Grants Approved

Health Care Coverage and Access

BOARD GRANTS

Georgetown University
$436,144

Monitoring and Analyzing Implementation of the Affordable Care Act’s Insurance Market Reforms, Year 3

The major provisions of the Affordable Care Act that go into effect in 2014 include the establishment of health insurance marketplaces, or exchanges, in all 50 states and sweeping new market reforms that protect consumers buying coverage on their own. Using the unique regulatory tracking system and network of state contacts it developed during the project’s first two years, the Georgetown research team will track and analyze implementation of the exchanges and the insurance market reforms. With access to comprehensive information about state variations in enrollment levels, premium costs, and the availability and quality of health plans, policymakers will be able to make adjustments to the exchanges as needed.

Kevin Lucia, J.D., M.H.P.
Associate Research Professor
3300 White Haven Street, N.W., Box 571444
Washington, D.C. 20057-1444
kwl@georgetown.edu

President and Fellows of Harvard College
$498,980

Examining the Early Impact of the Affordable Care Act on Low-Income Populations: Comparing State Decisions on Medicaid

In its 2012 ruling, the Supreme Court allowed states to opt in or out of the Affordable Care Act’s Medicaid expansion. To date, only about half the states have indicated they will expand their program, and at least three are exploring alternative approaches using private insurance. To examine the effects of this historic expansion, the research team will survey people in three states, each of which is taking a different approach toward expansion: 1) electing Medicaid expansion; 2) pursuing an alternative with private insurance; and 3) declining expansion. Phase 1 of this project will support a survey to examine awareness of the Medicaid expansion among state residents, as well as to collect baseline data on access to care, financial problems associated with getting health care, and health status. Phase 2 will follow up with residents one year later to assess the effects of the expansion.

Benjamin Sommers, M.D., Ph.D
Assistant Professor of Health Policy & Economics
677 Huntington Ave, Kresge Room 406
Boston, MA 02115
bsommers@hsph.harvard.edu

Massachusetts General Hospital
$299,980

Assessing Adverse Selection in California’s Individual Health Insurance Market, Phase 1

If disproportionately large numbers of sick people enroll in health plans offered in the new insurance marketplaces, insurers could raise premiums quickly and destabilize the exchanges. Anticipating such a scenario, the framers of the Affordable Care Act created premium stabilization mechanisms, including two transitional programs and a permanent risk adjustment program, to protect plans against the potential for “adverse selection.” Focusing on California, researchers will survey adults who have signed up for coverage through the state’s marketplace during the first six months of open enrollment, a first step in gauging whether sicker-than-average enrollees are enrolling in the exchanges. The findings, from a state with a large, diverse population, will provide essential information to officials charged with maintaining marketplace stability during the rollout. If phase 1 is successful, a second phase will be proposed to develop protocols for evaluating the risk-adjustment program’s effectiveness.

John Hsu, M.D., M.B.A., M.S.C.E. Director, Clinical Economics and Policy Analysis Program
Mongan Institute for Health Policy
50 Staniford Street
9th Floor, Suite 901
Boston, MA 02114
jhsu7@partners.org

National Opinion Research Center
$269,327

Surveying Small Employers to Inform the Design of State Insurance Marketplaces, 2014

With Commonwealth Fund support, NORC at the University of Chicago surveyed small business owners in 2013 about their needs and preferences with regard to providing health insurance benefits to workers. Building on that work, this project will resurvey small employers in 2014 to learn about their coverage decisions and their experiences in a small-group insurance market transformed by the Affordable Care Act. The findings will alert state and federal policymakers to possible problems in the functioning of the new insurance marketplaces for small businesses or in states’ implementation of them, as well as inform solutions that ensure the needs of employers and workers are met.

Jon Gabel, M.A.
Senior Fellow
4350 East-West Highway, Suite 800
Bethesda, MD 20814
gabel-jon@norc.org

Princeton Survey Research Associates International
$633,025

Assessing the Impact of the Affordable Care Act After Six Months: The Commonwealth Fund Biennial Health Insurance Survey, 2014

The Commonwealth Biennial Health Insurance Survey——conducted every two years since 2001——will be fielded in the summer of 2014 to assess the early effects of the Affordable Care Act. By interviewing a nationally representative sample of 6,000 U.S. adults, along with oversamples of residents of the four most populous states, the survey will shine a light on early changes in the health coverage of U.S. working families, including the proportion of people who lack insurance or have gaps in their insurance, have difficulty affording needed care, or are paying off medical debt. It also will identify shifts in employer coverage and in the experience of people who gain coverage as a result of the reform law. The findings will provide policymakers and the media with one of the first broad-based assessments of the law’s national and state-level impacts on the health and financial security of Americans.

Mary McIntosh, Ph.D.
Principal, President
1211 Connecticut Avenue N.W., Suite 305
Washington, D.C. 20036
mary.mcintosh@psra.com

Wake Forest University Health Sciences
$159,932

Examining Health Insurers’ Premium Rate Increases and Their Response to the Medical Loss Ratio Requirement, 2013-14

Since they began analyzing publicly reported data on insurers’ premium rate increases and changes in medical loss ratios (MLRs) in 2011, Commonwealth Fund——supported researchers Mark Hall and Michael McCue have found that the Affordable Care Act’s MLR requirement——which stipulates that insures must spend a minimum portion of premium dollars on health care and quality improvement——led to two-year savings of $3.4 billion in the form of consumer rebates and reduced plan overhead costs. Their findings also show that insurers spend very little on quality improvement, and that higher spending on medical care accounts for the bulk of larger premium hikes. Beginning in 2014, insurers are required to report increases of any amount, not just large ones. Hall and McCue will analyze this new set of increases and update their work on the MLR with newly available data. Their findings will yield important insights for regulators and policymakers striving to improve the efficiency of insurance markets and restrain premium growth.

Mark Hall, J.D.
Professor
Medical Center Boulevard
Winston-Salem, NC 27157-1066
mhall@wakehealth.edu

SMALL GRANTS

The George Washington University
$49,991

Examining Cost Sharing Reduction Assistance Under the Affordable Care Act

Consumers who purchase health insurance coverage through the marketplaces and who have incomes under 250 percent of poverty are eligible for cost-sharing reductions to help lower their out-of-pocket medical expenses. These cost-sharing reductions are in addition to the premium subsidies available to people with incomes between 100 and 400 percent of poverty. The cost-sharing reductions are aimed at raising the actuarial value of the law’s silver-level plans from 70 percent on average of medical costs to 73, 87 and 94 percent, depending on a consumer’s income. But insurers have considerable flexibility in how they achieve these targets through cost-sharing among benefits and providers. Insurers may also use this assistance to encourage or discourage use of certain services like emergency rooms. As a result, not every plan with cost-sharing reductions will be the same, and some models may be more or less optimal for a consumer depending on the services and care the consumer may require. This project will compare 30 silver plans with cost-sharing reductions across the country to inform policymakers, consumer assistance programs, and providers who serve lower income patients as to how widely and in what ways cost-reduction assistance plans vary, and how consumers are choosing among these plans.

Sara Rosenbaum, J.D. Harold and Jane Hirsh Professor of Health Law and Policy and Chair, Department of Health Policy
2021 K Street N.W., Suite 800
Washington, D.C. 20006
sarar@gwu.edu

Jonathan Gruber
$25,000

Describing pre-ACA Volatility in Insurance Market Prices

In the next few months, health insurers will issue 2015 premiums for plans they sell in the individual and small group markets including the Affordable Care Act’s marketplaces. In addition, many small employers with existing policies will begin to renew their coverage. It will help policymakers, consumers, small business owners, and the media understand the 2015 premiums if they are placed in context of historical trends prior to the reforms of the health law including new restrictions on underwriting, standardized benefits, and premium rate review, which went into effect in 2011. To provide this point of comparison, Dr. Gruber will compile a database of rate filings over 2009——2011 in as many states as it is possible to gather data.

