Funder: Robert Wood Johnson Foundation

April 2009 | Toolkit



The Center for Health Care Strategies’ Regional Quality Improvement (RQI) initiative was designed to leverage Medicaid’s significant purchasing power to improve chronic illness care through partnerships with commercial insurers, employers, providers, and consumer organizations.

Over the course of this initiative — implemented in Arkansas, North Carolina, Rhode Island, and Rochester, New York — CHCS collected and created a number of tools related to regional quality improvement, including specific strategies undertaken by participating regions. These resources are housed in this online toolkit for health care leaders interested in creating public-private partnerships to transform the quality of chronic care.


Design and Planning

The following resources can help organizations in the design and planning phase of regional quality improvement, providing examples of steps taken by the four RQI sites.

Regional Quality Improvement Initiative: Project Logic Models – Organizations participating in the RQI initiative benefited from developing logic models for their interventions. This process assisted the sites in standardizing key components of their planned activities.

Issue Brief: Creating Regional, Cross-System Quality Improvement: Early Lessons from Three Multi-Stakeholder Coalitions – This brief outlines key steps taken by the RQI initiative sites to establish a platform for improving quality throughout their regional health care systems.

Webinar: Roles for State Purchasers in Driving Cross-Payer Health Care Quality Improvement – Representatives from Rhode Island and Arkansas described their state efforts to improve care for all patients, regardless of insurance type.


Measurement and Data

The following resources illustrate the strategies adopted around data collection and reporting to create regional quality improvement.

Data Collection and Reporting Overview – This matrix presents an overview of the data collection and reporting activities that each of the four RQI sites is adopting. Data is collected uniformly across multiple payers at each site and aggregated at the physician level.

Common Measures Overview – The coalitions composing each RQI site have adopted common performance indicators to uniformly measure improvements in quality at the practice level throughout each region. This document presents the set of common measures selected by each site.

Approaches to Attribution for Measuring Physician Performance – In this presentation, Dr. Mai Pham, senior health researcher at the Center for Studying Health System Change, shares information about common patient-to-physician attribution methods being adopted by multi-payer quality improvement coalitions, and the pros and cons of their approaches.

Physician-Level Measurement and Reporting – These two presentations, from Jim Chase, executive director at MN Community Measurement and Sarah Hudson Scholle, associate vice president for Research at the National Committee for Quality Assurance (NCQA), discuss the benefits of, obstacles to, and strategies for measuring quality at the physician level.

Public_Reporting – These two presentations, from Barbra Rabson, executive director of Massachusetts Health Quality Partners and Jessica Greene of the University of Oregon, discuss consumerism in health care — from selecting a health plan, to identifying the best performing physicians/hospitals, to effectively managing one or more chronic conditions.


Practice Site Improvement and Financing

The following resources can help organizations learn about practice site improvement and financing strategies for creating regional quality improvement.

Practice Site Improvement and Financing Overview – This matrix presents an overview of how the four RQI sites are supporting physicians – financially and non-financially — to improve quality at the point of care.

Quality Improvement with an Electronic Health Record: Achievable, but Not Automatic – In this article, Dr. Richard Baron describes one small physician practice’s experience using EHRs to support a project to improve its mammography rate.

Redesigning Chronic Care at the Practice Level and Paying for It – These two presentations, from Robert Berenson, senior fellow at The Urban Institute and Deidre Gifford, chief of Health Policy and Programs at Quality Partners of Rhode Island, describe various financing strategies to support quality improvement at the point of care, including investment in HIT, multidisciplinary care teams, and practice redesign.

Advancing Health Information Exchange Initiatives through Medicaid-Led Regional Efforts – Developing an HIT/HIE infrastructure is a critical component of improving the quality of chronic care throughout a region. This presentation, from Shannah Koss, former vice president and director of HIT at Avalere Health, describes HIT/HIE efforts led by Medicaid programs.