Aligning Forces for Quality (AF4Q) in Minnesota
Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities and provide models for national reform. AF4Q asks the people who get care, give care and pay for care to work together toward common, fundamental objectives to lead to better care. The 16 geographically, demographically, and economically diverse communities participating in AF4Q together cover 12.5 percent of the U.S. population.
Led by MN Community Measurement (MNCM) and guided by a broad stakeholder group, Minnesota was an ideal partner for Aligning Forces for Quality. Through AF4Q, MNCM has served as a national model for quality measurement. Over the last eight years, AF4Q communities have built transformative partnerships, often where none existed before.
The MN AF4Q Alliance has helped to bring providers, consumers and community partners together to measure and assess everything from how doctors treat simple infections to more complicated measures that assess how hospitals, physicians and other health care providers manage costly, chronic conditions such as diabetes and heart disease, as well as how well they communicate with patients.
- Download the full report: A State of Innovation: The MN AF4Q Alliance’s Report to the Community (PDF)
- View the final report on the national initiative: Aligning Forces for Quality: A Tremendous Journey (PDF)
- Read the MNCM article: “After Eight Years, AF4Q Comes to a Close“
Cycle 1.0 – Pulling Together for Priorities
The Minnesota AF4Q community pulled together quickly to tackle its first two priorities: consumer engagement and ambulatory care quality. Additionally, voluntary patient experience reporting was also initiated during this cycle.
- 2006: Aligning Forces for Quality (AF4Q), Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities and provide models for national reform is formed. Minnesota is selected as one of the initial four sites.
- 2006: Patient Experience Measurement work begins.
- 2007: Consumer engagement starts to take shape. Minnesota takes part in Consumer Engagement Learning Communities to start the process.
- 2007: The D5 for Diabetes is launched to engage patients with optimal diabetes care.
- 2007: Minnesota develops measures for physician and ambulatory quality reporting for AF4Q.
Cycle 2.0 – Reducing Disparities and Improving Hospital Care
While the work started in Cycle 1.0 continued, new activities also kicked off that focused on reducing disparities and improving hospital care.
- 2008: Goals and strategies are set in participating communities with the focus on hospital care and reducing disparities.
- 2009: Race, Ethnicity and Language (REL) data collection begins.
- 2009: MNHealthScores.org was launched as part of consumer engagement efforts.
- 2009: Measures for Depression, Asthma, Colorectal Screening and Diabetes were formed to address the goal of improving publicly reported data. This measurement work continued throughout the entire grant cycle.
- 2010: MNCM’s diabetes measure was endorsed by the National Quality Forum, considered the gold standard for health care measurement in the United States.
- 2011: The Patient Experience measurement work continues with the Let’s Talk: A Guide for Transforming the Patient Experience through Improved Communication roundtable.
- 2011: The Ambulatory Provider Quality Improvement measure work ends.
Cycle 3.0 – Focusing on Payment Reform and the Cost of Health Care
With strengthened partnerships, new tools and increased trust with providers and consumers, the Minnesota AF4Q community turned its focus to payment reform and the cost of health care.
- 2011: New phase of AF4Q continues work on consumer engagement, performance measurement and quality improvement. Activities also include a focus on payment reform and cost measures, along with inpatient and ambulatory care. Colorectal cancer screening, depression and asthma interventions are emphasized.
- 2011: Minnesota alliance partners launch numerous initiatives, including RARE, high tech diagnostic imaging (HDTI), total cost of care, and health information technology.
- 2012: ConsumerReports partnered with MNCM to publish a special supplement for Minnesota subscribers focused on high-quality diabetes and vascular care. It included ratings of 552 clinics statewide and regional analyses.
- 2012: High Tech Diagnostic measure sets goal of limiting the increase in HDTI by four percent per year.
- 2012: First state mandated survey on Patient Experience, with 710 clinics participating. Data is published and available to both provider groups and the public at MNHealthScores.org.