Jonathan Gruber, Ph.D.
Professor of Economics
83 Pleasant Street
Lexington, MA 02421
gruberj@mit.edu

National Opinion Research Center
$48,471

Monitoring Trends in the Individual & Small Group Marketplaces on a Real-Time Basis: Phase One

When the 2015 open enrollment period for plans sold through the insurance marketplaces begins this November, people who enrolled in a plan this year will be able to switch to another plan, and those who have not yet signed up will be able to find a plan. A key question is how and to what degree health insurers will change their coverage for 2015——what adjustments will they make to premiums, deductibles and cost-sharing, and plan types? There is certain to be intense scrutiny of plan changes, particularly premiums as states release insurer offerings in the coming months. Evidence-based analysis of the new offerings will be critical to inform a dialogue that will otherwise rely on anecdote. Under a July Board proposal, the research team proposes to build a national database of marketplace health plans for years 2014 and 2015 that will enable the team, as well as Fund staff and grantees, to conduct national, state, and regional analyses of annual changes in premiums, benefit design characteristics, and plan enrollment. For example, the research team will collaborate with Kevin Lucia under his July Board proposal to understand the potential effect of different state marketplace designs and implementation of the law’s insurance market reforms on premiums in a select set of states. This small grant would allow the team to begin building the 2014 database to facilitate analyses of the 2015 premiums as they are released by states this summer. The database will provide timely information to policymakers and the media about trends in the cost and comprehensiveness of health plans sold through the marketplaces and implications for consumers, small employers, and the federal government.

Jon Gabel, M.A.
Senior Fellow
4350 East-West Highway, Suite 800
Bethesda, MD 20814
gabel-jon@norc.org

Small Business Majority Foundation Inc.
$48,000

Taking Stock of SHOP: Lessons from California and Colorado

Small Business Health Options (SHOP) exchanges are new health insurance marketplaces available in each state for small employers with 50 or fewer workers to purchase coverage for their employees. This year small employers in states with federally run marketplaces can apply via paper application or through an insurance broker or navigator, with online access available in November 2014. Employers in most of the 17 states and the District of Columbia that are running their own SHOPs can already access them online. California and Colorado have among the most well-developed SHOPs with promising early enrollment. Both states planned extensively for their SHOPs consulting with stakeholders and small business owners. These SHOPs have four to six insurers selling plans with networks and premiums that are competitive with existing small-group plans. Yet the two SHOPs differ on key dimensions such as the degree to which employers can select a range of plans for their employees to choose from. This project will study the SHOPs in California and Colorado, producing a comparative analysis of approaches that were successful or not, and how other state-run and federally facilitated small-group marketplaces can learn from these experiences in implementing their own SHOPs. This project complements the program’s existing work in the small group market, including tracking and analysis of the variation in SHOP design and a survey of small employers on the effects of health reform on their ability to provide health insurance.

John Arensmeyer, J.D.
Founder and Chief Executive Officer
4000 Bridgeway, Suite 101
Sausalito, CA 94965
jarensmeyer@smallbusinessmajority.org

Virginia Commonwealth University
$48,247

The Financial Burden of Medical Care: Implications of Recent Developments in Health Care Policy, Coverage, and Care Delivery

Rising health care costs and sluggish income growth have made health insurance and health care less affordable for millions of families in the United States. Over 48 million people are uninsured and those with coverage are spending more on premiums for plans that provide less out-of-pocket protection. In prior work supported by the Fund, the research team found that in 2009, 19 percent of American lived in families in which out-of-pocket spending for both premiums and health care exceeded 10 percent of family income, compared to 14 percent in 2001. This project would update these estimates between 2009 and 2011 with an analysis of the latest available Medical Expenditure Panel Survey, highlighting national trends by income and source of coverage. This research will inform federal and state policymakers and leaders in the employer community about the amount of income Americans are devoting to both insurance and medical costs, and how the Affordable Care Act might alter current trends.

Peter Cunningham, Ph.D. Professor
830 East Main Street, P.O. Box 980430
Richmond, VA 23298-0430
pjcunningham@vcu.edu

Health Care Delivery System Reform

BOARD GRANTS

Regents of the University of California
$280,130

Optimizing Quality in Home-Centered Primary Care, Phase 2

Some 4 million adults are unable to visit their primary care doctor’s office because they are too frail and have too many functional limitations. As care delivery systems seek to lower the high costs of treating complex, vulnerable patients such as the homebound, many are exploring the provision of care right in the patient’s home. To develop incentives, ensure provider accountability, and foster the spread of home-based primary care, it will be necessary to have ways to measure the quality of care delivered by these providers. With prior Commonwealth Fund support, researchers developed an initial set of measures covering 10 key performance domains for home-based primary care. In phase 2, the team will test the feasibility of the proposed measures with a group of home-based providers and develop new measures as needed. The tested measures will enhance national health care quality measurement sets and contribute to future incentive programs targeting this patient population.

Christine Ritchie, M.D., M.S.P.H. Professor of Medicine
3333 California Street, Suite 380
San Francisco, CA 94143-1265
christine.ritchie@ucsf.edu

Regents of the University of California
$221,648

The Case for Medicaid Managed Care Plan Investment in Programs Addressing the Social Determinants of Health

As providers are increasingly held accountable by payers for the quality and costs of the health care they deliver, interest has grown in interventions to address the social determinants of poor health. Focusing on Medicaid managed care organizations (MCOs), which may have financial and organizational incentives to address their enrollees’ social needs, this project will assess the rationale for investing in these interventions and the plausibility of bringing them to scale. The research team will interview leaders of Medicaid MCOs that are targeting social needs, as well as leaders of MCOs that are not, for their insights on the facilitators and barriers to implementing and sustaining these programs, as well as the design characteristics, financing mechanisms, and evaluation tools being used.

Laura Gottlieb, M,D., M.P.H.
Assistant Professor of Family and Community Medicine
995 Potrero Avenue
San Francisco, CA 94143
gottliebl@chc.ucsf.edu

Center for Health Care Strategies, Inc.
$462,731

Promoting Integrated Care for Medicare/Medicaid Dual Eligibles, Phase 2

This grant will continue support for Promoting Integrated Care for Dual Eligibles (PRIDE), a unique peer-to-peer learning collaborative of seven small but high-performing health plans that is seeking to address the organizational challenges inherent in creating integrated care systems for high-need, high-cost patients. By identifying the attributes and practices necessary to achieve well-integrated care, this highly visible collaborative could provide a model for Medicaid programs and managed care leaders in every state.

Sarah Barth, J.D.
Director, Long-Term Services
200 American Metro Boulevard, Suite 119
Hamilton, NJ 08619
sbarth@chcs.org

Center for Health Care Strategies, Inc.
$213,630

Enhancing the Capacity of Medicaid Accountable Care Organizations to Serve Vulnerable Populations, Phase 2

Under a current Commonwealth Fund grant, the Center for Health Care Strategies is leading a learning collaborative to help seven states design and implement accountable care organizations (ACOs) for Medicaid beneficiaries, offering technical assistance and peer-to-peer learning opportunities. In the second phase of the collaborative, the project team will help these states: 1) expand ACO services to include behavioral health, long-term care and support, public health, and community-based social services; 2) diversify provider participation in ACOs to include safety-net hospitals and clinics; and 3) broaden the patient population served to include people dually eligible for Medicare and Medicaid. Lessons will be disseminated to stakeholders in all states seeking guidance in bringing accountable care to vulnerable populations.

