Chapter 1. Introduction

Value-Driven Health Care

The Value-Driven Health Care Initiative launched by the Department of Health and Human Services (HHS) is designed to help achieve high-quality, cost-effective care for patients. Through a collaborative process that brings together community stakeholders, such as providers, employers, health plans, and consumers, the initiative will drive clinical quality improvement by providing the public and providers with reliable and consistent health data.

An essential component of implementing value-driven care is creating a national network of regional coalitions. By making comparable information widely available at the local level, regional coalitions are crucial to helping stakeholders make informed health decisions and improve health care quality on a broad, systemic level. They accomplish this important goal by fostering collaboration across multiple stakeholders in the community and facilitating four national cornerstone actions designed to enhance the effectiveness of our health care system:

1. Connecting the system through health information technologies.
2. Measuring and publishing quality data based on agreed-upon standards.
3. Measuring and publishing price information for specific services to patients.
4. Creating positive incentives that reward high-quality, cost-effective care and encourage consumers to actively choose the care that meets their needs.

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The Community Leader's Role

An important first step to forming a regional coalition for this initiative is for HHS to recognize a community group as a community leader. These local, multiparticipant organizations are designated Community Leaders because they demonstrate the capacity for developing key characteristics of a regional coalition, including:

• Actively engaging with critical stakeholders in the community.
• Facilitating the collection of provider-level measurement across the six Institute of Medicine performance domains (safe, timely, effective, efficient, equitable, and patient-centered).
• Using, or promoting the use of, performance measures for:
  • Publicly reporting costs and consumer satisfaction.
  • Rewarding and fostering better performance.
  • Provider improvement.
  • Fostering collaboration across multiple stakeholders and serving as a hub for sharing information and dialogue.

The initial stages of forming and maintaining these and other aspects of a regional coalition can be challenging for Community Leaders. This guide is a compilation of insights and lessons learned culled from six established regional coalitions to help guide Community Leaders as they begin to formulate strategies for developing their own coalitions.

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The Better Quality Information Project

Several regional coalitions currently are operating around the country. The Ambulatory Care Quality Alliance and the Agency for Healthcare Research and Quality (AHRQ) selected the six groups represented in this document to participate in the Better Quality Information (BQI) to Improve Care for Medicare Beneficiaries Pilot Project. The pilot sites in this national project sponsored by the Centers for Medicare & Medicaid Services are:

• The California Cooperative Healthcare Reporting Initiative, San Francisco, California.
• The Center for Health Information and Research-Arizona State University, Tempe, Phoenix, Arizona.
• The Indiana Health Information Exchange, Indianapolis, Indiana.
• Massachusetts Health Quality Partners, Boston, Massachusetts.
• Minnesota Community Measurement, St. Paul, Minnesota.
• The Wisconsin Collaborative for Healthcare Quality, Madison, Wisconsin.

Before the Ambulatory Care Quality Alliance and AHRQ selected these coalitions as BQI sites in 2006, each community group had independently brought together a variety of constituencies to combine public and private data for measuring and, ultimately, reporting on physician practice in its geographical region.

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Lessons Learned From BQI Sites

As a way to capture and share with Community Leaders the rich knowledge these six pilot sites have gained through successfully building and managing regional coalitions, AHRQ has collaborated with the Delmarva Foundation to produce this broad compilation of essential lessons learned.

Because each coalition is unique in its specific regional setting, this guide is not intended to be a one-size-fits-all toolkit or a detailed "how-to" guide. Rather, the information captured from the BQI sites is organized around key issues of interest to Community Leaders that are in the process of forming a coalition. Community leaders will need to apply these general lessons on leadership skills, establishing the coalition's credibility, building trust among stakeholders, and communication to their own circumstances. For further reference, the appendices include overviews for each BQI site, a chart comparing the sites, the framework behind the site visits, summaries of the site visits, a list of mentors who Community Leaders may contact for advice, and resources.

This guide will assist Community Leaders in taking the crucial first steps in creating and sustaining a regional coalition. It is through the vision, leadership, and hard work of Community Leaders that the Value-Driven Health Care Initiative will successfully transform American health care into a truly value-driven system.