Progress Toward Reaching Better Health and Providing More Affordable Care for Vulnerable Populations

Over the last three decades we have discovered methods for improving the quality of health care and that applying those methods measurably improves health care in local, regional and national settings.^1,2,3,4 We have also discovered that improvement can occur in all types of delivery settings, by all types of providers, serving very diverse populations.^5,6 It is very encouraging that these methods can also result in narrowed disparity in care for the poor and underserved.⁷ The papers in this supplement are offered to stimulate innovative and forward thinking to support the next generation of collaborative quality improvement initiatives. The articles will help to inform future efforts by providing lessons learned and examples of what has worked. You will find many examples of improvement in very diverse care settings serving a wide variety of vulnerable populations. There are insights that will be helpful for those serving patients of all socioeconomic backgrounds in all settings of care.

Awareness of our ability to improve health care comes at an important time in the life of our nation. We face a substantial economic challenge in the wake of the great recession of recent years.⁸ Health care costs have a relentlessly increasing negative impact on Federal and State budgets as well as those of private companies. Future projections are for an unsustainable pattern of growth of health care costs relative to personal incomes as well as state, federal and private company budgets. Unfortunately, we also spend more on health care than any other nation and have relatively poor health outcomes to show for it.^9,10,11 The manner in which those we serve experience care is too often unsatisfactory for preventive care, for acute care, for chronic care and for care at the end of life. The variation in health and health care across our cities, our communities, and our states is substantial, ranging from very good to very poor when compared with health outcomes from other nations.^9,10 The unfortunate conclusion for the United States is that where you live matters with respect to the quality of health care you receive and your potential for good health.^12,13 In addition, no matter where you live, you are likely to receive care that results in less satisfactory outcomes if you are poor.^10,14,15

We must aim for substantial improvement. On March 23, 2010, President Obama signed the Affordable Care Act into law. This law required the Secretary of the U.S. Department of Health and Human Services to establish a National Strategy for Quality Improvement in Health Care. A year later, in March of 2011, after extensive public input as well as input from the members of the National Quality Forum (NQF) and the National Priorities Partnership (NPP), this National Quality Strategy was reported to the congress and released to the public.¹⁶ The National Quality Strategy provides a useful framework for addressing the substantial issues we face in improving quality of care. It challenges us to improve by making health care more patient-centered, reliable, accessible, and safe. It challenges us to promote effective communication and coordination of care. It challenges us to make prevention and treatment more effective, starting with cardiovascular disease. It challenges us to improve the health of our population by supporting proven interventions to address behavioral, socioeconomic, and environmental determinants of health. It challenges us to reduce the cost of quality health care for individuals, families, employers, and government.¹⁶

Regardless of the outcome of the nation’s ongoing discussion about the Affordable Care Act itself, the National Quality Strategy serves as an important statement of national aims for improving quality of care. Importantly, these aims have also been adopted by many organizations in the private sector because they resonate so well with what so many think needs to be achieved. Every one of us, regardless of our race, ethnicity, social circumstance, or economic condition should receive excellent care and have the best opportunity for good health. Every one of us should have that excellent care efficiently delivered...