Patricia McGinnis, M.P.P., M.P.H.
Director of Delivery System Reform
200 American Metro Boulevard, Suite 119
Hamilton, NJ 08619
tmcginnis@chcs.org

Trustees of Dartmouth College
$243,492

Examining the Efforts of Accountable Care Organizations to Improve Coordination of Care for Vulnerable Patients

Because of their emphasis on coordinating patient care, accountable care organizations, or ACOs, have great potential to improve the health of vulnerable populations with complex health and social needs. Despite the rapid formation of ACOs serving Medicaid and other safety-net populations, little is known about the strategies ACOs are implementing to transform care delivery for vulnerable individuals and how they are addressing patients’ varied medical, behavioral health, and social service needs in an integrated fashion. Building on the principal investigator’s current examination of ACO formation in the safety net, this project will interview ACO leaders to identify the strategies and programs they are using to improve care coordination for vulnerable populations and describe the ways in which frontline clinical providers are engaged in these transformation efforts.

Valerie Lewis, Ph.D.
Research Faculty, Center for Population Health
35 Centerra Parkway
Lebanon, NH 03766
valerie.a.lewis@dartmouth.edu

Trustees of Dartmouth College
$423,992

Evaluating the Formation and Performance of Accountable Care Organizations: Focus on High-Need, High-Cost Populations, Year 5

Evaluating the formation of accountable care organizations (ACOs) is essential to determining whether this model of integrated care delivery can achieve its promise of providing high-quality, population-based care at lower cost. In the previous phase of this project, the Dartmouth team conducted a first-of-its-kind national survey of more than 170 ACOs, identified ACO market characteristics, and described how these organizations manage high-risk patients and distribute shared savings. In the next phase, the team will continue to advance the state of knowledge about ACOs. Focusing on the treatment and management of high-need, high-cost patients, the team will field a follow-up survey of ACOs and conduct additional analysis to assess: 1) ACOs’ management of care transitions for these patients; 2) the degree to which Medicare ACOs are pursuing Medicaid contracts, and how these contracts affect care for dually eligible beneficiaries; 3) whether ACOs are engaging patients in care decisions and treatment plans; and 4) the likelihood of ACOs forming in areas with a concentration of high-need residents.

Carrie Colla, Ph.D.
35 Centerra Parkway
Lebanon, NH 03766-1421
carrie.h.colla@dartmouth.edu

The George Washington University
$130,431

Identifying Innovative Payment Models for Federally Qualified Health Centers, 2014

Federally qualified health centers, an important component of the health care safety net, have come to rely on Medicaid’s system of payment on a per-visit basis. Under the Affordable Care Act, it will be important for states to identify alternative payment methodologies that promote value over volume in care delivery, while still continuing to shield health centers against losses from providing uncompensated care to the poor and uninsured. Through interviews with experts, a survey of state Medicaid officials, and case studies of high-performing health centers, this project will identify and assess these alternative payment models. The findings will alert policy leaders to opportunities for integrating health centers into an increasingly value-driven care delivery system.

Peter Shin, Ph.D., M.P.H.
Associate Research Professor
The George Washington University
School of Public Health and Health Services
2021 K Street N.W., Suite 800
Washington, D.C. 20006
pshin@gwu.edu

President and Fellows of Harvard College
$191,783

Examining the Impact of the Alternative Quality Contract on the Treatment and Costs of Patients with Mental Illness

Although there is movement toward integrating mental health services financing and delivery with the rest of the health care sector, very little is known about the care and costs of mentally ill patients who are enrolled in integrated delivery systems that reimburse providers with global payments. Focusing on provider organizations participating in Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract (AQC), Harvard researchers will analyze differences in mental health services use and spending, as well as total health care spending, between providers whose contracts hold them accountable for mental health outcomes and resource use and providers who do not bear this financial risk. The results will then be compared with a control group of providers not taking part in the AQC. Interviews will further explore how the AQC’s payment incentives are affecting care delivery for patients with mental illness and comorbid chronic conditions.

Haiden Huskamp, Ph.D.
Professor of Health Care Policy
Harvard Medical School
Department of Health Care Policy
180 Longwood Avenue
Boston, MA 02115
huskamp@hcp.med.harvard.edu

President and Fellows of Harvard College
$328,141

A Meta-Analysis of Medical Home Evaluations

Published studies of the medical home model’s impact on costs, use of services, and health outcomes have so far yielded decidedly mixed findings. A major challenge for evaluators has been the preponderance of relatively small “underpowered” studies. Under this grant, researchers will perform a meta-analysis that will pool the results of these small studies, both published and unpublished, thus enabling more precise and robust conclusions regarding the effectiveness of medical homes. The analysis is expected to inform policy decisions on whether to sustain, expand, or revise initiatives that are testing new payment and delivery models in primary care.

Meredith Rosenthal, Ph.D.
Professor of Health Economics and Policy
Department of Health Policy and Management
School of Public Health
677 Huntington Avenue
Kresge Building, Room 405
Boston, MA 02115
mrosenth@hsph.harvard.edu

President and Fellows of Harvard College
$441,681

Care Utilization and Spending Patterns for High-Cost Medicare Beneficiaries

Although it is understood that most health care spending is concentrated in a small segment of the population, we know little about the health problems these individuals have, the services they use, or whether any of this spending is avoidable. A detailed study of high-cost Medicare beneficiaries will begin to tease out the differences among subgroups——whether people newly diagnosed with cancer, those suffering a catastrophic event, or those experiencing an exacerbation of a chronic condition. The research team will identify patient-level predictors of high-cost status, examine major sources of spending, and determine the proportion of inpatient and emergency care that is potentially preventable. The study’s findings, which will lay the foundation for future work in this area, will help clinical leaders and policymakers target interventions more effectively for the most expensive patients and, possibly, identify ways to improve Medicare’s solvency.

Ashish Jha, M.D., M.P.H.
Professor of Health Policy
677 Huntington Avenue, Fourth Floor
Boston, MA 02115
ajha@hsph.harvard.edu

President and Fellows of Harvard College
$800,000

Mongan Commonwealth Fund Fellowship in Minority Health Policy: Support for Program Direction and Fellowships, 2014-15

Since 1996, the Mongan Commonwealth Fund Fellowship in Minority Health Policy has developed a network of physicians dedicated to reducing disparities in health care. During the year-long master’s program at Harvard, physicians receive enriched training in health policy, public health, and management, all with an emphasis on minority health issues. Fellows may also pursue an optional second year of practicum experience, during which they work closely with experts from a delivery system, government agency, or policy-oriented institution. With the fellowship’s renewed focus on improving vulnerable populations’ access to high-performance health systems, the Harvard staff will continue to implement a variety of changes to further this mission. The Fund grant for 2014-15 will support at least four M.P.H. candidates at the Harvard School of Public Health.

Joan Y. Reede, M.D., M.P.H., M.S., M.B.A.
Dean for Diversity and Community Partnership
Minority Faculty Development
164 Longwood Avenue, Room 210
Boston, MA 02115
joan_reede@hms.harvard.edu

Joan and Sanford I. Weill Medical College of Cornell University
$100,000

Assessing the Large Primary Care Medical Group as an Alternative Model for Organizing Health Care

As primary care physicians continue to migrate from small independent practices to large multispecialty medical groups, or join hospital staffs as salaried employees, an alternative organizational model has gone largely unnoticed: the large independent primary care medical group. Anecdotal evidence suggests these groups are thriving financially and performing at a high level. A Cornell research team will conduct a qualitative study of at least six large primary care groups——along with the providers and payers with whom they interact——to understand how these groups got started, how they are structured, how they coordinate care with other providers, and how they remain financially viable. By studying their experience, the investigators will be able to tell us whether the model could potentially play a significant role in delivery system reform.

