In keeping our promise to improve the health and health care of all Americans, the Robert Wood Johnson Foundation has developed an impact framework that sets long-, medium- and short-term objectives for each of our priority areas. Over the past few years, we have become increasingly sophisticated about using all of our resources to achieve these objectives. Although writing checks may be central to our work, we have many other tools at our disposal. Among them are what I call “the five Cs” of effective philanthropy, and the way we employ them can be seen throughout this volume of The Robert Wood Johnson Foundation Anthology. The five Cs are:

Communicating. The Foundation has always placed a high value on sharing the results of our work and that of our grantees. Historically, we have emphasized speaking through our grantees. Now we are trying to speak with our grantees, to be more open in our communications about our own objectives, and to ensure that different audiences get the information they need in a form that they can use and from a source they can trust. The chapter by Susan Krutt and David Morse (Chapter Nine) illustrates the ways in which the Foundation fosters transparency and public accountability. It is complemented by the discussion of Cover the Uninsured Week, a series of communications campaigns designed to keep the uninsured in the public’s consciousness, in Robert Rosenblatt’s chapter (Chapter Three) on the Foundation’s efforts to promote health ­ insurance coverage.

Convening. The Robert Wood Johnson Foundation has used its prestige and its influence to bring together people who might not ordinarily be in the same room. Perhaps the best recent example is our convening of what we call the “strange bedfellows,” discussed in Chapter Three, which brought together health insurance experts with differing positions to see whether they could agree on an approach to covering the uninsured. Although they do not agree on a single approach, the strange bedfellows do agree on some general principles and are continuing to explore options to achieve those principles. On a local scale, under the Free to Grow program, examined by Irene Wielawski in Chapter One, community leaders working with the Head Start program were able to mobilize residents with varied interests who were all concerned about drug and alcohol abuse by young people in their community.

Coordinating. Although it takes time, requires considerable interpersonal skills, and too often is unrewarded, coordination among multiple stakeholders, especially other funders, is essential. A deft touch is required, and no one has had a defter touch than legendary grantmaker Terrance Keenan, whom we honor in Chapter Eight. In fostering the growth of nurse practitioners and physician assistants, the Foundation, through Keenan, was able to work with and coordinate the efforts of the federal government, academic medical centers, and the nursing profession, among others. As noted by the chapter’s author, Digby Diehl, the Foundation, under Keenan’s tutelage, developed the Local Initiative Funding Partners program, in which the Robert Wood Johnson Foundation collaborates with local foundations in funding projects that they have identified. Students Run LA, described by Paul Brodeur in Chapter Seven, is a prime example of an effective project funded through the Local Initiative Funding Partners program.

Connecting. Individual grants become more powerful when one grant builds on another and when the lessons from one project inform others. Continuity and connectivity are often the hallmarks of a well-executed strategy. One of the roles the Foundation plays is connecting the dots—helping grantees see how their own work fits into a larger scheme to meet bigger objectives. In their chapter on healthy aging (Chapter Two), Robin Mockenhaupt, Jane Isaacs Lowe, and Geralyn Graf Magan demonstrate how a group of seemingly disparate grants are in reality elements in a larger strategy, or series of strategies, to improve the health and well-being of older Americans. Similarly, in Chapter Six, Victor Capoccia discusses the evolution of the Foundation’s approach to combating drug and alcohol addiction and how individual grants reflect and advance the Foundation’s strategies.

Counting. Monitoring progress by using rigorous and appropriately timed indicators is critical to knowing whether change is taking place. This has long been a hallmark of
the Robert Wood Johnson Foundation. Chapters in earlier volumes of the Anthology have discussed the Foundation’s research and evaluation efforts and the work of grantees such as the Center for Studying Health System Change. In this volume, Marsha Gold and her colleagues Justin White and Erin Fries Taylor at Mathematica Policy Research write about their evaluation of the Medicaid Managed Care program. The chapter (Chapter Five) illustrates not only the importance of timely assessments but also their value in providing an empirical basis for shifting the emphasis of a program.

The use of the five Cs—combined with a sixth C, cash—can be powerful indeed. Perhaps the best example of the Foundation’s using the Cs strategically is its work to reduce smoking between 1990 and the present. The challenge for the Robert Wood Johnson Foundation is to employ all the tools available to it aggressively and purposefully. If we do so, we greatly increase our potential impact and the likelihood of achieving long-lasting returns in health and well-being.