Start: May 2007

End: June 2008

Funder: The Commonwealth Fund with additional funding from the Robert Wood Johnson Foundation


In Medicaid, state officials, legislators, and other stakeholders are increasingly being challenged to identify programs with potential to both improve quality of care and control health care costs. In response, the Center for Health Care Strategies (CHCS) launched the Return on Investment Purchasing Institute to build state capacity to forecast the financial returns that may be generated by investments in quality improvement.

Through this 12-month initiative, eight states — Arizona, Colorado, Connecticut, Idaho, Louisiana, Oklahoma, Pennsylvania and Washington — received focused training paired with intensive technical assistance around concepts and methodology for calculating return on investment (ROI). Participants evaluated the ROI potential for specific quality initiatives and analyzed the implications of ROI analyses for program planning and resource allocation. Participating state teams had pre-release access to the CHCS ROI Forecasting Calculator for Quality Initiatives, a tool designed to help states assess and demonstrate the ROI from proposed quality improvement initiatives.

Participating state teams attended two Purchasing Institute (PI) meetings, received personalized technical assistance, collaborated with other state participants, attended a PI Summit with the broader Medicaid policy community, and shared information through an online learning network.