Letter From the Guest Editor

Dear Colleague:

I am excited to present this supplement to The American Journal of Managed Care entitled “The Aligning Forces for Quality Initiative: Early Lessons From Efforts to Improve Healthcare Quality at the Community Level.” The Aligning Forces for Quality (AF4Q) initiative is a bold and historic effort to test an important and promising approach to improving healthcare system performance, and these papers constitute the first attempt to assess its effects.

The old truism that “all healthcare is local” lies at the heart of the design of this initiative. If we want to improve the quality and efficiency of care, we must ultimately change behavior among critical players at the local level where clinicians and institutions work together (or more commonly, don’t) to provide healthcare services and consumers make personal choices about their health and healthcare. The critical question facing would-be healthcare reformers is how to create the means and the will to build more coordinated, collaborative, and effective healthcare systems in the local neighborhoods and communities where providers and consumers live and work

Recognizing this challenge, the AF4Q initiative addresses it head on and with greater comprehensiveness and focus than any previous governmental or philanthropic effort. The AF4Q initiative was launched in 2006 and will continue (at least in its current form) until 2015. It builds multi-stakeholder partnerships—among insurers, providers, purchasers, and consumers—for the purpose of improving patient health and healthcare. These partnerships focus on aligning these key players—building coordinated action plans for improvement—in 5 main programmatic areas: (1) measurement and public reporting of healthcare quality and efficiency for ambulatory physician practices and hospitals; (2) efforts to engage consumers as partners in their own care (consumer engagement); (3) adoption and spread of effective quality improvement strategies to improve care; (4) ensuring the equitable receipt of healthcare; and (5) integration of alliance activities with payment reform initiatives.

The AF4Q initiative is expanding and evolving over time. In the first 5 years, alliances have focused on engaging consumers in their care and improving the quality of care

patients receive through quality improvement activities. Communities will face new challenges as they continue to build on their investments and strive to maintain the

momentum necessary to deliver measurable improvements in patient health and healthcare.

Building alliances that succeed at the local level is hard work. They must overcome intense competition among providers, divergent interests between providers and payers, and deficits in information and understanding among consumers. Although the will to work together may exist, the knowledge of how to do so, how to build systems and processes that actually change quality and efficiency, is scarce. No matter what global changes in policy are instituted in Washington or state capitals, they will not succeed unless the kinds of alliances and programs envisioned by the Robert Wood Johnson Foundation arise and flourish. That is why this program is such an important initiative, and why its evaluation will be of such great interest to policy makers and scholars.

It is still very early in the life cycle of a program as complex and ambitious as the AF4Q initiative, and the evaluations published in this supplement capture experiences that may have changed (given the time it takes to analyze and publish results). Nevertheless, the work presented here is an essential first step in a process of learning, an assessment that should continue for some time to come.

This supplement includes 8 original research manuscripts describing the AF4Q initiative and results thus far. Select publications appear in the print issue, and all manuscripts are available online at ajmc.com. Perspectives of the AF4Q initiative are presented in 6 articles from nationally recognized thought leaders. All perspective articles appear in the print issue and are available online.

Please refer to the Table of Contents on page S89 to begin learning about the AF4Q initiative, preliminary results, and future implications of this important endeavor.

Sincerely,

David Blumenthal

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