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Quality Field Notes


Regional Health Improvement Collaboratives

Issue Brief

What Were Learning:

Regional Collaboratives Can Improve the Value of
Local Health Care
The Challenge

Increasing the value of health care is a national issue, but health care is delivered locally, and
improving its quality and making it more affordable requires local action. Moreover, no single
person, group, or profession can go it alone.
Aligning Forces for Quality
AF4Q is the Robert Wood
Johnson Foundations
signature effort to lift the
overall quality of health
care in 16 targeted communities across America.
These briefs distill some
of the key lessons learned
by these regional alliances
of providers, patients,
and payers as they work
to transform their local
health care and provide
models for national

Aligning Forces for Quality (AF4Q) is comprised of 16 regional health improvement collaboratives
(RHICs) that bring together people who get, give, and pay for care to improve the value of health
care in their community. These multistakeholder groups include organizations that might not
otherwise collaborateincluding purchasers, patients, providers, and payers.
As an independent forum, a collaborative can serve roles no one else can, such as:
Measuring the performance of the regions providers in order to identify opportunities to
improve care and monitor progress
Facilitating payment and delivery system reforms to reward providers that deliver higherquality care, while encouraging patients to use higher-quality providers
Providing training and assistance to health care professionals so they can learn new ways to
analyze problems in care delivery and implement solutions
Educating and engaging patients in their care
Helping to plan and coordinate many different health improvement activities1

Number of regional health care collaboratives in
the U.S. as of 2010.2

Percentage of the U.S. population that is covered
by Aligning Forces for Quality communities.3

Whats Working

Health care is local and improving it requires those in the community to be the
driving force for improvement. Every community is differentin its distribution of illness,
demographics, and culture. The same is true for the structure of local health care systems and the
types of cost and quality problems that patients, providers, and employers face.
RHICs are well suited to tackle local issues because they understand their markets, and can
organize and energize stakeholders. In addition, since they serve diverse geographies, no
two are alike.

The true benefit of

the multistakeholder
approach is that the
alliances create value
for all stakeholders in
the community. Instead
of each group advancing
strategies that can
conflict or compete,
they have a place where
they can come together
and reach a consensus
on how to improve care


For example, Maine Quality Counts and Aligning Forces Humboldt serve geographically dispersed
populations where providers are stretched thin, while the Greater Detroit Area Health Council
and the Common Table Health Alliance in Memphis serve largely urban populations with a
higher density of health care systems. Collaboratives also are created based on local conditions,
and their approaches to finding solutions reflect their roots and local needs. The Maine Health
Management Coalition, organized by employers, created public reports about the quality and, later,
the cost of health care to help employers steer employees toward high-value health care providers.
These reports also enable providers to see where they can improve quality. Providers created the
Wisconsin Collaborative for Healthcare Quality, which focuses on using performance measurement
data to let its members benchmark their performance against one another and share quality
improvement techniques.
Health care collaboratives offer an independent forum for convening
stakeholders, some of whom are competitors, filling a role no one else in the
community can. All stakeholdersincluding patients, clinicians, hospitals, health plans,
businesses, and the governmentare affected by the local health care system and any changes in
it. This means that all groups need to be involved in planning and implementing change. Bringing
these unlikely partners together can be a challenging task, since they are from different industries
that have diverse and sometimes conflicting goals.4
Since RHICs do not directly deliver or pay for health care services, they provide a common table
at which stakeholders can share knowledge, skills, and resources. This gives the community a place
to plan, facilitate, and coordinate programs that can change the health care system and strengthen
community relationships.
This independence helps position RHICs as a trusted source of information. The New Mexico
Coalition for Healthcare Quality was created as a result of a need in the community for a neutral
body to bring stakeholders together to help the community move toward a more transparent health
care system. Within a year and a half of its creation, the organization published its first public
report on provider performance.
Governing structures differ among collaboratives. Some ensure that organizations of different
stripes are equally represented. Others are governed solely by representatives of one sector, such
as health care providers, but they collaborate with payers, health plans, and consumer advocates in
their external work.
Leadership is a critical factor in the success of a RHIC. Elizabeth Mitchell, CEO of the Network
for Regional Healthcare Improvement, says successful RHICs have leadership teams that excel
at building and managing relationships. Katherine Browne, chief operating officer of the AF4Q
National Program Office, says it is harder to create a value proposition that multiple stakeholders
can realize in the near term than it is if you are trying to serve only one group, such as employers,
but that is what RHICs must do.
Top Five Must Reads on Regional Health Improvement Collaboratives



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Improving Health Care Quality Through Community



The Future of Collaboration: The Power of Collective Impact


Regional Coalitions for Healthcare Improvement: Definitions,

Lessons, and Prospects

Regional Health Improvement Collaboratives: Essential Elements for Successful Healthcare Reform.
Regional Health Improvement Collaboratives: Essential Elements for Successful Healthcare Reform.
Robert Wood Johnson Foundation. 2014. Aligning Forces for Quality. Accessed September 18.
Regional Health Improvement Collaboratives: Essential Elements for Successful Healthcare Reform.