Craig Brammer
Director,
Cincinnati AF4Q

On May 11, President Obama met with representatives of trade groups including the American Medical Association, America's Health Insurance Plans and the American Hospital Association to discuss health care in America. The groups pledged to reduce health care costs by 1.5 percent annually by increasing efficiency in the way health care is delivered. The President projected that such a commitment would save $2 trillion over 10 years.

The Obama Administration has listed reduction in health care costs as a priority, along with ensuring that all Americans have health care coverage and rewarding doctors for the quality - not the quantity - of the care that they provide. Many are looking to the 15 Aligning Forces for Quality (AF4Q) markets across the United States to be pioneers in health care cost and quality reform.

Now in its second year, Cincinnati AF4Q continues to actively address health care improvement through five inter-related approaches.

Quality Improvement
Chair: Stephen Grossbart, PhD

By helping providers gather and evaluate patient data, this workgroup is delivering essential training and technical assistance for those working to improve systems of care in our community.

• The Primary Care Innovation Group (PCIG), a consortium of 10 primary care practices, concludes its 18-month program in the fall. Results to date indicate:
  • A 21 percent increase in the number
    of patients who have a
    measured HbA1c < 7
  • A 9 percent increase in the number
    of patients whose blood pressure
    met the goal of < 130/80
  • An 8 percent increase in the number of patients with LDL < 100
• In April, AF4Q launched the Cincinnati Expecting Success project, an initiative to help local hospitals obtain highly reliable race, ethnicity and language data so that they can then see where disparities are occurring and be better positioned to address any inequities in treatment and outcomes.

Health Information Technology
Chair: Michael Hibbard, MHSA

In close partnership with HealthBridge, one of the leading Health Information Exchanges in the United States, the HIT workgroup is working to capture clinical data from electronic health records for performance measurement and improvement.

• HealthBridge supports a registry for PCIG practices.
• HealthBridge is piloting data extraction from electronic medical records for performance measurement.
• The workgroup is closely following federal policy to identify opportunities for stimulus funding for our region relative to quality measurement and improvement.

Performance Measurement
and Public Reporting
Chair: Jeff Susman, MD

Based in part on learnings from the PCIG pilot, data on diabetes care is being collected from primary care practices across the region, with the goal of publicly reporting performance measures for 50 percent of area primary care physicians by the summer of 2010.

• Area physicians are helping shape the design of the measurement strategy that will be deployed in Cincinnati. (View editorial by Jeff Susman, MD.)
• Guiding principles have been established by area physicians for the effort: transparency, valid measurement and incentive alignment.
• The workgroup is working closely with Minnesota Community Measurement (MNCM), using their highly successful measurement strategy as a model. (View MNCM's measurement strategy.) MNCM is widely viewed as a national leader in outpatient quality measurement. Cincinnati's work with MNCM represents the first time this technology has been exported beyond Minnesota.

Consumer Engagement
Chair: Judy Hirsh

The aims of this workgroup are to provide consumers with resources that encourage them to take a more active role in their own health care and to aid in the design of a public reporting system that is engaging and useful to consumers.

• The workgroup has developed partnerships to enable the distribution of Diabetes Footprints Campaign materials to more than 90,000 Greater Cincinnatians with diabetes in the next year.
• Judy Hirsh, a Procter & Gamble health care marketer, is conducting groundbreaking research on how best to engage the public in health care quality measurement. Preliminary findings indicate that:
  • Consumers lack a sense of the overall quality of care provided in Cincinnati.
  • Consumers welcome having comparative information about outcomes.
  • For consumers, quality of care is more about the emotional connection with their provider than about clinical outcomes.
  • If a practice is not highly rated, most consumers want to work with their doctor to understand what the practice will do to improve. Most consumers want to stay with their current physician.

Patient-Centered Medical Home
Chair: Robert Graham, MD

This workgroup is executing one of a few pilot programs in the country with the aim of focusing practice reimbursement on prevention and maintenance, rather than response to acute illness.

• Leading health plans and employers in our region are working with primary care practices to decide on common measurements and collaborate on the program's design. (View a model Medical Home.)
• Evaluation of Cincinnati's Patient-Centered Medical Home (PCMH) pilot is conducted by Meredith Rosenthal at Harvard University and supported by the Commonwealth Fund, a private foundation working toward improvements in quality and efficiency.
• The PCMH pilot will launch in the fall of 2009, with 10 to 15 physician practices that will be reimbursed differently than their peers.
• This workgroup is working closely with PCMH leaders across the United States. As PCMH is a key component of the Obama Administration's health care reform agenda, the local PCMH model is being monitored by state and national policy makers.

Combined, these workgroups are taking tangible steps to empower consumers to access quality health care, help providers improve the efficiency and quality of the care they offer, and ensure that care is equitable for all people in Greater Cincinnati.

Sincerely, Craig Brammer