The Power of Multi-Stakeholder Collaboratives

The U.S. health care system is large and complex, with multiple stakeholders—patients and families, employers, providers, payers, government—each holding a vested interest in how dollars and resources are allocated, and each having a pivotal role to play in implementing changes to transform care delivery.  In order to create transformative change in how health care is delivered and paid for, these stakeholders need to coordinate their efforts and work toward collective goals, as no single organization can create large-scale, lasting change alone.[1] Further, local market dynamics have a huge impact on how these stakeholders interact and their willingness to partner and share resources. For this reason, Aligning Forces for Quality (AF4Q) was designed around regional multi-stakeholder Alliances. Alignment of stakeholders maximizes the impact of individual system efforts in payment and delivery reform, and is necessary to achieve population-level improvements to health care costs, quality, and outcomes.


[1] See and Kania, J. and Kramer, M. (2011). Collective Impact. Stanford Social Innovation Review, Winter 2011. Accessed at



The Network for Regional Healthcare Improvement (NRHI) is a national organization representing over thirty member Regional Health Improvement Collaboratives (RHICs).

This brief examines regional collaboratives and how they have successfully transformed health care delivery systems, increased public reporting, and lowered costs in 16 communities across the country.

This article discusses The Robert Wood Johnson Foundation’s Aligning Forces for Quality program. In June 2008 RWJF launched phase II of Aligning Forces for Quality, a long-term, $300 million initial commitment to help up to twenty geographically, economically, and demographically diverse communities reweave the fabric of their health care systems to be stronger, more resilient, and of higher quality across the full continuum of care.

National and regional data aggregation and reporting efforts are each important in their own right, and together have had a huge impact on the quality of care delivered across the United States. AF4Q Alliances have created regional data sets, collecting clinical and claims data from multiple payers, including a majority of providers and systems within a given Alliance's region, and aggregating those data to measure health care quality and outcomes. The collective experience of the 16 Alliances working to develop and use data sets for public reporting, quality improvement, payment reform, and benefit design offers valuable lessons about how regional and national measurement efforts can play complementary roles to improve quality and value.

Those involved in improving healthcare quality and reducing costs know that data are power. Data are the raw material that health care systems need to rebuild care and payment systems that deliver value rather than volume. Data are what engaged consumers use to make informed decisions about their care, what payers and purchasers use to design value-based benefit packages, and what government and public health entities use to make policy decisions. All of these players need access to uniform, actionable data in order to effect change. Through the ​Aligning Forces for Quality program, Alliances have built sophisticated data aggregation infrastructure and data analysis capability that provides community stakeholders with access to these data. As Alliances transition from grant-supported to revenue-generating business models, they offer a number of insights into how a community can realize economies of scale and value in data aggregation.