Community efforts to reduce racial and ethnic health disparities: Challenges and facilitators identified by 16 multi-stakeholder alliances

Although quality of care is improving for underserved populations, access to care is declining and health disparities remain. The Robert Wood Johnson Foundations’ Aligning Forces for Quality program is designed  to improve overall quality of care and reduce racial and ethnic disparities in 16 geographically, demographically, and economically diverse communities through multi-stakeholder alliances involving healthcare providers, payers, and consumers . Our analysis of key stakeholder interviews across the 16 communities revealed three main barriers to reducing disparities and three corresponding factors important for overcoming these barriers. Barriers included (1) collecting accurate race, ethnicity and primary language (REL) data to identify disparities, (2) sustaining community support for alliances’ disparities reduction efforts due to competing federal payment reform and public reporting initiatives, and (3) difficulty obtaining stakeholder buy-in from local organizations representing underserved populations. Communities that were most successful in overcoming these barriers cited the following facilitators: (1) access to technical assistance regarding best practices for collecting REL data, (2) synergy with federal and state REL data collection initiatives, especially Meaningful Use, and (3) engagement of key stakeholders to align community resources and activities to address disparities. The challenges and facilitators experienced by these 16 communities will be of interest to other communities attempting to reduce local disparities.