Started in in 1996, VCSQI is a voluntary consortium that has grown to include 18 hospitals, 14 cardiac surgical practices, and in 2016 expanded to include the cardiology specialty with the goal of coordinating care, CASTS's goal is to improve clinical quality across the state in heart surgery programs of all size through outcomes analysis and process improvements. The objective is to help members effectively redesign clinical processes and modify provider behavior using the best evidence available. Quality improvements can lower costs of care.