In 2007, the Robert Wood Johnson Foundation launched Aligning Forces for Quality, a multi-phase trial program to raise the overall quality of health care and reduce racial and ethnic disparities in 16 U.S. communities. The initiative began with the hope of producing models for future national health care reform.

Now, a new report co-authored by School of Public Health Professor Jon Christianson reveals the lessons learned from the project.

The report was recently published in the American Journal of Managed Care.

The program attempted to align and improve five key “forces” that can dramatically affect health care performance and satisfaction: performance measurement and reporting; quality improvement; consumer engagement in their health and health care; health care disparities reductions; and payment reform.

Attempts to improve the forces in each community were driven by a consortium of local organizations, known as an “alliance.” The 16 alliances were made up of groups like health departments, insurance plans, medical societies, and clinics as well as patients, nurses, and physicians.

“There was a wide range in performance across the funded alliances and across different pre-specified outcome measures,” says Christianson. “Overall, our findings reinforce how difficult it is to accomplish significant change in community health care systems through the efforts of voluntary community stakeholder coalitions, even under the best circumstances.”

Christianson and his colleagues found that implementing and aligning activities by alliances across all five forces proved difficult for any one community. The report said that there are many challenges to sustaining regional relationships, engaging consumers, maintaining quality and price transparency, and reducing disparities.

In terms of successes, the study reported the work of the alliances produced some promising models for health care reform. The study also noted that the idea of transforming the system “by patients and for patients” is gaining traction and that disparity reductions occurred with more intensity in areas that had long-established relationships with community groups representing diverse and underserved populations.

In the end, while all communities tended to trend toward improvement, the alliances showed no major differences in improvement rates in quality and health measures examined when compared with control communities.