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OVERALL AIM: To: a) prioritize coordination among existing national initiatives focused on regional health care improvement; b) promote the development of strong regional leaders and leverage partnerships with regional leaders to help drive sustainable improvement; c) capture knowledge and experience gained through these initiatives and spread that knowledge within and beyond current participating communities; d) ensure readiness for reform in other geographic regions; and, d) foster networking among national and regional leaders in a wide range of communities seeking to improve cost and quality of care. PARTNERS: The Robert Wood Johnson Foundation/Aligning Forces for Quality, The Agency for Healthcare Research and Quality/Chartered Value Exchange, and the Office of the National Coordinator for Health Information Technology/Beacon Communities; Network for Regional Health Care Improvement, Key Regional Leaders. SPREADING AND SUSTAINING REGIONAL CHANGE Independently, the major initiatives have supported an aggressive agenda to partner with and assist local regional leaders to promote sustainable improvement in quality and cost of care in targeted communities. Together, these national initiatives working with their local partners can and must work together to build on these successes to enhance coordination of those efforts, ideally, establishing a community of regional leaders across America. This work will be supported by the tested resources and technical assistance of each partner and its collaborators, but led increasingly over time by the communities themselves. Leveraging knowledge gained by existing regional reform efforts²and spreading to other regions equally positioned for change²will help communities across the country make substantial progress toward achieving sustainable high value care.
BACKGROUND: A number of major national initiatives are bringing or attempting to bring an unprecedented commitment of resources, expertise and training to help leaders in local and regional health care markets dramatically improve the quality and cost of care. Participating communities have already achieved a great deal and are now working even harder to make significant progress in their regional efforts. These large national initiatives importantly demonstrate that reform can and probably must unfold region by region. For that to happen, local or regional multistakeholder leaders need to design and implement changes in the way their respective market organizes, delivers and pays for health services. While these initiatives have much in common, each has a unique emphasis and strengths and growing areas of expertise. These initiatives also cover similar but not exactly the same geographic areas or types of regional entities.
Further, the regional leaders, themselves, have developed their own significant experience and expertise regarding specific aspects of necessary reform. Necessary But Not Sufficient. Much has been accomplished in recent years. However, these initiatives highlight that long term, sustainable improvement cannot rely solely on strong national leadership. The success of these national efforts also cannot rely on strong partnerships with capable, multi-stakeholder local leadership. National and regional leadership matters²but the specific activities driving toward the improvement do as well. For instance, all these initiatives highlight that it is not sufficient for a regional effort to focus simply on one area of improvement at a time such as improving key tools like health information technology or getting better at supporting quality improvement or ensuring widely available public information about the quality and cost of care. All of the major initiatives promote a concerted focus on a suite of related simultaneous activities. That concerted effort is hard, complicated, expensive work. Nevertheless, in spite of the enormous task, the regional reform movement is robust and ready to take on the next set of challenges. Both regional leaders as well as national leaders in these initiatives recognize that while there are many pending challenges, several major areas of need are particularly important including these two: 1. Assistance for communities outside the current cohort of regional initiatives. In communities across the nation, key stakeholders are already collaboratively improving key aspects of their health care markets. Many communities that were unsuccessful Beacon Community applicants, for example, demonstrated the capacity and will for change. 2. Enhanced coordination and collaboration among existing regional efforts. To date, existing programs, like Aligning Forces or the Beacon Community program, have understandably had stringent enrollment criteria and fairly competitive selection processes for participation. Organizers have relied largely on a closed architecture with a central program office serving as the link among participating communities. Because of the importance of this regional work, its many difficult aspects, the steep learning curve and vast need for technical resources, it is in the strong national and local interest, that the existing initiatives coordinate efforts, share learning and align assistance, where possible. It is also critical that these national efforts and the local leaders from the frontline communities in those efforts find ways to share their hard won expertise, experience and wisdom with other communities to assist those markets as they attempt similar work. The nation cannot afford to recreate this critical learning market by market, place by place. The need for rapid innovation and spread of that innovation is too great. In the future, the major national initiatives will coordinate and collaborate extensively. Local community leaders, themselves, will assume greater responsibility for the design and management of this work. This standard of regional and national coordination will encourage self-organization, peer-to-peer knowledge transfer and co-creation of solutions by and among community leaders around common issues.