Lawrence Casalino, M.D., Ph.D
Chief, Division of Outcomes & Effectiveness Research
402 East 67th Street, Room LA-217
New York, NY 10065
Boston, MA 02115
lac2021@med.cornell.edu

Johns Hopkins University
$271,000

Identifying Successful Programs for Managing Care for High-Need, High-Cost Populations, 2014

Patients referred to as “high need” require a range of medical, behavioral, social, and long-term support services, all of which need to be coordinated. This high level of care today often comes at a high cost. Johns Hopkins University researchers will perform a comprehensive scan of public and private programs across the nation that have demonstrated success in improving outcomes for complex patients while lowering the costs of care. Selected programs targeting specific patient subpopulations will be studied in greater detail to learn about the intervention’s features, care settings, implementation processes, success factors, and impacts on quality and costs. The team will then identify commonalities across programs, as well as individual features that need to be tailored to patient subgroups. Findings from this work will enable health system leaders to be strategic in selecting and deploying an approach to treating these patients effectively and efficiently.

Gerard Anderson, Ph.D.
Director, Center for Hospital Finance and Management Professor
Center for Hospital Finance and Management
Bloomberg School of Public Health
624 North Broadway, Room 302 Hampton House
Baltimore, MD 21205
ganderso@jhsph.edu

LeadingAge, Inc.
$484,602

Leveraging Change Through Engagement: Building on the Advancing Excellence Campaign to Improve Nursing Homes For Their Residents and Staff

Since 2007, The Commonwealth Fund has partnered with the Centers for Medicare and Medicaid Services (CMS) to support the national quality improvement campaign Advancing Excellence in America’s Nursing Homes, in which more than 9,000 nursing homes——nearly 60 percent of the nation’s total——now participate. In the past year, the campaign has revised its goals, measures, and resources to reflect new national health policy priorities. A major undertaking in the coming year will be an attempt to create a national database of resident care outcomes——with data submitted by participating facilities——that will allow nursing homes to compare their performance against benchmarks and enable payers to select and reward high-performing homes.

Cheryl L. Phillips, M.D.
Senior Vice President
2519 Connecticut Avenue NW
Washington, DC 20008-1520
cphillips@leadingage.org

Manatt, Phelps & Phillips, LLP
$260,000

Examining the Implications of the 2014 Medicaid Expansion for Behavioral Health Services

Starting in 2014, the health care system must be able to accommodate millions of new patients seeking behavioral health services as a result of the Medicaid expansion, new essential health benefits standards, and mental health parity legislation. The currently disjointed systems for financing, administering, and delivering behavioral health services to Medicaid beneficiaries, however, pose major challenges for states, health plans, and providers in meeting the new demand. This project will: 1) examine new opportunities to create integrated care systems that meet the behavioral health needs of beneficiaries; 2) assess administrative, financing, and care delivery hurdles that stand in the way; and 3) identify policy and delivery system strategies that will help ensure access to well-coordinated, comprehensive health care.

Deborah Bachrach, J.D.
Partner
7 Times Square
New York, NY 10036
dbachrach@manatt.com

Regents of the University of Michigan
$344,298

Improving the Performance of Primary Care Physicians in Caring for High-Need, High-Cost Patients

The Physician Group Incentive Program (PGIP), launched by Blue Cross and Blue Shield of Michigan in 2005, encourages providers to work together to assume joint responsibility for their patients’ care. A previous Commonwealth Fund——supported evaluation by the research team found that, over a three-year period, the program was associated with lower health spending and improved quality of care. This project will identify strategies that can help to ensure that a large-scale improvement initiative such as PGIP produces consistent, positive results across all participating care providers. The research will focus on primary care practices with a large proportion of high-need, high-cost patients, as the capacity to improve is likely greatest in these practices.

Julia Adler-Milstein, Ph.D.
Assistant Professor
3003 South State Street, 1020
Ann Arbor, MI 48109
juliaam@umich.edu

National Senior Citizens Law Center
$110,000

Amplifying the Consumer Voice as States Integrate Care for Dual Eligibles, Phase 3

The process of planning, designing, and implementing a major policy initiative such as the State Demonstrations to Integrate Care for Dual Eligible Individuals is lengthy and complex. To ensure the effort’s ultimate success, consumers need to be equal partners with state policymakers each step of the way. With Commonwealth Fund support, the National Senior Citizens Law Center has created a much-praised website and informational program that have enabled consumer representatives in each state to participate meaningfully in preparations for launching the demonstration. In this third and final phase of the project, the center’s team will focus on helping consumers in those states ready to implement their integrated care initiatives, with the goal of ensuring a smooth rollout and providing vital feedback on user experiences.

Kevin Prindiville, J.D.
Executive Director
1330 Broadway, Suite 525
Oakland, CA 94612
kprindiville@nsclc.org

SSRS
$176,786

Commonwealth Fund/Kaiser Family Foundation 2014 Survey of Primary Care Providers

With the Affordable Care Act (ACA) nearly fully implemented at the outset of 2014, The Commonwealth Fund and the Kaiser Family Foundation will collaborate on a survey of primary care physicians, independent nurse practitioners, and physician assistants to learn their overall opinions of the law, their perceptions of how it is affecting their patients and practices, and their views of the changes brought about by the reforms. The survey’s findings, which will be discussed in two issue briefs coauthored by Fund and Kaiser staff, will inform policymakers, the media, and the public about the ACA’s early impact on a group of providers widely considered to be critical to the law’s success.

Robyn Rapoport
Vice President, Health Care, Public Policy, & International Research Director
53 West Baltimore Pike
Media, PA 19063
rrapoport@ssrs.com

SMALL GRANTS

Brandeis University
$15,000

21st Princeton Conference at the Robert Wood Johnson Foundation

The 21st Princeton Conference is scheduled to take place May 13-15, 2014 in Princeton, NJ. This annual conference is led by Stuart Altman, chairman, and Michael Doonan, director, of the Council on Health Care Economics and Policy. The Princeton Conference has brought together key domestic and international policymakers and experts for two decades. The proposed topic of the 2014 conference is “The Changing Healthcare Landscape.”

Stuart Altman
Chairman
415 South Street, MS 035
Waltham, MA 02454-9110
altman@brandeis.edu

Center for Health Care Strategies, Inc.
$45,403

State Payment and Financing Models to Promote the Integration of Health Care and Social Services

States have become increasingly interested in establishing new care delivery and payment models that better coordinate and integrate health care and social services. Under a previous project, The Center for Health Care Strategies (CHCS) convened a group of experts to develop a state-level framework for achieving integration of health care, public health, and social services. Building on that work, this project will conduct a literature review and key informant interviews to produce an issue brief which explores funding streams and incentive structures needed to encourage health and social service integration at the state level. Findings will be used as a technical assistance tool with states in the CHCS Accountable Care Organization Learning Collaborative as well as those participating in the Center for Medicare and Medicaid Services’ State Innovation Models initiative.

Stephen Somers, Ph.D.
President & Chief Executive Officer
200 American Metro Boulevard, Suite 119
Hamilton, NJ 08619
sasomers@chcs.org

Coalition to Transform Advanced Care
$44,600

Strategies to Promulgate Advanced Illness Care Models that Work

Patients with advanced illness are high utilizers of health care services and represent a group that is a major contributor to rising costs. However, when asked, these patients often opt for and value less acute care, more supportive care for themselves and help for their caregivers. A number of health systems have developed excellent clinical models to meet the needs of patients with advanced illnesses however not all of them report a similarly strong economic model. This threatens sustainability and hampers replication. This project would convene representatives from some of these exemplar programs, along with several payers, to identify and agree upon the common elements found in advanced care programs and the necessary economic model needed to sustain such services. This project represents the first step of a larger initiative which will seek to further strengthen the evidence base and further analyze utilization, cost and outcomes data in order to take these programs to scale.

