Engaging consumers—the end users of the health care system—in efforts to improve health and healthcare has been a core component of the Aligning Forces for Quality (AF4Q) program since its inception. AF4Q took a dual approach to promoting consumer engagement in the 16 communities. On one hand, some core expectations applied to all Alliances, including consumer representation in decision-making and consumer-friendly public reports. At the same time, Alliances had broad autonomy in designing and implementing activities to engage consumers in their own health, efforts to improve direct care, and program planning and implementation. AF4Q’s programmatic expectations, funding, and technical access have supported developing and implementing a range of consumer engagement efforts in the Alliances.

Across AF4Q focus areas (including but not limited to consumer engagement), the early years of the program saw Alliances focused on developing core capacities in the realm of quality improvement, building stakeholder relationships, and developing strategies.  Since the beginning of the AF4Q program, Alliances have focused on developing capacity for later programming, including work in the area of consumer engagement. Alliances since have transitioned into implementing, improving, and expanding. Alliances built on their strengths and accessed technical assistance to close gaps in capacity or knowledge. As Alliances near the end of the AF4Q program, they are increasingly focused on identifying strategies for sustaining their work. Many seek to monetize their data or clinical quality improvement services, yet consumer engagement remains a critical element of multi-stakeholder efforts to improve care. Although a number Alliances identify consumer engagement as strategically important, few have quantified the cost or benefit of those activities.

Securing continued support for these efforts will require Alliances to demonstrate—and quantify—value to stakeholders. There are multiple approaches to calculating this value, including return on investment (ROI) and cost-benefit analysis.[1] Such approaches are useful in helping an Alliance organize its thinking about its value proposition for specific stakeholders. Quantifying the ROI, with either positive or negative results, can spur important conversations about whether and how to continue to support consumer engagement.

To help capture the value of consumer engagement activities, the AF4Q National Program Office (NPO) issued a request for proposals to Alliances to assess the ROI of consumer engagement. Seven Alliances were granted funds to gather data and assess the costs, benefits, and ROI of a specific consumer engagement (CE) activity. This work, discussed in greater detail below, offers a number of lessons for others seeking to quantify the costs and benefits of consumer engagementwork.

[1]Cellini, S. R., and J. E. Kee.(2010). Cost-Effectiveness and Cost-Benefit Analysis. In Joseph S. Wholey, Harry P. Hatry, and Katherine E. Newcomer (Eds.), Handbook of Practical Program Evaluation (3rded) (pp. 493-530).San Francisco, CA:Jossey-Bass.