SPECIFIC AIMS AIM 1 . Leverage knowledge gained through existing initiatives for spread within and beyond current participating communities. 1. A series of practical best-practice reports on key topics, based on successful models employed by local leaders. 2. Use appropriate social media tools to promote and create where possible vibrant, virtual, open learning communities. 3. A living database of community objectives, measured outcomes and key strategies. 4. A showcase and story database of community successes in online forums and meetings. 5. Advocacy and shaping of policy agendas in accordance with the aims and challenges identified by communities. 6. An online clearinghouse of community-level strategies and best practices in a practical, action-oriented format. 7. A common research agenda for investigating models, barriers and facilitators for regional healthcare change. 8. Leadership Forums hosted by a community with demonstrated success in a key area of work. For example, in 2011 the Indiana Health Information Exchange hosted a Leadership Forum on leveraging HIE¶s for performance measurement and payment reform. Similarly, the Minnesota Community Measurement could host a Leadership Forum on public reporting and consumer engagement. Hosting the Forums locally in a ³delegated learning model´ provides an opportunity for attendees to interface with a number of key staff and stakeholders, to understand both the work and community context, and to interact in smaller groups of stakeholders who can work together to take practical lessons to their own communities. AIM 2. Manage a Peer-to-Peer Network of Community Leaders 1. Open the meetings, web resources, training and technical assistance to any and all communities. 2. Aggressively deploy social networking tools to facilitate networking and knowledge sharing among community leaders. 3. Work with community foundations and others to support work in local communities and leverage resources and participation particularly regarding sustainability of regional.
4. Working together, the major initiatives would offer an assistance package to a cohort of selected communities through an application process designed to ensure broad community support for regional health system reform. The effort would provide a small amount of support to leaders from selected communities for attending meetings and perhaps for other focused resources. Communities would demonstrate an established leadership structure representing multiple stakeholders including providers, health plans, employers, and consumers. Through their work, these participating communities would develop a vision and strategic plan for implementing comprehensive health system reform. That work would promote concerted, synchronized dramatic improvement in multiple, key pieces of the respective community¶s market infrastructure. It would include steps to leverage electronic health records and information exchange, test and implement specific care delivery improvements, establish performance measurement and public reporting of those measures, engage the consumers in those markets, develop feedback and reporting infrastructure, and accelerate payment reforms. AIM 3: Promoting Sustainable Approaches for community support 1. Help communities identify and understand their potential regional improvement resources and find ways to monetize that resource to help sustain the effort. 2. Monitor for potential program related Investment that would boost regional improvement resource sustainability. Project Description and Possible Elements: 1. Regional Resource Entity. Identify an entity by competitive selection who would serve as the clearinghouse and coordinator for regional improvement resource management. y y y y y Build and serve as hub for national regional improvement network. Identify range and categories of regional improvement needs Connect those who need regional improvement resources to those who have regional improvement resources. Promote convening activities that help spread regional improvement learning and shared experiences Manage a database of regional improvement resources, knowledge, experiences, and stories.
2. Leadership and sustainability. Promote and assist efforts to identify efforts with marketable rates of return and opportunities for monetization of resource activities. Engage and deploy consultant assistance to develop sustainability and business plans, examine opportunities for ³income streams´ from regional improvement resources and create business operations to support viable business models.
3. Technology tools. Develop a variety of media tools to help disseminate regional improvement knowledge, materials, information as well as tools that promote and manage networks of regional improvement leaders and stakeholders. The tools would include: y y y y y Electronic resource database Social media tools²blogging, micro-blogging, networking, YouTube. Webinar capability Video conferencing Mobile applications
4. Communications. Engage communications support to build platforms, create and enhance content and disseminate knowledge and information. Communications expertise will be critical in building networks.