked together over six months to select a set of proven best practices that include identifying eligible patients, redesigning clinic workflows, leveraging electronic medical records, improving patient-physician communications, and educating patients on different screening options. The proven best practices were presented through a series of webinars led by two physicians from the colorectal cancer project team.

To clearly illustrate areas for improvement for health care organizations, the Wisconsin Collaborative for Healthcare Quality (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. There were many ways for health care organizations to improve, but putting the measures on a visual scorecard helped set the agenda and priorities.

 

WCHQ has also leveled the playing field when it comes to accessing the publicly reported data. WCHQ creates measures summary 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.