Lessons From a 10-Year AF4Q Initiative on Improving Healthcare

Portland, Me – Lessons learned during the 10-year initiative, Aligning Forces for Quality (AF4Q), have given stakeholders more information than ever about both barriers and opportunities for improving the delivery of high-quality, cost-effective, equitable healthcare. Those lessons are detailed in a special supplemental issue of The American Journal of Managed Care being released today.

While the ideal healthcare system “remains out of reach,” says the former administrator of the Centers for Medicare and Medicaid Services (CMS), Donald M. Berwick, MD, MPP, “Aligning Forces for Quality (AF4Q)  offers insights for those who want to improve the health of their communities”. Berwick served as special Guest Editor for the issue, which you can read by clicking here.

The issue focuses on independent evaluation of AF4Q led by Dennis Scanlon, director of the Penn State Center for Health Care and Policy Research, and researchers at Northwestern University, the University of Minnesota, the University of Michigan and the George Washington University. This 10-year, mixed methods evaluation examined the AF4Q design and implementation across 16 regions, known as alliances, while the national healthcare environment underwent tectonic change, including the passage of the Affordable Care Act (ACA) in 2010.

“Change in healthcare happens locally because healthcare is local. AF4Q allowed these local relationships to expand and deepen” said Elizabeth Mitchell, one of the authors featured in the issue and president and CEO of the Network of Regional Healthcare Improvement (NRHI), a national network of 35 Regional Health Improvement Collaboratives. Thirteen of NRHI’s 35 member RHICs were AF4Q Alliances.

Funded by the Robert Wood Johnson Foundation, (RWJF) AF4Q aimed to improve the health and healthcare of 37 million people with the aim of providing models for widespread national reform. With AF4Q, RWJF sought to align five key “forces,” with the goal of improving healthcare and patient experiences, while reducing costs:

  • performance measurement and reporting
  • quality improvement
  • engaging consumers in their health and healthcare
  • reducing healthcare disparities
  • reforming payment


Key findings at the conclusion of AF4Q:

About NRHI

The Network for Regional Healthcare Improvement is a national organization representing regional multi-stakeholder groups working to achieve the Triple Aim of better health, better care, and reduced costs through continuous improvement. NRHI and all of its members are non-profit organizations, separate from state government, collaborating directly with physicians, hospitals, health plans, and patients to improve health care through the use of data. www.nrhi.org


About the Robert Wood Johnston Foundation

For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and health care of all Americans. We are striving to build a national Culture of Health that will enable all Americans to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook


About the American Journal of Managed Care

The American Journal of Managed Care is the leading peer-reviewed journal dedicated to issues in managed care. AJMC.com distributes healthcare news to leading stakeholders across a variety of platforms. Other titles in the franchise include The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.


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