Jon Broyles6
Deputy Executive Director6
1625 Eye Street N.W., Suite 12106
Washington, D.C. 20006
jbroyles@advancedcarecoalition.org

The Commonwealth Fund
$50,000

Mongan Commonwealth Fund Fellowship in Minority Health Policy: Support for Identifying Second Year Practicum Opportunities, and Support for Augmenting Leadership Training

Since 1996, the Mongan Commonwealth Fund Fellowship in Minority Health Policy has developed a network of physicians dedicated to improving the health of vulnerable populations. In November 2011, the Board approved a shift in the program towards creating leaders capable of transforming health care delivery systems for vulnerable populations, as well as the addition of an optional second year of practicum experience in a health care delivery system setting, a federal or state agency, or a policy-oriented institution. The program has experienced challenges identifying placements that fit the fellows’ individual career interests and geographic preferences, as well as in identifying organizations willing to provide financial support to the fellows during the practicum year. This authorization will enable the Fund to contract with four to five health care delivery system leaders to assist in identifying placements and obtaining funding commitments from host organizations. Funding will also support the addition of a more formal leadership training session to the first-year fellowship curriculum.

Pamela Riley, M.D., MPH
Assistant Vice President, Delivery System Reform
1 East 75th Street
New York, NY 10021
pr@cmwf.org

The Commonwealth Fund
$38,225

Health Care Delivery System Reform Advisory Group

A major program area of The Commonwealth Fund’s work is Health Care Delivery System Reform. This newly reformed program will now concentrate its efforts on two patient populations——those with complex, long-term health care needs, and those with low income, often no health insurance, and few social supports——in order to target our energy and resources where the impact will likely be greatest. The Advisory Group of roughly 15 advisors will help guide the program’s new direction. The anticipated time commitment includes two in-person meetings and one teleconference per year.

Melinda Abrams
Vice President, Delivery System Reform
1 East 75th Street
New York, NY 10021
mka@cmwf.org

Johns Hopkins University
$35,000

Understanding the Health and Health Care Needs of High-Cost Patients: Evidence for Care Coordination and Payment Reform

A small proportion of all patients accounts for a disproportionate share of health care spending in the United States. Numerous studies have identified and described patients with high levels of health care spending, but few have simultaneously examined a broad set of patient- and delivery system-level factors to identify ways to improve care quality and lower costs. This project will examine patient characteristics and patterns of use that are predictive of expensive medical care to provide a better understanding of which particular delivery system reforms are best suited to the health and social needs of this patient population. The resulting analyses will inform The Commonwealth Fund’s work on delivering care to the nation’s sickest and frailest.

Gerard Anderson, Ph.D.
Director, Center for Hospital Finance and Management Professor
Center for Hospital Finance and Management
Bloomberg School of Public Health
624 North Broadway, Room 302 Hampton House
Baltimore, MD 21205
ganderso@jhsph.edu

KNG Health Consulting, LLC
$48,938

Tracking ACA Provisions Related to Payment and Delivery System Reform

In anticipation for the fifth anniversary of the passage of the Affordable Care Act (ACA) in March 2015, the Commonwealth Fund’s Controlling Health Care Costs Initiative plans to produce a report that focuses on the ACA’s progress in addressing health care costs and improving the quality of care.The ACA includes a number of payment reforms intended to reduce Medicare costs and improve the quality of care to beneficiaries, however, not all of the ACA’s payment related provisions are being extensively tracked and only some of the major provisions have been featured in the media and in research reports. Under this project, KNG Health Consulting will work with the Fund staff and selected grantees to follow the progress of system improvement provisions that deal with payment modifications as well as payment pilot programs initiated by the Center for Medicare and Medicaid Innovation (CMMI). Collected data will be structured around implementation status, program and regulatory changes, successes and challenges in achieving its desired outcomes, and provider, patient and expert perspectives. The project will result in monthly tracking updates, as well as assistance producing blog posts and a report on the five-year implementation of the ACA.

Lane Koenig, Ph.D.
President
15245 Shady Grove Road, Suite 365
Rockville, MD 20850
lane.koenig@knghealth.com

L&M Policy Research
$49,650

Tracking ACA Provisions Related to Primary Care and Medicaid/Medicare Delivery System Reform Provisions

In anticipation of the five-year anniversary of the passage of the Affordable Care Act (ACA) in March 2015, the Commonwealth Fund’s Health Care Delivery System Reform Program plans to produce a report that focuses on the ACA’s progress in addressing how health care is organized, structured and delivered. In general, a lot of attention has been given to the coverage and affordability provisions of the ACA, and less information is widely available regarding provisions related to delivery system reform. This project will focus on provisions related to new delivery models in primary care for Medicaid and Medicare beneficiaries, and it will help The Commonwealth Fund provide easily accessible information on the status of the law’s implementation. The project team will work closely with Fund staff and Lane Koenig of KNG Health Consulting , whose proposal seeks to monitor and track ACA provisions related to payment reform. This project will provide ample material for use on the Fund website and in Fund reports about the ACA. The project team will also produce an issue brief for Fund publication.

Julia Doherty, M.H.S.A.
Senior Research Director
1743 Connecticut Ave N.W., Suite 200
Washington D.C., 20009
jdoherty@lmpolicyresearch.com

Manatt, Phelps & Phillips, LLP
$50,000

Arkansas Payment Reform: A Leading Laboratory for Health Transformation

This grant will support analysis and publication of a report that describes the Arkansas Payment Improvement Initiative (APII), addresses the history and implications of its key components, assesses progress and challenges with implementation, and discusses the applicability of the Arkansas model to other states.

Deborah Bachrach, J.D.
Partner
7 Times Square
New York, NY 10036
dbachrach@manatt.com

National Academy of Sciences
$25,000

Study of Family Caregiving in the United States

More than 35 million Americans are family caregivers for people unable to care for themselves independently. While most often relatives, this terminology also regularly includes partners, close friends, and neighbors. It was estimated in 2009 that the care that family caregivers provided for older adults was worth over $250 billion. Under this project, the Institute of Medicine will convene a committee of experts in the field to assess and analyze evidence to do with all aspects of caregiving. The committee’s work will culminate in a report, Study of Family Caregiving in the United States, which will include conclusions and recommendations for providers, consumer advocates, and policymakers.

Jill Eden, M.B.A, M.P.H.
Senior Program Officer, Board on Healthcare Services
The National Academies
500 Fifth Street, N.W., Keck 864
Washington, D.C. 20001
jeden@nas.edu

National Committee for Quality Assurance
$49,964

Practice Transformation: Using Patient-Reported Outcomes and Measures in Learning Health Care Systems

In an effort to improve quality and reduce costs, policymakers and providers are focusing on developing and assessing the quality of integrated services (clinical, behavioral, and social) delivered to patients with multiple chronic conditions. Providers mostly rely on process or disease specific measures to manage patients and to assess the quality of their care. Most important for this population are patient-reported outcomes measures (PROMs), which have the potential to provide a broader picture of patient functioning, incorporate the patient voice into care planning and delivery, and can serve as management tool for assessing accountability and improvement. Several measures already exist and have been validated. Yet, there is a lack of knowledge on how to integrate the use of PROMs into clinical workflows and how to use them to measure the quality of care that is delivered. Working with a leadership group of experts, the project will seek to further define and examine the conditions necessary for successful implementation of PROMs in care delivery workflows and in using PROMs to support performance measurement.

Phyllis Torda
Senior Executive, Strategic Initiatives
1100 13th Street N.W., Suite 1000
Washington, D.C. 02005
torda@ncqa.org

New York Academy of Medicine
$25,000

The Margaret E. Mahoney Fellowship Program

To honor former Commonwealth Fund president, Margaret E. Mahoney (1980-1995), the Commonwealth Fund, Robert Wood Johnson Foundation, Carnegie Corporation, The New York Academy of Medicine (NYAM), and other private donors created a fellowship program focusing on health care delivery systems for vulnerable populations, urban health issues, and early childhood development and prevention. Throughout the summer, selected fellows conduct quantitative or qualitative research projects on their related issue of choice and have the opportunity to attend seminars on the policymaking process and leadership development. The fellowship is now in its second year.

