AF4Q Health Care Transformation Alliance Comes to an End

May is graduation season and as the calendar turns a page, The Health Collaborative is celebrating a graduation of sorts. Aligning Forces for Quality (AF4Q), the signature health transformation project of the Robert Wood Johnson Foundation (RWJF), has come to a close. In essence, we have graduated to pursue our multi-stakeholder health improvement agenda using the partnerships we developed through our AF4Q journey. We continue to be guided by the triple-aim: better health, better care and lower cost.

Cincinnati was one of only 16 communities selected back in 2008 to participate in AF4Q. The Health Collaborative is grateful for the technical assistance, guidance and financial support which allowed us to experiment with many important initiatives these last seven years. Perhaps as important as the funding was the confidence we developed to believe it was possible to try to improve the quality of health care.

Either directly or indirectly, AF4Q is responsible for programs such as the initial Patient-Centered Medical Home (PCMH) transformation, Public Reporting and YourHealthMatters, Payment reform initiatives such as Comprehensive Primary Care (CPC), and the regional Collective Impact on Health initiative.

An example of quality improvement resulting from AF4Q is “” Data provided to the website voluntarily by providers allows us to track measures of patient care and align healthcare outcome goals with patient self-management goals. Throughout the duration of the initiative, every measure reported has improved over baseline. The website measures colorectal cancer screening rates, cardiovascular health, hypertension/high blood pressure, and diabetes.

The “MakeTheRightCall” campaign was created by our Consumer Council as a part of AF4Q. Using digital media, the community learned the value of saving the emergency room for real emergencies and strengthening their relationship with their primary care doctor to get treatment for urgent health issues. The campaign has been embraced and shared by the faith community, health care providers, the Council on Aging, and many other partners.

AF4Q was the forbearer of Collective Impact on Health effort, currently underway in the seven-county Greater Cincinnati region of Hamilton, Clermont, Warren, and Butler counties in Ohio; and Boone, Kenton, and Campbell counties in Kentucky. This work will result in a coordinated community agenda to improve health and health care and reduce the burden of health care costs on our community.

AF4Q enabled The Health Collaborative to fulfill a need for expertise in the region with the hiring of former Procter & Gamble brand specialist and marketing manager, Judy Hirsh. As director of consumer strategy & engagement and the AF4Q program director, Hirsh convened focus groups to determine how consumers would best understand and use health care quality ratings.

In March of 2014, Cincinnati’s efforts to improve diabetes care and increase patient engagement in their own diabetes management was featured in an article in the publication Journalists on Quality. This 2014 series included insightful profiles written by prominent health policy journalists on how RWJF’s AF4Q initiative has affected care in local communities. As noted in Geri Aston’s article “An Infusion of Resources Gets the Quality Ball Rolling,” prior to receiving the $3 million grant from AF4Q, our health improvement efforts in the Cincinnati region were abundant but not systematic, said Craig Brammer, CEO of The Health Collaborative. Past initiatives were plentiful but generally small and isolated, such as seasonal flu shot programs and mental health awareness campaigns. “AF4Q provided that infusion of resources, expertise, and cooperation with sister alliances to allow us to ramp up the level of our work,” Brammer said. Today, about 800 Cincinnati-area primary care practices are reporting diabetes measures on the YourHealthMatters website and more than 200 practices are certified as PCMH practices.

A debt of gratitude is owed to friend of The Health Collaborative Robert Graham, MD, an original program director who later became the director of the AF4Q National Program Office. Along with Dr. Graham, we wholeheartedly thank our past AF4Q project directors:

  • Craig Brammer
  • Melissa Kennedy
  • Nancy Strassel
  • Judy Hirsh
  • Dr. Richard Shonk

As The Health Collaborative enters the next phase of its work as a newly-merged entity with the organizations formerly known as the Greater Cincinnati Health Council and HealthBridge, we are enormously grateful to the Robert Wood Johnson Foundation and Aligning Forces for Quality for their support and expertise, and for the enduring legacy they helped create in improving Greater Cincinnati’s health landscape.