Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in targeted communities, as well as reduce racial and ethnic disparities and provide real models for national reform.  Can bringing together the people who give care, get care and pay for care improve quality in America? The 16 AF4Q communities are showing that it can. After six years, AF4Q communities have built transformative partnerships, reaching 37 million people—12.5 percent of the total U.S. population.

Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in targeted communities, as well as reduce racial and ethnic disparities and provide real models for national reform.  Can bringing together the people who give care, get care and pay for care improve quality in America? The 16 AF4Q communities are showing that it can. After six years, AF4Q communities have built transformative partnerships, reaching 37 million people—12.5 percent of the total U.S. population.

Spotlight highlights recent trends, breakthroughs, and lessons learned from the 16 AF4Q communities. Improving health care is complicated, but Spotlight sheds some light on the big picture themes and issues. AF4Q is tackling these issues to improve quality and equality of care.

This first edition explores the problem of price transparency in health care, and how “bullish” businesses can influence the quality and cost of health care for their employees.

If you’re in the market for a new car, it’s easy to find out if, say, a Toyota costs more than a comparable Chrysler. In fact, a small amount of research can help a consumer compare prices on just about any good or service in America.

The exception: health care. If you need a hip replacement, diabetes treatment, or heart surgery, and you want to know how much you will have to pay, you’re likely out of luck. Health care costs in America are such a mystery that often even doctors and most people who work in hospitals or clinics don’t know what they’re charging.


We do know that health care is more expensive in the United States than in any other nation in the world. U.S. per capita health expenditures are far greater than those of other industrialized nations. Americans consistently indicate in polls that they are happy with the care they receive but think it is too expensive.

Employers matter. Employers have great—if underutilized—market leverage in buying health care, and often can influence other stakeholder groups, even exercising a leadership role. If fully engaged, they can push hospitals and health plans in their communities to improve care for their employees at a manageable cost.

Employers buy health care for their employees—lots of it. Yet, as the paying customer, employers typically have little control over—or even input into—the product they’re buying. Negotiating on cost? It’s the health plan that usually boasts the upper hand.

Negotiating on quality? Forget it—most employers profess not to know the first thing about how to judge it. The fact is, American businesses, typically so good at managing contracts with vendors and suppliers, have long found themselves adrift and overmatched in the vast, dysfunctional health care marketplace. Aligning Forces for Quality (AF4Q) is working closely with employers to raise their engagement in health quality and cost.