Jo Ivey Boufford, M.D.
President
1216 Fifth Avenue
New York, NY 10029-5293
jboufford@nyam.org

International Health Policy and Practice Innovations

BOARD GRANTS

The Commonwealth Fund
$50,000

Commonwealth Fund/Nuffield Trust Commissioned Papers on Delivery System Reform, 2015

Since 1999, the annual transatlantic forum on health care quality sponsored by The Commonwealth Fund and the Nuffield Trust has provided a unique opportunity to build relationships among senior policymakers in the United States and United Kingdom, showcase innovations in quality improvement and health care delivery systems, and facilitate an exchange of ideas. The 14th conference in this series, held in July 2013, focused on the challenges in implementing accountable care organizations in the U.S. and clinical commissioning groups in England, and the opportunities for better care and greater cost savings. Building on this valuable collaboration, project staff will commission experts to produce papers for the 15th U.S.-U.K. meeting in 2015. Topics will include: delivery system changes aimed at improving care for high-need/high-cost populations; patient engagement; and health system performance and accountability.

Robin Osborn
Vice President, International Health Policy and Practice
Innovations
1 East 75th Street
New York, NY 10021
ro@cmwf.org

The Commonwealth Fund
$365,000

International Symposium on Health Care Policy, Fall 2014

The 17th annual International Symposium on Health Care Policy will focus on “high cost, complex patients” and the international evidence underpinning outstanding health system performance. Looking across industrialized countries, the program will feature the payment mechanisms and delivery system strategies that appear to produce the best health outcomes and lowest costs. Topics will include care delivery models and financial incentives for managing high needs patients; strategies to avoid hospital admissions/readmissions, integration of health and social services, and end-of-life care. In bringing together leading policymakers and researchers from 11 countries, the symposium will distill for U.S. policymakers the lessons relevant to health reform implementation, including lessons from low-income nations’ use of “frugal innovations.” The Commonwealth Fund and the Alliance for Health Reform will also cosponsor a briefing for Capitol Hill audiences. The journal Health Affairs will consider publication of papers commissioned for the symposium.

Robin Osborn
Vice President, International Health Policy and Practice
Innovations
1 East 75th Street
New York, NY 10021
ro@cmwf.org

The Commonwealth Fund
$1,800,625

Harkness Fellowships in Health Care Policy and Practice, 2015-16

Harkness Fellows in Health Care Policy and Practice make an important impact on policy and practice, both in the United States and in fellows’ home countries. Support for an 18th class of Harkness Fellows will allow The Commonwealth Fund to continue developing promising policy researchers and practitioners from Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. Renewed support for a Swiss Harkness Fellowship will be sought, and, to enrich and diversify the program further, a new French fellowship position will be developed. The Fund will also continue to leverage the program, drawing on alumni fellows’ on-the-ground expertise to highlight delivery system innovations in their home countries that are potentially transferable to the U.S. A high-level policy retreat planned for July 2014 will bring selected Harkness alumni together with U.S. policymakers to discuss international innovations relevant to U.S. health reform.

Robin Osborn
Vice President, International Health Policy and Practice
Innovations
1 East 75th Street
New York, NY 10021
ro@cmwf.org

London School of Economics and Political Science
$378,080

International Working Group on Care for High-Need, High-Cost Patients, Year 7

The seventh in a series of grants to the London School of Economics and Political Science will support the work of a team of health policy experts to examine innovative models for treating high-need, high-cost patients, as well as the international evidence underpinning outstanding health system performance for this population. Areas of focus will include: strategies for targeting complex patients and conducting needs assessments; care delivery models and financial incentives; and the role of caregivers. National approaches to managing patients with stroke and chronic kidney failure will be used to illustrate frontline clinical innovations that improve quality and reduce costs. An international working group on high-need, high-cost patients will identify delivery system innovations, inform the Fund on how these models work, and advise the Fund’s Health Care Delivery System Reform program in adapting international models for the United States.

Elias Mossialos, Ph.D.
Professor of Health Policy
LSE Health and Social Care, J413
Cowdray House
Houghton Street
London, WC2A 2AE
United Kingdom
e.a.mossialos@lse.ac.uk

London School of Economics and Political Science
$173,800

International Data Tracking Project: Comparison of Health Care Costs in the U.S. with Those in Selected Countries, 2014

This project will build on earlier work that generated baseline health system cost data for the United States and selected countries belonging to the Organization for Economic Cooperation and Development (OECD). The data analyses for 2014 will include an updated comparison of prices for 25 or more hospital procedures or diagnoses, and a comparison of costs for three high-volume, high-cost medical devices, including analysis of the impact of national procurement and transparency policies. Subjects for additional country comparisons will be informed by discussions with The Commonwealth Fund’s new council of economic advisers. The findings, which are expected to generate interest among policymakers, researchers, and journalists, will be presented at the Fund’s 2014 International Symposium.

Elias Mossialos, Ph.D.
Professor of Health Policy
LSE Health and Social Care, J413
Cowdray House
Houghton Street
London, WC2A 2AE
United Kingdom
e.a.mossialos@lse.ac.uk

SSRS
$450,000

International Health Policy Survey, 2014

The 2014 International Health Policy Survey, the 17th in an annual series, will assess health care system performance and responsiveness from the perspective of adults age 55 and older. To be conducted in 11 countries, the survey will inquire about access to care, coordination, management of chronic conditions, and costs and complexity of care. The focus on older adults will allow the survey team to explore new topics that are relevant to the baby boom generation. The resulting analysis will examine the extent to which variations reflect differences in countries’ systems and policies for health care delivery, insurance, and social services. The findings, to be released at the 2014 International Symposium and summarized in a Health Affairs article, will likely generate substantial interest among health ministers, policymakers, researchers, and the media. The results also will inform U.S. delivery system reform efforts and the Fund’s strategic priorities around improving outcomes and care experiences for higher-cost patients with complex conditions.

Melissa J. Herrmann, M.A.
President
53 West Baltimore Pike
Media, PA 19063
mherrmann@ssrs.com

SMALL GRANTS

The Brookings Institution
$50,000

Global Experiences in Accountable Care: Implications for Health Care Reform in the US and Abroad

Through an international collaboration supported by the World Innovation Summit for Health (WISH), Brookings Institution has undertaken a series of case studies from developed to less-developed countries showing how countries with different health care policies have begun to successfully implement accountable care. This initial collaboration has identified common components for the success of accountable care reforms worldwide. By building on the Brookings case studies (U.K., Sweden, Spain, India, Brazil, Australia, and Singapore) and initial framework, and, comparing the impact of different country approaches, specific implications can be identified for how health policy reform should proceed in individual countries, especially the United States.

Mark McClellan
Director, Initiative on Innovation and Value of Healthcare
1775 Massachusetts Avenue N.W.
Washington, DC 20036-2188
mmcclellan@brookings.edu

Erasmus University Rotterdam
$41,000

Commonwealth Fund and European Health Insurance and Risk Adjustment Collaboration

As the United States implements the Affordable Care Act, it has a unique opportunity to learn from other countries’ experiences with health insurance exchanges and risk adjustment. The European Risk Adjustment Network (RAN), which includes leading country experts on health insurance markets, has been meeting for over 12 years. With co-funding from The Commonwealth Fund, a half-day would be devoted to the United States at their annual meeting planned for September 2014. Sessions will examine the U.S. strategy for risk adjustment in the health insurance exchanges and whether it would threaten good quality care for high need/high cost patients, and, overall lessons learned for U.S. health reform from European countries. Products will include a paper to be submitted to Health Affairs and a Commonwealth Fund International Issue Brief. Insights gained insights from other countries with dynamic health insurance markets should be valuable in informing U.S. policy thinking.

