• Dennis P Scanlon, Jeff Beich, Jeffrey A Alexander, Jon B Christianson, Romana Hasnain-Wynia, Megan C McHugh, and Jessica N Mittler.
• School of Public Health, University of Michigan, Ann Arbor, MI, USA.
• Am J Manag Care. 2020 Dec 9; 18 (6 Suppl): s115-25.

ObjectivesThe Robert Wood Johnson Foundation's (RWJF's) Aligning Forces for Quality (AF4Q) initiative is the largest privately funded community-based quality improvement initiative to date, providing funds and technical assistance (TA) to 16 multi-stakeholder alliances located throughout the United States. The objectives of this article are to describe the AF4Q initiative's underlying theory of change, its evolution over time, and the key activities undertaken by alliances.Study DesignThis is a descriptive overview of a major multi-site, community-based quality improvement initiative.MethodsA qualitative approach was used with information obtained from program documents, program meetings, observation of alliance activities, and interviews with RWJF staff, TA providers, and AF4Q alliance stakeholders.ResultsAF4Q is a dynamic initiative, expanding and evolving over time. Participating alliances are addressing 5 main programmatic areas: (1) measurement and public reporting of healthcare quality and efficiency for ambulatory physician practices and hospitals; (2) efforts to engage consumers as partners in their own care (consumer engagement); (3) adoption and spread of effective quality improvement strategies to improve care; (4) ensuring the equitable receipt of healthcare; and (5) integration of alliance activities with payment reform initiatives.ConclusionsThe AF4Q initiative is an ambitious program affecting multiple leverage points in the healthcare system. AF4Q alliances were provided a similar set of expectations and given access to substantial TA. While participating alliances have made progress in addressing the AF4Q programmatic areas, given differences in the alliances' composition, market structure, and history, there is considerable variation in program implementation.

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