About the Center

The Agency for Healthcare Research and Quality (AHRQ) provided core funding to RAND, in collaboration with researchers from Penn State, UCLA, Stanford and Harvard, to create the RAND Center of Excellence on Health System Performance. The Center's charter is to identify, classify, track, and compare health systems in today's increasingly concentrated health care markets, and to characterize the attributes of high-performing health systems — those systems that can more nimbly translate new research evidence into routine clinical practice, and thereby improve quality, reduce costs, and achieve better patient outcomes. Prior to the initiation of the Center, little work had been done to enumerate health systems in the United States, to document how they vary from one another, and to understand what characterizes those that perform well from those that do not. Policymakers and payers cannot reward high performance without being able to identify high performers and without a better understanding of what health systems are doing to achieve high performance.

Our Strategy

The Center's researchers use a mix of qualitative and quantitative methods to examine the rapidly evolving health system landscape. We are investigating changes in health systems (for example, increased consolidation, greater integration among hospitals and physician organizations, and the growth of health IT capabilities), seeking to understand how changes like these may affect the ability of health systems to achieve high quality care at lower costs. The Center is characterizing health systems, cataloging their important attributes, and examining the relationship (if any) between health system attributes and system performance on quality and cost measures.

Research Questions

Our Center's researchers are addressing questions like:

  • What is a health system?
  • What types of health systems currently exist and how do they change over time?
  • What important attributes characterize different types of health systems?
  • What defines a health system as "high performing"?
  • What "mechanisms" available to health systems (such as deploying clinical decision support within health IT, adopting risk-based payment models, or using care redesign strategies) facilitate more rapid uptake of evidence-based care practices?
  • Is there a relationship between health system attributes and health system performance on cost and quality measures?
  • How do market factors (e.g., the competitiveness of the local health care market) influence health system performance?
  • Does being part of a health system matter (i.e., is quality of care and total cost of care better/worse/no different for physician organizations affiliated with health systems as compared to those that are not)?
  • How do health systems vary in the amount they spend on primary care, and, relatedly, does quality of care vary by the amount of primary care spending?
  • Are disparities in care smaller for physician organizations that are affiliated with of health systems versus those that are not?

Center researchers are examining some of the mechanisms that health systems and their affiliated physician organizations use to promote the uptake of evidence-based practices in primary care. In particular, our investigators are keenly interested in how these three sets of mechanisms affect health system performance:

  • Adoption and routine use of health IT
  • Provision of financial and non-financial incentives to physicians
  • Strategies for addressing fragmentation of care

In addition, Center researchers are analyzing how strategies adopted by federally qualified health centers and other safety net providers to achieve greater integration with specialists, hospitals, and social service agencies affect their ability to deliver high quality, cost-effective patient care.

Taking a Deep Dive to Characterize Health Systems

Research literature on health systems is limited and what literature exists reveals a surface-level assessment of their organization and functioning. By contrast, our Center researchers took a "dive deep" within 24 health systems and their affiliated physician organizations in four regions of the United States. We conducted in-depth interviews with a range of leaders within each system to gain a richer understanding than is possible to glean from analyzing administrative and claims data or examining the responses to fixed choice surveys. This in-depth assessment is leading to a more complete understanding of the complex structures of health systems as well as the myriad contextual and environmental factors that contribute to health system performance.

Our Partners

In addition to the Center’s multi-disciplinary, multi-institutional research team, we are fortunate to have partnered with four of the nation's pre-eminent regional quality collaboratives. By sharing their insights, experience, contacts, and data with us, these organizations provided an invaluable laboratory for the Center's work and are collaborating with us to disseminate our findings to those who can most benefit from them.

The Center’s partners are:


The RAND Center of Excellence on Health System Performance is directed by Cheryl Damberg, principal senior researcher and RAND Distinguished Chair in Health Care Payment Policy and by M. Susan Ridgely, senior health policy researcher.


The Center is led by Cheryl Damberg, principal senior researcher and RAND Distinguished Chair in Healthcare Payment Policy, and Susan Ridgely, senior health policy researcher. For more information about the Center, contact Cheryl_Damberg@rand.org.