Wynand P.M.M. van de Ven
Professor of Social Health Insurance
PO Box 1738
Rotterdam, 3000 DR
The Netherlands
vandeven@bmg.eur.nl

Lown Insitute, Inc.
$50,000

Lancet Series on Low-Value, Avoidable Care

As the United States grapples with rising health care costs and the challenge of expanding coverage for its 55 million uninsured, getting more value for the money it spends on health care is imperative. An increasingly voiced theme in this drive has been to identify, measure and reduce waste, from administrative inefficiency, fraud, and duplicative effort, to in the clinical context, the overuse of unnecessary, potentially harmful health care practices. This project will support two writing workshops bringing together international experts in this field to co-author an invited three-paper series covering the spectrum of waste/overuse/avoidable care for The Lancet, a top-tier journal.

Adam Elshaug, Ph.D.
Visiting Fellow
1401 17th Street N.W. #207
Washington, D.C. 20036
elshaug@sydney.edu.au

SSRS
$19,250

Expansion of 2014 Commonwealth Fund International Health Policy Survey to Include Germany

Since 2005, Germany has participated in the Fund’s annual International Health Policy Surveys, providing a valuable opportunity to assess the performance of the German health care system relative to the U.S. and other OECD countries as well as evaluate the impact of national policies and reforms on health system performance. The 2014 International Health Policy Survey, the 17th in the annual series, will assess health care system performance and responsiveness from the perspective of adults age 55 years and older in 11 countries, comparing access, care coordination, management of chronic conditions, home care, caregiver responsibilities, and end-of-life care. The analysis of results will highlight the extent to which variations reflect differences in country systems of health care delivery and insurance and social services policies. The findings, to be released at the 2014 International Symposium and summarized in an article for Health Affairs, should generate substantial interest among health ministers, policymakers, researchers, and the media and will inform U.S. delivery system reform efforts and the Fund’s strategic priorities around high need/high cost patients with complex conditions. Germany is a particularly important comparator country because of its insurance system, funded by employer/employee-based contributions, individual mandate and insurance exchanges, benefit package and use of comparative and cost-effectiveness, disease management programs, and health system governance structures. As the nextlargest country in the International Health Policy survey after the United States, it contributes to the meaningfulness of the survey findings from the perspective of a U.S. policy audience.

Robyn Rapoport
Vice President, Health Care, Public Policy, & International Research
53 West Baltimore Pike
Media, PA 19063
rrapoport@ssrs.com

Scientific Institute for Quality of Healthcare
$34,507

Expansion of 2014 Commonwealth Fund International Health Policy Survey to Include the Netherlands

Beginning in 2006, the Netherlands has participated in the Fund’s annual International Health Policy Surveys, providing a valuable opportunity to assess the performance of the Dutch healthcare system relative to the U.S. and other OECD countries as well as evaluate the impact of national policies and reforms on health system performance. The 2014 International Health Policy Survey, the 17th in the annual series, will assess health care system performance and responsiveness from the perspective of adults age 55 years and older in 11 countries, comparing access, care coordination, management of chronic conditions, home care, caregiver responsibilities, and end-of-life care. The analysis of results will highlight the extent to which variations reflect differences in country systems of health care delivery and insurance and social services policies. The findings, to be released at the 2014 International Symposium and summarized in an article for Health Affairs, should generate substantial interest among health ministers, policymakers, researchers, and the media and will inform U.S. delivery system reform efforts and the Fund’s strategic priorities around high need/high cost patients with complex conditions. The Netherlands is a particularly important comparator country because of its private insurance system, individual mandate, insurance exchanges and use of sophisticated risk-adjustment, bundled payment reforms for chronic conditions, and strong primary care infrastructure. As a country that performs well in the International Health Policy surveys, but also struggles with costs, the second-highest for health spending as a percentage of GDP after the United States, it contributes to the meaningfulness of the survey findings from the perspective of a U.S. policy audience.

Gert Westert, Ph.D.
Professor and Director
Raboud University Medical Center
P.O. Box 9101 114
Nijmegen, 6500 HB
The Netherlands
gert.westert@radboudumc.nl

The Governing Council of the University of Toronto
$50,000

International Roundtable to Advance Physician Leadership on Overuse

Building on the Choosing Wisely campaign, which has gained significant traction in the United States, an international collaboration of experts would compare the broader structural and systemic issues behind overuse and waste in health care systems, and, work jointly across countries to reduce waste and improve care on the front lines. With the endorsement of professional bodies in each country, this effort would build momentum for changing provider behavior and could powerfully use “Professionalism” (i.e. nonfinancial incentives) as a tool in the Incentives 2.0 Toolbox to change provider behavior. This initiative would also enable the U.S. to benchmark performance against other countries and identify overuse and waste, providing a potential opportunity for reining in health care costs.

Wendy Levinson, M.D.
Sir John and Lady Eaton Professor and Chair
Suite 3-805, R. Fraser Elliot Building
190 Elizabeth Street
Toronto, Ontario M5G 2C4
Canada
wendy.levinson@utoronto.ca

Breakthrough Health Care Opportunities

BOARD GRANTS

The Commonwealth Fund
$500,000

Breakthrough Health Care Opportunities Program: Year 1 Strategic Implementation

In July 2013, the Commonwealth Fund Board approved the creation of the Breakthrough Health Care Opportunities program. This appropriation will support the launch of the new program by allowing for nimbleness and flexibility in making the initial set of small grants. Fund staff will first convene a multistakeholder advisory group to establish criteria for identifying high-leverage opportunities and prioritize ideas for in-depth study. The first projects will likely focus on: 1) new approaches for using information technology to engage consumers in their care; 2) consumer and provider incentives designed around the principles of behavioral economics; and 3) “frugal innovations” from around the world that the U.S. might adopt. Staff also will explore the establishment of an incubator network of health care organizations willing to pilot-test ideas the Fund has identified and vetted.

Anne-Marie Audet, M.D., M.Sc. Vice President, Delivery System Reform & Breakthrough Innovations
1 East 75th Street
New York, NY 10021
ama@cmwf.org

SMALL GRANTS

American Society of Health Economics
$25,000

Advanced Pay-For-Performance — Reegineering Provider Incentive Programs using Behavioral Economics

Financial incentives are an important strategy for supporting and encouraging higher-value health care. Behavioral economic research suggests that such initiatives could benefit greatly from rethinking the design of incentives in order to make them more salient to front-line providers and to take into account other barriers to high-value care, such as cognitive biases. The American Society of Health Economists, an organization dedicated to promoting excellence in health economics research, will host its 5th biennial conference at the University of Southern California on June 22-25, 2014. This project will support a plenary session and two panel sessions dealing specifically with behavioral economists’ perspectives as they relate to the many factors that influence provider decisions. Involvement in the meeting will allow the Fund to network and establish a stake in the behavioral economics research community as the Breakthrough Opportunities program develops and surveys the field for promising collaborators.

Anthony LoSasso, Ph.D. Executive Director
725 15th Street, N.W., Suite 600
Washington, D.C. 20005
tony@ashecon.org

AcademyHealth
$15,000

Academy Health Annual Research Meeting: Innovation Station Sponsorship

The Commonwealth Fund has been invited to sponsor the “Innovation Station” at the 2014 Academy Health Annual Research Meeting (ARM) and host an hour-long meeting on the topic of breakthrough innovations. Through this opportunity, Fund staff will be able to present the goals of the breakthrough program and engage in interactive conversations with a network of researchers interested in innovations. In advance of ARM, the Fund will also issue a call for ideas to the ARM network which will allow the shaping of the discussion around the Fund’s specific focus on breakthrough opportunities in health care.

