Overview

The Robert Wood Johnson Foundation (RWJF) recognizes that there is wide variation in the quality of health care available to Americans, and that this variation in care has significant costs in lives and dollars. To bridge the gap between the care people receive and the care our health system is capable of providing, the Foundation is working to increase public awareness of the performance of health care providers. Under the Quality/Equality portfolio, many RWJF grantees are working to measure and report physicians' performance to help doctors improve the care they deliver and to help consumers and patients make informed choices.

History

The Foundation has been a leader in the quality movement—funding early development of quality measures and some of the first pay-for-performance experiments. In 2007, RWJF launched the first phase of Aligning Forces for Quality (AF4Q), a long-term, multi-million-dollar commitment to help a number of communities strengthen their local health care systems. Teams in AF4Q communities work to improve the quality of information about physicians' performance and make sure the public has access to those measures. Consumers can potentially use the information to help choose the doctors that are right for them, while doctors and other providers can use the information to better understand what they do well and what they need to improve. The expectation is that comparative public reports will motivate and improve the delivery of care.

Another program supported by the Foundation, the Consumer-Purchaser Disclosure Project, is a collaboration of leading consumer, employer and labor organizations working with leading physicians' groups and health insurers to guide how health plans measure doctors' performance and report the information to consumers.

Many reporting initiatives have been poorly coordinated, with disparate measures that are confusing both to health care providers and consumers. The Foundation has worked to remedy this through its support of the National Quality Forum (NQF), which since its founding in 1999 has been a neutral convener of consumers, purchasers, providers, practitioners, government and oversight agencies, supporting industries and other interested parties to identify and standardize "best-in-class" measures of clinical quality and health system performance. NQF's endorsement has become the "gold standard" for health care performance measures.

The Foundation is also working with the Quality Alliance Steering Committee (QASC), a collaborative effort among government agencies, physicians, nurses, pharmacists, hospitals, health insurers, consumers, accrediting agencies and foundations to ensure that quality measures are constructed and reported in a clear and consistent way that informs both consumer and employer decision-making, as well as the efforts of practitioners to improve.

Application

Efforts to measure and report on the quality of health care are on the rise around the country. But the United States is still a long way from the kind of open, informative health care system needed to support standardized measurement and reporting activities that are meaningful to patients, providers and others. The Foundation's quality improvement activities will continue to support work that explores how to structure and provide reporting systems that resonate with consumers and providers while rewarding high-quality care. Our work in this field is guided by four core principles: 1) transparency in the measurement process so both doctors and patients can trust the data; 2) consumer and provider input into the process to help ensure that information is meaningful to consumers and fair to doctors; 3) independent verification to provide assurances that programs are fair and valid; and 4) nationwide consistency of measures so that "good health care" means the same thing across the country.

We have to get this right, which means answering questions from doctors about fairness, making it easy for doctors to report data (and compensating them to do it), designing systems that do not produce unintended consequences, and learning to present the data to the public in way people can understand. We believe that if public reporting is done right, it can:

• Help providers measure and publicly report their performance.
• Help providers improve their own ability to deliver quality care.
• Help patients and consumers understand their vital role in recognizing and demanding high-quality care.