Hundreds of Bright Spots

A Message from Chris Amy, Project Director

In November, all 16 of the AF4Q communities came together in Washington, D.C. to get energized about what’s happening, and what’s to come in quality health care. The goal of the conference was to encourage communities to ALIGN with each other’s project goals; generate ideas to ACCELERATE each community’s work; and, walk away with examples for continuing to ACHIEVE cutting-edge, transformative work.

I, along with ten of our AF4Q – South Central PA leaders participated in the semi-annual conference. Looking back on the event, I would like to share what I learned, and how it fits into our local efforts.  While the conference’s goals were lofty, I think the participating organizations and presenters did a great job providing opportunities to connect with each other, learn new ideas and share successes.

To highlight the key items from the event, and where our local efforts stand, I’m using a recommendation made by Chip Heath, author of the book SWITCH. When Mr. Heath presented at the May 2011 AF4Q Annual Conference, he charged each of the AF4Q communities to “find the bright spots.” Bright spots are the successful efforts worth emulating, and he believes they are the key to fixing everything from addiction to corporate malaise to malnutrition.

Bright Spot #1 – Engaging Consumers is the Key to Health Care Improvement.
During the conference, a meeting was held specifically for consumers to be exposed to the terms and concepts often used within health care. While educating consumers is essential, AF4Q – South Central PA is taking it one step further by intermixing consumers with stakeholders, so each group has a better understanding of each other. In 2011, AF4Q launched the Patient Partners Program, which helps primary care practices that are working to transform to Patient-Centered Medical Homes, integrate two consumers into their process improvement teams. It’s amazing to see the providers and the end users of health care building a new system together.

AF4Q strives to provide meaningful public reporting of healthcare performance data, improved quality of care and payment reform that supports healthy outcomes, so we need to engage consumers in all of AF4Q’s initiatives!

Bright Spot #2 – The Primary Care Practice is at the Center of the Solution.
Yes, patients may have received more patient-centered care when the town doctor went to the house to treat the ill patient, or to deliver a new baby. I’m not saying it was better care, but it was more patient-centered.  Today, our world is too complex for that model to work.

However, there are models for providing more efficient communication between the health care team, and between patients and providers. The models allow the proper care to be provided to meet the patients’complex needs and produce results that improve the quality of care.

During the latest phase (3.0) of our AF4Q work, we have begun to focus on transitions of care.  Our ability to successfully provide and support these critical handovers from one healthcare provider to another will define the health status of our local community in the next decade.  No matter what the transition, the primary care practice will need to be the most knowledgeable (outside of the patient) member of the medical neighborhood (specialists, hospitals, community agencies, and more).

In partnership with York & Gettysburg Hospitals, AF4Q provides reports to Planned Care Collaborative practices, showing which patients were hospitalized for diabetes complications, and could have been better treated by the primary care provider. This key information gives the practices the ability to figure out what they could have done better, and the opportunity to work with the patient to prevent a future costly hospitalization. The idea of hospitals working with a primary care practice to keep patients out of hospitals is not happening in many places in the U.S.

I was privileged to present this bright spot to the other 15 communities at the conference. Rush Gross, Planned Care Coordinator, and Karen Jones, Physician Champion for AF4Q, were on hand to help me answer questions.

Bright Spot #3 – It’s Really About Value. Quality and Cost Have to Match Up.
This conference, more than any other one, explored the concept of cost and the fact that we all realize the current system is unsustainable.  I challenge everyone who reads this article to spend five minutes thinking about health care cost and what it means to you personally.  Does the highest cost provider or health plan offer the level of quality that you want?  Do you even know what the level of quality is or what the cost of a procedure will be?

Most of us pay $10, $15 or $20 for a visit to our primary care physician, or $100 for a visit to the hospital.  The actual cost for that visit is approximately $100 for the primary care visit, or $1,000 or higher for the hospital visit.  Who pays for what your co-pay doesn’t cover?  The answer is your employer, health plan or no one (charity care).

For almost everything else we buy (shoes, cars, vacuum cleaners) we can compare prices and find some report on the product’s quality with a little bit of research – even if it’s only consumer reviews. In the majority of U.S. communities, there is no local resource to measure healthcare quality.

Our community is an exception.  In Adams and York counties, health care comparisons can be made. This is a bright spot for AF4Q, as we are ahead of other Pennsylvania counties. AF4Q offers the Community Checkup online and accessible to anyone:  By visiting the site, you can find data related to the care patients with diabetes and heart disease receive from primary care doctors; review local hospitals’ care for various conditions; or even find the average amount of money that the hospital asked to be paid (charges) for a patient’s hospital stay or procedure.

Another resource for consumers to learn about quality and value is through two of AF4Q’s programs, It’s Your Health…Take Charge! and the I Can! Challenge. Both of these programs help individuals learn where to go to find healthcare quality information, and how to better communicate and partner with their providers.

As project director, I’m proud to title this article Hundreds of Bright Spots because we do have a lot more than what is shared in this article. There’s only so much space available, so I encourage you to continue to visit our website, read our articles, and get involved with AF4Q to learn about the other bright spots. In addition, Robert Wood Johnson Foundation redesigned the national AF4Q website, where you can learn more about what is happening in our peer AF4Q communities. You can also view the slides and case studies from the November conference by visiting
Thank you for being a part of our efforts, and I look forward to working with each of you in 2012.

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