Research

Research center completes 10-year evaluation of health care study

UNIVERSITY PARK, Pa. — The Center for Health Care and Policy Research (CHCPR) at Penn State has completed a novel 10-year evaluation of a massive community health care study undertaken by the Robert Wood Johnson Foundation (RWJF).

Led by Dennis Scanlon, professor of health policy and administration and director of CHCPR, a team of researchers evaluated RWJF’s 10-year study to improve the delivery of high-quality, cost-effective, equitable health care. Known as Aligning Forces for Quality (AF4Q), the study was intended to identify barriers and opportunities for change in health care. RWJF is the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans. 

"Such change needs to happen locally, even in the context of significant federal policy changes, such as the Affordable Care Act (ACA),” Scanlon said. “Our findings from AF4Q provide insight into the important work happening locally to create better health care systems and the many challenges regions face when trying to make things better and more affordable.”

AF4Q was a $300 million initiative involving 16 different communities across the United States. The AF4Q sought to improve the health and health care of 37 million people with the aim of providing models for widespread national reform.

From a wellness check to major surgery, patients, providers and purchasers all experience the complexity of a mammoth system with many moving and interrelated, yet often isolated, parts. With AF4Q, RWJF sought to align five key “forces,” with the goal of improving health care and patient experiences, while reducing costs:

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

The American Journal of Managed Care published a special supplement Aug. 24 on the lessons learned from the independent evaluation of AF4Q led by Scanlon and colleagues at Penn State, as well as researchers at Northwestern University, the University of Minnesota, the University of Michigan and the George Washington University. Using a mixed methods evaluation, the researchers examined the AF4Q design and implementation across 16 regions, known as alliances. The study continued through tectonic changes in the national healthcare environment, including the passage of the ACA in 2010.

Scanlon and his research team evaluated the impact of the AF4Q program in each of the 16 communities. Specifically, they focused on whether the program resulted in changes in the care of patients with chronic illnesses or in improvements in structures and processes that can lead to improved health care.

Key findings at the conclusion of AF4Q:

  • Implementing and aligning activities across all five “forces” proved difficult for any one AF4Q community. 
  • While collaboration among stakeholders to improve systems is conceptually appealing, there are many challenges to sustaining regional relationships, though AF4Q highlighted some promising models.
  • Over time, the AF4Q regions showed no major differences in improvement rates in quality and health measures examined, compared with control communities. However, all communities tended to trend towards improvement.
  • Engaging consumers in reforming the system proved more difficult than expected, but the conversation has been elevated. The importance of transforming the system “by patients and for patients” is gaining traction.
  • Sustaining quality and price transparency at the community level is challenging. Important questions moving forward include: Who will fund and produce this information, and who receives the most value from it?
  • Disparity reduction activities proved challenging but happened with more intensity in communities that had long-established relationships with community groups representing diverse and underserved populations.

The American Journal of Managed Care supplement features three guest commentaries in addition to the eight original research reports.

“Social scientists will for many years be mining the AF4Q experience for detailed lessons and ethnographic and political insights,” said Donald Berwick, MD, MPP, former administrator of the Centers for Medicare and Medicaid Services. Berwick served as special guest editor for the supplement.

Berwick described the evaluations detailed in the reports as “both quantitative, in nearly breathtaking scale, and qualitative,” including the summary by Scanlon and his co-authors.

Last Updated August 26, 2016

Contact