- 2013: Building on the DIAMOND initiative, the Help and Healing toolkit is created to foster collaboration between patients and providers. Developed through a partnership between MNCM and the Minnesota Health Action Group, the toolkit also supports employer engagement with effective depression care.
Cycle 4.0 – Sustaining the Momentum
Moving into its final cycle, Minnesota’s AF4Q Alliance continued to build on the milestones accomplished in previous cycles and complete several critical long-term projects — all with an emphasis to sustain the momentum after the conclusion of the AF4Q initiative.
- 2013: Shift towards sustainability into a business model through community conversations, broadening stakeholder groups, identifying community resources, and leadership team retreats.
- 2013: Mini-grant initiatives are introduced as part of the sustainability model.
- 2013: The RARE campaign reaches goal of preventing 6,000 avoidable admissions within 30 days of discharge with 7,975 readmissions prevented. The campaign also reduced overall admissions rate by 20% from 2009 and maintained it through 2013.
- 2014: MNHealthScores.org was highlighted as a robust resource for quality and cost information in a report by the Catalyst for Payment Reform (CPR) and Healthcare Incentives Improvement Institute (HCI3).
- 2014: Minnesota, Massachusetts and Wisconsin AF4Q alliances recognized by RWJF for their collaborative work with ConsumerReports to help consumers make informed health care choices.
- 2014: The RARE campaign ends in 2014 with almost 8,000 prevented avoidable readmissions and close to 32,000 more nights at home instead of in the hospital.
- 2014: A report by the MN Department of Health shows that 43% of the state’s primary care clinics are now certified as Health Care Homes (HCHs). An additional study by the University of Minnesota indicates that these clinics reduced Medicaid costs and outperformed non-HCH clinics on quality.
- 2014: Launch of redesigned MNHealthScores.org website.
- 2014: Minnesota releases nation’s first total cost of care data that allows consumers for the first time to compare the cost of care at medical groups across the state. Costs from more than 1.5 million patients were included.
- 2015: Minnesota releases first-of-its-kind Health Equity of Care Report which includes statewide and regional results showing disparities in care for diabetes, vascular and asthma care as well as colorectal cancer screening by race, Hispanic Ethnicity, preferred language and country of origin.
Cycle 4.0 Mini-grants - Supporting Partner Initiatives
In Cycle 4.0, AF4Q provided additional technical support as mini-grants. This funding supported five Minnesota Alliance partner initiatives that further developed sustainable networks, supported consumer engagement and facilitated strategic alignment. The projects included:
Collective Action Planning
The Minnesota Council of Health Plans, with metropolitan public health and hospital partners under the auspices of the Center for Community Health, conducted a community scan and drafted a Collective Action Planning report that details how community partners aligned mental health measures and activities. The report included lessons learned as well as recommendations for implementing and measuring collective action.
Community Health Worker Integration in Asthma and Mental Health Care
Called Success with CHWs, this multi-faceted educational initiative was developed by the Minnesota Community Health Worker (CHW) Alliance to increase awareness and adoption
of team-based CHW strategies among pediatric asthma care and mental health providers.
Evaluation of Benefits and Burdens of Medical Group Performance Reporting
Acknowledging the tremendous effort providers put forth to meet requirements associated with data submission, this initiative strived to uncover the causes of data collection burden and document the benefits to health care providers who participate in health care measurement and reporting programs. Deliverables included: A literature review & analysis on provider burden; key informant interviews & summary report; a 8-12 page white paper of findings and recommendations; a measurement brief – depression measures and a measurement brief – provider benefits and burdens
Measures Testing Lab
MNCM developed an online platform to efficiently test newly developed quality measures. The Measures Lab will facilitate testing the feasibility, reliability and validity of new measures before submitting them for endorsement or inclusion into federal programs or to support quality improvement efforts.
Multi-lingual Advanced Care Planning Resources
Through this initiative, patient education videos on how to complete and share advance care planning were created and translated into Somali, Hmong and Spanish languages by The Twin Cities Medical Society— Honoring Choices Minnesota.