To improve chronic care throughout a region or state, key stake­holders in the health care marketplace must implement coordinated strategies at the purchaser, health plan, provider, and consumer levels. When this health care system alignment occurs, major breakthroughs in improving health care quality can be achieved.

The Regional Quality Improvement (RQI) initiative is designed to test Medicaid’s capacity to drive system-wide improvements in chronic care delivery through partnerships with other health care stakeholders, including commercial insurers and large employer purchasers. RQI is coordinated by the Center for Health Care Strategies (CHCS), with funding from the Robert Wood Johnson Foundation. The initiative includes three sites – the state of Arkansas; Rochester, New York; and the state of Rhode Island – where Medicaid is leading the effort to influence broader marketplace efforts to improve health care quality.

This issue brief outlines key steps taken by the RQI sites to establish a platform for improving quality throughout their regional health care systems. Efforts to target common chronic conditions, adopt common performance measures, support common provider improvement interventions, and develop a consistent payment method to support and sustain provider interventions, are examined, as is the ongoing effort to keep stakeholders at the table.