Rosenthal suggests that policies that pay explicitly for quality improvement, rather than strictly rewarding high achievement levels, could alter the incentives for high-performing and low-performing groups and increase the overall impact of incentives. Rosenthal is currently examining how financial incentives targeting both physicians and patients affect cost and quality in a large health and welfare trust for culinary workers in Nevada.

In order to build the capacity for change in the health care system, the Program on Health Care Quality Improvement and Efficiency has promoted the "learning collaborative" model, in which experts help to facilitate improvements by offering clinical or technical support and organizing staff into quality improvement teams. With Fund support, the nonprofit Primary Care Development Corporation led learning collaboratives in four community health centers in New York City. According to the case study reports published by the Fund in August 2004, the clinics were able to make significant improvements in key operations: reducing waiting times; offering on-demand appointments with patients' primary care providers; enhancing revenue collections; and attracting and retaining patients. Another Fund grant to the Primary Care Development Corporation will enable the evaluation of 25 learning collaborative teams to determine what organizational characteristics contribute to the achievement, maintenance, and spread of improvements.