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It becomes clear from studying the configuration of most of these alliances that allegiance to and partnerships with federal agencies such as AHRQ and CMS are critical to any strategy driving health care system change that is focused on higher quality. CMS, at the behest of Congress, controls decisions determining reimbursement for services, how to reward for higher‐quality care, and how to make deductions in reimbursement due to preventable negative outcomes of care. NQF has been made the arbiter of measure endorsement and of which measures’ data, gathered by institutions and providers, point to the outcomes that either get rewarded or penalized. And AHRQ has played a major role from a federal perspective in the creation and validation of standards, offering guidelines for best practice, and being a clearinghouse of national quality measures and research related to quality, safety, and best practice. Any professional alliance looking to develop measures or to suggest that given measures are or are not appropriate for considerations of payment would do well to bring these entities along to the discussion, keep them informed of challenges and lessons learned, and either heed or shape the future they want to see. Some of the alliances that have developed and achieved endorsement of their measures from NQF ensured their measures continued through AHRQ representation.