Commission Goals:
In establishing the Commission on a High Performance Health System in 2005, The Commonwealth Fund's Board of Directors recognized the need for national leadership to revamp, revitalize, and retool the U.S. health care system. The Commission's 17 members, a distinguished group of experts and leaders representing every sector of health care, as well as the state and federal policy arena, the business sector, professional societies, and academia, are charged with promoting a high-performing health system that provides all Americans with affordable access to high-quality, safe care while maximizing efficiency in its delivery and administration. Of particular concern to the Commission are the most vulnerable groups in society, including low-income families, the uninsured, racial and ethnic minorities, the young and the aged, and people in poor health.
The Commission has ignited considerable public interest and attention. Its greatest accomplishments so far have been to highlight for the public specific areas where health system performance falls short of what is achievable, and to recommend key strategies for transforming the system.
The Commission on a High Performance Health System is chaired by Fund board member James J. Mongan, M.D., President and CEO of Partners Healthcare System, Inc. Steve Schoenbaum, M.D., M.P.H., is the Commission's Executive Director, Cathy Schoen, M.S., is the Commission's Research Director, and Rachel Nuzum, M.P.H., is the Commission's Senior Policy Director.
The Issues:
The United States provides some of the best medical care in the world, yet a growing body of evidence indicates the system falls short. Although national health spending is significantly higher than the average rate of other industrialized countries, the U.S. is the only such country that fails to guarantee universal health insurance. Today, health care coverage is deteriorating, leaving millions without affordable access to preventive and essential health care. The quality of care is highly variable and delivered by a system that too often is poorly coordinated, driving up costs, and putting patients at risk. With rising costs straining family, business, and public budgets, access to care deteriorating and variable quality, improving health care performance is a matter of national urgency.
Recent Projects:
Outlining and Measuring Health System Performance. In its first report, Framework for a High Performance Health System in the United States, published in August 2006, the Commission traced the critical sources of health system failures and outlined a vision of a uniquely American, high performance system.
Since that initial report, the Commission has made a significant contribution, issuing National and State Scorecards measuring U.S. health system performance. Published in July 2008, the second National Scorecard, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008, rates U.S. health system performance on 37 core indicators for a score of 65 out of 100, a slight decline from the 2006 score of 67. The report demonstrates that access to health care declined significantly during this period and that health system efficiency remains low. However, selected quality metrics have shown improvement. Overall, the 2008 Scorecard indicates that despite pockets of progress, the U.S. health system continues to operate far below the performance of leading nations, delivery systems, states, and regions.
The Commission published the first State Scorecard on U.S. Health System Performance report in June 2007. Closely following the National Scorecard, the State Scorecard is the first attempt to cover a set of indicators that span core dimensions of health system performance—including healthy lives, access, quality, efficiency, and equity—in a comprehensive report. The report, Aiming Higher: Results from a State Scorecard on Health System Performance, endeavors to spur policymakers and private stakeholders to improve health system performance at the state level, and to offer a metric for evaluating state health system performance.
Establishing Integrated Care. The Commission also has issued a number of policy reports with specific recommendations to achieve high performance.
In August 2008, the Commission published Organizing the U.S. Health Care Delivery System for High Performance, which examines the detrimental effects of fragmentation in the current system and offers policy recommendations to establish greater coordination across providers and care settings. For example, the authors recommend that payers move away from fee-for-service payments toward bundled payment systems that reward coordinated, high-value care, and that regulatory changes be made to facilitate clinical integration among providers.
Accompanying the report is a Commission data brief based on a survey of U.S. adults, Public Views on U.S. Health System Organization: A Call for New Directions. The survey found that eight of 10 respondents believe that the U.S. health system needs fundamental change or complete rebuilding. Adults want their health care to be more patient-centered and integrated and support a greater role for health information systems and teamwork in improving care.
Improving Value. In December 2007, the Commission published Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending. To inform national policy development, this project analyzed federal options for potential short- and long-term savings and opportunities to invest for future gains in value. The Lewin Group modeled the likely effects of each option and estimated the five- and 10-year cumulative impact on total national health spending as well as the effects across federal and state budgets, employers, and households. The analysis determined that if implemented along with universal health coverage, selected policy options could save $1.5 trillion in national health expenditures over 10 years, while also improving the value of care in terms of access, quality, and health care outcomes.
Developing Strategies for the Country to Guide Health Reform. In its November 2007 report A High Performance Health System for the United States: An Ambitious Agenda for the Next President, the Commission presented a set of strategies necesssary for the U.S. to reach, and improve upon, benchmark levels of health system performance. They are:
- extending comprehensive, affordable, and seamless insurance coverage to all;
- aligning incentives to reward high-quality, efficient care;
- organizing the health system to achieve accountable, coordinated care;
- investing in public reporting, evidence-based medicine, and the infrastructure necessary to deliver the best care; and
- exploring creation of a national entity that set aims for health system performance and priorities for improvement, monitors performance, and recommend practices and policies.
Analyzing Health Reform Plans. In the fall of 2007, the Commission published A Roadmap to Health Insurance for All, which examined the importance of universal coverage for a high-performance health system and evaluated the 2008 presidential candidates' health reform proposals. The Commission believes the most pragmatic approach to coverage for all is mixed private-public group insurance that builds on the best features of our current system and minimizes dislocation for the millions of Americans who currently have good coverage. Responsibility for financing should be shared among individuals, employers, and government.
Offering Recommendations for Comprehensive Reform. As the federal health reform debate began taking shape in February 2008, the Commission released The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way. This influential report contains a comprehensive set of insurance, payment, and system reforms that could guarantee affordable health insurance coverage, improve health outcomes, and slow the growth of health spending by $3 trillion by the end of the next decade.
Informing Policymakers. In addition to issuing publications, the Commission works to engage and inform federal policymakers in the executive and legislative branches of government and to key stakeholders involved in the health policy dialogue. At the same time, legislative advances at the national level have implications for the work of the Commission, for the Fund’s intramural research agenda and for grantmaking efforts by the Fund.
Senior Policy Director Rachel Nuzum informs and responds to the health policy dialogue in several ways including the following: convening bipartisan briefings, meetings and retreats for members of Congress and their staff, conducting research on relevant reform topics, generating written products designed especially for policy audiences, providing invited testimony and technical assistance as requested by legislative and executive branches of government, and fostering public-private collaboration on health performance improvement. The Fund works in a bipartisan manner, engaging in educational and informational activities and is restricted from lobbying as a private foundation.
The Washington-based Alliance for Health Reform receives support from the Fund to hold policy briefings and roundtable discussions, as well as an annual bipartisan congressional retreat and congressional staff retreat that gives members of Congress and their senior staffers a unique opportunity for off-the-record discussion of pressing health policy issues.
Future Directions:
The Commission is currently developing further recommendations for the next president and Congress and will issue a second State Scorecard in the fall of 2009.