reduce racial and ethnic disparities in care, and provide models for national reform” (Robert Wood Johnson Foundation, 2012). A goal is to build multistakeholder alliances to focus on common areas for progress at the local level. These alliances include physicians, nurses, patients, consumers and consumer groups, purchasers, hospitals, health plans, safety-net providers, and others. The Aligning Forces initiative has spread to 16 communities in different geographic areas with various demographic and economic profiles. Communities involved in the initiative have assisted providers seeking to improve the care they offer, increased the measurement and reporting of care performance, and expanded the ability of patients and consumers to recognize and demand high-quality care (Robert Wood Johnson Foundation, 2012).

The Brookings Institution’s Engelberg Center for Health Care Reform seeks to develop data-driven, practical policy solutions that promote broad access to high-quality, affordable, and innovative care. The Center pursues this goal by conducting research, making policy recommendations, facilitating consensus around key issues, and providing technical support to stakeholders implementing new solutions. Specific projects in which the Center has been involved include the Accountable Care Organization (ACO) Learning Network, a member-driven network that provides participating organizations the tools necessary to implement accountable care successfully; the Quality Alliance Steering Committee, a collaborative effort aimed at implementing measures to improve the quality and efficiency of health care; and the Medicare Payment Reform Project, which is developing policy proposals to reward providers for improving the efficiency, quality, and coordination of care by moving toward greater accountability and support for overall quality and value (The Brookings Institution, 2012; Quality Alliance Steering Committee, 2012).

These examples highlight the diversity of initiatives that are under way, as well as the energy available for transformative action. They are part of a large body of work on which this report draws in exploring what is needed to move toward a health care system that continuously learns and improves.

Related Work of the Institute of Medicine

With a dedicated commitment to improving the quality of care delivered in the United States, the IOM has produced a number of highly influential reports—such as To Err Is Human: Building a Safer Health System (1999), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), Building a Better Delivery System: A New Engineering/Health Care Partnership (2005), Knowing What Works in Health Care: A Roadmap for the Nation (2008b), and Initial National Priorities for Comparative Effectiveness Research (2009a). These reports have drawn



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