In the widespread quest to find remedies for America's pricey healthcare system, some say the answers lie locally, from the bottom up.

Aligning Forces for Quality is a national program of the Robert Wood Johnson Foundation (RWJF) designed to lift the overall quality of care in 16 targeted communities, involving 37 million patients. For six years, Aligning Forces communities have worked with local healthcare stakeholders – the people who give, receive and pay for care – to improve their health system, RWJF leaders say.

At a Sept. 24 briefing, local leaders and national experts explained how the different communities involved in the program are making fundamental changes to enhance care.

“The U.S. is experiencing, not one giant national healthcare problem, but hundreds of local problems,” said John R. Lumpkin, MD, director of the Health Care Group at RWJF. “Like politics, healthcare is best handled on the local level.”

RWJF launched the program in 2006, in a quest to find best practices. Last year, the program began to focus on payment reform issues, Lumpkin said.

“It hasn’t always been easy, or gone as planned, but the progress has been significant,” he said. “It shows the transformative power of front-line demonstrations, and how change can come from the bottom up.”

Early findings from the Aligning Forces for Quality program are featured in the September issue of The American Journal of Managed Care.

[See also: RWJF seeks healthcare quality app in $100K challenge.]

Anne Weiss, director of quality/equality team at RWJF said participants of the trial had to overcome diverging interests and deficits of information. “The will was there, but the knowledge of how is what we we're trying to get,” she said. “What we learned in these 16 local labs will help inform others.”

The program is slated to last until 2015, with an ending focus on sustainability, she said.

“The local chapter is often missing from the story of healthcare reform,  but I think it’s an important one,” said Dennis Scanlon, professor of Pennsylvania State University. “Local level people have good insights that not often covered by the media.”

Randall Cebul, MD, director of Better Health Greater Cleveland, one of the pilots, credited healthcare IT to improving care and lowering costs. “We’ve documented that EHRs can help shorten the path to better outcomes for all patients, despite how you are covered or if you’re uninsured.”

[See also: Cleveland Clinic creates center for personalized healthcare.]

Lisa Letourneau, MD, executive director of Maine Quality Counts said her pilot focused on quality improvement support for doctors, mainly medical home work. “Returning to primary care is important to improving care and lowering costs,” she said.