Across the U.S., there are wide gaps between the health care that people should receive and the care they actually receive. The Robert Wood Johnson Foundation (RWJF) is working to close these gaps through Aligning Forces for Quality (AF4Q), a multi-stakeholder effort to improve the overall quality of health care in 16 targeted communities (“alliances”), reduce racial and ethnic disparities, and provide models for national reform. 

As the nation’s largest health coverage program, Medicaid can use its purchasing leverage, access to performance and race/ethnicity data, and financial resources to transform the way health care is delivered and paid for throughout a region. Medicaid can work with other purchasers and its partners, including health plans, quality improvement organizations, and provider practices, to advance cross-payer, system-wide improvement efforts. The Center for Health Care Strategies (CHCS) provided technical assistance to engage Medicaid in the AF4Q initiative, with activities ranging from one-on-one technical assistance to group collaboratives.

CHCS technical assistance addressed:  

  • Delivery System and Payment Reform:  CHCS provided technical assistance to better align regional efforts with state-level programs. For example, CHCS facilitated discussions between alliances and state leadership in the State Innovation Model program; convened community discussions in states rolling out health homes; and helped alliances define performance measurement strategies that align regional and state requirements.
  • Improving Quality by Reducing Disparities:  CHCS worked with the University of Chicago’s Finding Answers: Disparities Research for Change to facilitate disparities-focused quality improvement interventions at ambulatory practices. Technical assistance emphasized using data to reduce disparities and incorporating a focus on equity into existing quality improvement efforts.
  • Federally Qualified Health Center (FQHC) Leadership and Quality Improvement:  CHCS  worked with the South Central Pennsylvania alliance to design and deliver a learning collaborative for medical directors in quality improvement design for five FQHCs in the region.
  • Connecting the Dots on Super-Utilizer Programs:  Super-utilizer programs provide intensive outpatient care management to complex, high-needs patients to improve health outcomes and reduce costs. CHCS worked with alliances to share strategies for effective implementation of super-utilizer focused approaches.

About Aligning Forces for Quality

The Center for Health Care Quality at George Washington University supports RWJF as the national program office for AF4Q. For more information about AF4Q, visit