Care Quality

The United States outspends other comparable countries on health care, yet Americans fail to receive about half of recommended health services, leading to both higher costs and increased risk of mortality.

RAND Health, at the vanguard of measuring the quality of health care, helped establish the scientific basis for assessing quality of care across multiple settings, including ways to reliably assess the quality (including appropriateness of care) and overall value of care, and continues this work today. Beyond measurement, RAND Health evaluates novel approaches to improve the quality, accessibility, and safety of care.

Keeping Clinical Quality Measures Relevant

Medicare uses a Star Ratings program to give beneficiaries actionable information about the quality of Medicare Advantage (MA) and Part D plans. Because MA and Part D plans change yearly, Medicare needs to adjust its ratings system accordingly—and do so in a way that does not unwittingly penalize plans.

A reliable analytic partner: RAND researchers support Medicare with ongoing analyses to calculate Star Ratings, uncovering issues before any potential adjustments to the ratings are implemented.

• RAND’s work helped CMS understand whether its Categorical Adjustment Index (CAI) helped address measurement bias within the Star Ratings, ensuring that the Star Ratings do not undervalue the performance of MA contracts that enroll higher percentages of people with greater social risk.
• RAND regularly convenes a Technical Expert Panel to obtain input on how to streamline the measures.

Assessing Patients' Experiences of Care

Before the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Study launched in 1995, there had not been a way to measure patients’ experiences of care across health care settings.

An undisputed leader: Since the launch of CAHPS®, RAND has supported the implementation of its family of surveys, which capture patient-reported experiences of care in Medicare, Medicaid, and large private health insurance plans, as well as experiences with providers and facilities.

• RAND found that patient experience scores of hospital care declined in recent years.
• A CAHPS Hospice Survey of more than 650,000 family caregivers of patients who died in more than 3,000 hospices across the United States uncovered substantially worse care in for-profit hospices than not-for profit hospices.
• Results from the CAHPS Clinician and Group survey have also been used in research to evaluate interventions, differences in patient experience, and associations of patient experience with factors such as organizational climate, physician empathy, and medication adherence.
• RAND released the Serious Illness Survey for Community-Based Care in 2025.

Improving Quality and Patient Safety

The Institute of Medicine identified patient safety and poor quality as the most pressing problems facing the U.S. health care system 25 years ago, yet these remain huge challenges to the U.S. medical system to this day.

Advancing science over decades: RAND conducted pioneering analysis that assessed progress in patient safety improvement and developed a widely used toolkit to help hospitals improve patient safety. RAND later brought together an international panel dedicated to making health care safer. Our researchers continue to work toward that goal through a variety of projects, including

• assessing the effects of a Medicare program, which was found to reduce hospital-acquired infections
• conducting a review of the many available patient-safety tools, which concluded that tool use and impact varied widely. (Voluntary incident reporting may also miss safety events among some populations of hospital patients.)
• implementing and evaluating an ongoing project that encourages use of AHRQ-developed resources to support health care organizations in diagnostic safety efforts.

Evaluating novel approaches to improve care: RAND has worked to identify and evaluate promising ways to improve patients’ access to care and provider and health system performance.

• Working with a California health system, researchers used data on surgeons’ prescribing habits to “nudge” overprescribers to reduce their prescription amounts closer to recommended guidelines. The project prevented an estimated 42,000 opioid pills from entering the community.
• Because transportation is an often-reported barrier to completing a recommended colonoscopy, researchers modeled the effects of a potential solution: a rideshare intervention. Within the microsimulation, people receiving the rideshare were more likely to complete the colonoscopy and detect a cancer early.
• Multiple clients have worked with RAND to improve care, including finding holistic ways to detect cognitive impairment and assess efforts to screen for toxic stress.

Making Care More Patient-Centered

Quality measures can help objectively measure whether quality of care is delivered. But for some aspects of care, patients are the only source of feedback. Incorporating their perspective as objectively as possible is crucial to patient-centered care.

New methods to include patient voices: RAND developed the RAND/PPMD Patient Centeredness Method to get patients involved in developing clinical guidelines. Our researchers also released the Technical Expert/Clinical User/Patient Portal (TECUPP) model, which promotes discussion and understanding among patients, caregivers, clinicians, and measure experts during measure development.

• Building on the previously developed ExpertLens™, an online modified-Delphi approach allows caregivers and patients to use their first-hand experience with treatment to have a say in what works—or doesn’t—as they receive care.
• RAND helped fill a gap in patient-reported measures of palliative care.
• Deliberative democracy, another group decisionmaking approach, helps engage community members who have lived experience with maternal mortality and severe maternal morbidity to identify priorities to address these problems.