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Denise Bollheimer announces Aligning Forces for Quality Initiative in June to key stakeholders in the Memphis community.

There’s no denying the mounting deficiencies in the healthcare industry, especially with the fragmentation of delivery and unequal outcomes. While it’s true that Memphis and Shelby County are often on the bottom of such health lists, what the city lacks in configuration, it makes up for in solid grassroots involvement. A real paradigm shift has taken place as physicians, nurses, administrators, insurance providers and now consumers are demanding higher quality healthcare.

In June, the Robert Wood Johnson Foundation (RWJF) and the Healthy Memphis Common Table (HMCT) announced to various business, health, media and faith-based stakeholders in the community, the second phase of the Aligning Forces for Quality (AF4Q) initiative. Memphis was originally one of four pilot cities chosen in 2006 for this $300 million national community project, to receive grant monies to begin AF4Q strategies, which included working with physicians to improve the quality of care, measure and publicly report on the quality of ambulatory care, and initiating programs to educate the public on making informed healthcare choices. A year and half later, HMCT is being awarded $1 million to expand their efforts.

“How did we start addressing these problems together? Our motto is T-E-A-M, together everyone accomplishes more,” said Denise Bollheimer, chair of HMCT. “We are excited to be selected for this initiative, so we can bring all the parties together — those who get care, give care and pay for care — to drive real improvements in Memphis.”

As part of the grant’s second phase, Memphis was one of 14 cities selected to receive RWJF resources, expertise and training to bring together patients, healthcare providers and payers to turn proven quality improvement strategies into tangible results. Building upon that foundation, this phase includes inpatient care, a specific focus on reducing racial and ethnic gaps in care, and the enhancement of consumer involvement.

“Healthcare has reached a tipping point,” explained president and CEO of RWJF, Dr. Risa Lavizzo-Mourney, via satellite at the June announcement. “Good and bad care are being delivered. There is too much miscommunication, inequity and mistakes. Americans are not receiving the care they need.”

New research commissioned for the AF4Q initiative was conducted by the Dartmouth Institute for Health Policy and Clinical Practice. This “Dartmouth Atlas Project” reported that the quality of healthcare in the United States can vary greatly depending on race and where people live. The report highlighted issues with women getting recommended mammograms and diabetic patients receiving essential blood tests as well as striking statistics of leg amputations due to diabetes complications.

According to the Dartmouth report, African-American Medicare beneficiaries lost legs to amputations at a rate nearly five times that of whites on Medicare. In Memphis, four in 10 women insured by Medicare are not getting recommended mammograms, and nearly two in 10 patients with diabetes are not getting crucial blood tests. The rate of amputations due to complications from peripheral vascular disease and diabetes is on par with the national average, but the amputation rate is far higher among African-Americans than among whites.

Director of AF4Q, Dr. Bruce Siegel with George Washington University added, “We are tired of slow change or no change in improving healthcare. We want to show how it can be done.”

The second phase of the AF4Q grant emphasizes three core areas: public reporting, provider engagement and consumer engagement. The four major foci of chronic illness were chosen based on prevalence in the community and the availability of standardized measurement for quality improvement. They include coronary artery disease, congestive heart failure, hypertension and diabetes.

“Aligning Forces for Quality is crucial for understanding and addressing challenges patients will face,” said chief medical officer for the Tennessee Department of Health, Dr. Veronica Gunn.

“What we have to improve upon is measuring what we do in a way that is usable to both the public as well as to ourselves, so we’ll be able to know what we’re doing is achieving the health outcomes that we seek,” she explained. “The evidence-based to quality service delivery to measurement kind of step is translatable to a variety of different health conditions and clinical settings.”

Over the past 18 months, data has been gathered from insurance companies, which are slowly but surely cooperating, to develop an all-payer database. While it’s an arduous task, the end justifies the means. The database can provide physicians and payers one, collective place to review and verify quality and outcomes.

“Being graded is really hard for all of us, exposing yourself to public scrutiny,” acknowledged internist Dr. James Bailey, director of the Healthy Memphis Data Center, an arm of HMCT created to organize and track healthcare data. “We’re doing it without the idea to punish but to support improvement.”

Additionally, consumers will have a place to learn about what good quality care is and where to find it. Other ways of engaging consumers to be advocates for their own healthcare: creating quality checklists that patients can bring to their doctors, procedure price information and community awareness programs.

“I think the reason we were able to get this grant was really because of the physician leadership in Memphis and their willingness to lead the charge rather than be dragged along.”
— Dr. James Bailey, UTHSC, director of Health Memphis Data Center

The Memphis Medical Society joined the AF4Q team to assist in classifying and organizing provider data. Mike Cates, executive director of Memphis Medical Society, said they plan to give physicians their own first report card this fall, with the goal of reporting publicly in 2009. Cates said he knows there won’t be universal support for this, but, he added, “If you’re not at the table, you’re on the menu. We thought we should be at the table.”

On top of measuring outcomes, public reporting, “is integral for doctors being paid for quality,” Bailey maintained. “I think the reason we were able to get this grant was really because of the physician leadership in Memphis and their willingness to lead the charge rather than be dragged along.”

“You are part of creating lasting change that will take place in your own backyard, concluded Lavizzo-Mourney to the selected cities of this historic RWJF grant. “It’s time to roll up our sleeves and get to work.”

Turn to Memphis Medical News for regular updates about planned projects from Aligning Forces for Quality.

For more information on Aligning Forces for Quality in Memphis, visit www.healthymemphis.org/news/



July 2008

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