The Robert Wood Johnson Foundation: Anne Weiss, Team Director and Senior Program Officer

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The Robert Wood Johnson Foundation is the nation’s largest philanthropic organization that is dedicated solely to the public’s health. Founded in 1973, RWJF’s mission is to improve the health and healthcare of all Americans.

According to Anne Weiss, team director and senior program officer, one of the Foundation’s greatest assets is the way in which it helps to create leverage for change.

Organizing forces for quality

Currently, one of the Foundation’s signature initiatives is Aligning Forces for Quality, a program that confronts vexing problems in healthcare quality and cost on a local level. This program is the product of more than a decade of experimental highs and lows, during which time RWJF has been working to address these issues.

For example, the foundation supported early efforts to measure healthcare quality and oversaw early pay-for-performance experiments. It has also played a high-level role in developing a chronic-care model that is rethinking the delivery of care outside of the hospital, especially to those with chronic illnesses. Additionally, RWJF has championed the incorporation of safety techniques that originated in other industries into the hospital environment.

In spite of the foundation’s diligence, though, Weiss said staying ahead of the problems is a staggering task.

“We were first of all frustrated that the pace of change was not keeping pace with the growing urgency of the problem,” she explained. “There’s no silver bullet. There’s no one thing you can do to fix a broken system.”

Factor in the intensely local aspect of healthcare, along with differences in systems, and it becomes difficult to implement blanket change across the delivery spectrum. Because of this, RWJF adjusted its strategy from national to local.

“We decided to adopt a strategy that would identify a limited number of target markets or communities and bring to bear all of the different lessons and approaches that we’d developed in that first generation,” Weiss said. “We really believe and we’ve learned that you have to bring together the people who give care, the people who get care, and the people who pay for the care. No one of those kinds of stakeholders alone could fix these problems. They needed to work together. They needed to align their efforts. ”

RWJF launched four pilots in 2006, then went national with Aligning Forces for Quality in 2007. As of 2011, they’ve launched the third strategic phase in Aligning Forces and are working in 16 target markets around the country, four of which are states while the others are multi-county regions or metropolitan areas. In these markets, the leadership teams consist of the providers, the purchasers, and the consumers.

Centered around three core strategies

RWJF works with each team on three core strategies–measuring and making public information about the performance of their system (e.g., how good the clinical care is, the patient’s experience of care, and the cost of care); engaging providers in quality improvement and building  providers’ capacity to improve quality; and working to engage consumers in being demanding of better care, being responsible for their own care, and being more effective consumers of care.

The lynchpin of these three strategies is information.

“They all turn on information,” Weiss said. “They all turn on people agreeing to measure and be transparent about how the healthcare system in their market is performing. That really is the transformational step, and I’m really proud of the progress we’ve made.”

Recently, RWJF has increased its emphasis on encouraging communities to experiment with payment reform.

“The current way that healthcare is paid for in this country really aggravates the problems of poor quality and high cost,” Weiss said. “If communities can come together and talk about ways to have real leverage over quality and cost in their community, then they’re not waiting for the federal government to mandate changes in reimbursement policy by Medicare.”

She added, “Payment reform is becoming an increasing part of their tool kit.”

Reducing racial and ethnic disparity

Another aspect to Aligning Forces, Weiss said, is the reduction of racial and ethnic disparities in care. She believes that people do not always recognize the degree to which minorities are not given the same quality of care from their system.

“There are clearly a lot of social and economic factors that contribute to those problems,” Weiss clarified, “but it’s also clear that some of the solution lies in the healthcare system.”

RWJF encourages providers to analyze the race and ethnic information of their patients to analyze patterns of care. Many times, when providers think there aren’t any disparities in their system, Weiss said an analysis of the data proves otherwise.

In 2009, Saint Luke’s Health System and Truman Medical Center became sites for two of RWJF’s  initiatives focused on reducing disparities, one aimed at  improving cardiac care for minority patients and the other focused on aiding hospitals in learning how to more effectively deliver language services. So far, Weiss said, these initiatives have been a huge success.

Working for 2015

RWJF has set a deadline of 2015 for Aligning Forces for Quality. At this point, the initiative’s effectiveness will be examined.

“We are intensely focused on  2015 ,” Weiss said. “We are all about getting these 16 communities to a place where we can tell a story about how, with very different assets and in very different markets, they all improved quality, took on the cost curve, and improved patient experience.”

Weiss is confident that RWJF’s locally based approach to healthcare change is the catalyst that will drive future reform.

“Transformational change in healthcare is essentially local and will not be possible if we don’t have an aligned partnership of the people that deliver care with the people who are paying for the care, the business community and the health plans, and a meaningful engagement by the consumers,” she said. “It takes those stakeholders working together to really create the incentives and support for change. You cannot do it alone, no matter how healthy your bottom line is.”

-by Pete Fernbaugh

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