Alison Rein, M.S.
Director, Health Innovation and Information Infrastructure
1150 17th Street N.W., Suite 600
Washington, D.C. 20036
alison.rein@academyhealth.org

Regents of the University of California
$50,000

Scanning for Disruptive Innovations: Identifying Potential Innovations for Enhanced Access, Reduced Costs, and Rapid Scalability

High health care costs coupled with an increased demand for health care services threaten the sustainability of the health care sector as it faces significant resource constraints. There has been an increased awareness about the importance of scanning for scalable breakthrough opportunities that have the potential to disrupt the current marketplace in order to drastically increase access, improve quality, and reduce costs. The Institute for Innovation in Health (IIH) at the University of California, Los Angeles has initiated a process to identify these opportunities and has developed a scanning scoring tool to prioritize results. The team at IIH requests support from The Commonwealth Fund to broaden the pool of sources to scan, refine scanning criteria and the scoring tool, evaluate the opportunities identified through the scoring tool, and vet these through an advisory group of experts and potential users. The project team will highlight breakthrough opportunities taking place domestically and internationally, provide evidence about their potential value, and identify barriers that need to be addressed before they can be scaled.

Molly Coye, M.D.
Chief Innovation Officer, UCLA Health
524 2nd Street
San Francisco, CA 94107
mcoye@mednet.ucla.edu

The Foundation for Medical Excellence
$25,000

Creation of a Charter on Organizational Professionalism

Medical professionalism is a key driver of quality and cost in health care. The increasing complexity of regulations and financial incentives within the health care delivery system requires deliberate attention to promoting environments that encourage effective professional behavior. While the behavior of individual physicians and their relationships with their patients has been the main focus of medical professionalism, the context in which physicians practice has an important influence on their behavior. Thus, this project will build on and complement an existing charter on medical professionalism among physicians to create a charter on organizational professionalism directed at health organizations and systems. In defining the professional competencies and behaviors that organizations can leverage, the charter will seek to strengthen the importance health care systems place on the organization’s role in creating a culture that enables medical professionals to provide high-quality care. This project will support the development of this charter through meetings composed of experts in medical professionalism and representatives from health systems.

Barry Egener, M.D.
Medical Director
One S.W. Columbia Street, Suite 800
Portland, OR 97258
begener@tfme.org

Massachusetts General Hospital
$50,000

A Proposal to Improve the Quality of Health Care through Peer-to-Peer Assessment

Despite increased investments in quality and safety programs, voluntary and regulatory reporting of data, and accreditation, unintentional harm to patients continues to be recognized as a major quality gap. The scientific literature suggests that social networks, particular when composed of external professional peers, may influence conduct and behavior in ways that differ from incentives created by regulatory or financial strategies. A model of peer-to-peer (P2P) assessment has been successfully implemented in other high-reliability, high-risk industries such as the nuclear industry, and therefore, could be a promising approach in health care. The project team will first conduct a literature review to explore the role of P2P in promoting quality and safety in high-risk industries. They will also compare other models used in aviation and collaborative models used by professional organizations such as the Northern New England Cardiovascular Disease Consortium. Based on the results of the literature review, the team will then develop a framework of improvement that maps problems in health care organizations to processes that will improve clinical outcomes. Using the framework as a foundation, the team will develop an assessment methodology which will include instruments, such as data collection tools and open-ended questions, that will be pilot tested by interdisciplinary review teams during site visits at the Massachusetts General Hospital and John Hopkins Hospital. Specifically, the review teams will use the instruments to assess quality infrastructure, processes, measurement, and accountability. The instruments will be assessed for usability, feasibility, and potential impact. The project will provide insight on the feasibility and acceptability of a peer/professionally based model to improve quality and performance in health care settings.

Elizabeth Mort, M.D., M.P.H.
Senior Vice President
55 Fruit Street, Bulfinch 280
Boston, MA 02114
emort@partners.org

Tracking Health System Performance

BOARD GRANTS

The Commonwealth Fund
$104,102

Authorization to Support Data Acquisition and Analytic Software

The health system performance scorecards produced by The Commonwealth Fund’s research unit at the Institute for Healthcare Improvement reveal severe deficits in the functioning of the U.S. health system overall, wide variability in performance across states and local health care markets, and persistent income-based disparities. The scorecards’ findings have helped focus public attention and policy action on areas where improvement is needed. As major federal and state reforms unfold, the scorecards help position the Fund as a go-to resource for health system performance tracking. The proposed grant will support the research unit’s activities in 2014: producing the third edition of the state scorecard and the second editions of the local health system and child health scorecards. The unit also will collaborate with senior Fund staff in preparing issue briefs on topics of national, state, and local policy interest.

David Radley, Ph.D., M.P.H.
Senior Scientist
20 University Road, 7th Floor
Cambridge, MA 02138
dr@cmwf.org

Institute for Healthcare Improvement
$349,410

Support for a Research Unit to Produce Health System Performance Scorecards, Year 4

The health system performance scorecards produced by The Commonwealth Fund’s research unit at the Institute for Healthcare Improvement reveal severe deficits in the functioning of the U.S. health system overall, wide variability in performance across states and local health care markets, and persistent income-based disparities. The scorecards’ findings have helped focus public attention and policy action on areas where improvement is needed. As major federal and state reforms unfold, the scorecards help position the Fund as a go-to resource for health system performance tracking. The proposed grant will support the research unit’s activities in 2014: producing the third edition of the state scorecard and the second editions of the local health system and child health scorecards. The unit also will collaborate with senior Fund staff in preparing issue briefs on topics of national, state, and local policy interest.

David Radley, Ph.D., M.P.H.
Senior Scientist
20 University Road, 7th Floor
Cambridge, MA 02138
dr@cmwf.org

Issues Research, Inc.
$360,690

Research and Advisory Services in Support of Health System Performance Monitoring, Reform and Innovation

As the Affordable Care Act takes effect, it will be important to monitor the law’s impact and learn how leading health care organizations pursue and achieve high performance. Through a contract with Issues Research, Inc., The Commonwealth Fund will engage the full-time services of its longtime partner Douglas McCarthy to oversee development of the suite of health system performance scorecards produced by the Fund’s research team at the Institute for Healthcare Improvement, and to direct case studies of innovators in health care delivery to inform policymakers and practitioners. In his role as senior research director, McCarthy also will provide strategic guidance for the Fund’s new Health Care Delivery System Reform and Breakthrough Health Care Opportunities programs.

Douglas McCarthy, M.B.A.
Senior Research Director
7116 Falls Creek Main
Durango, CO 81301
dmccarthy@issuesresearch.com

Island Peer Review Organization Inc
$352,028

Sustainability Planning and Readying for Transition: WhyNotTheBest.org, Phase 6

WhyNotTheBest.org was launched in 2008 to demonstrate through proof-of-concept that benchmarking and trend data can drive performance improvement in health care. Over five years, the site has evolved into a valued resource for thousands of quality improvement professionals, business coalitions, and journalists. Given the Commonwealth Fund’s new priorities, 2014 will be the last year of the foundation’s support for WhyNotTheBest.org. In the coming year, the IPRO team will focus on exploring options for ensuring the site’s long-term sustainability, while also continuing to update its quality-of-care data and engage target audiences through social networking and enhanced user support.

Jaz-Michael King
Senior Director, eServices and Health Care Transparency
1979 Marcus Avenue, Suite 105
Lake Success, NY 11042-1002
jmking@ipro.us

Pear Tree Communications, Inc.
$78,292

Sustainability Planning and Readying for Transition: WhyNotTheBest.org, Phase 6

WhyNotTheBest.org was launched in 2008 to demonstrate through proof-of-concept that benchmarking and trend data can drive performance improvement in health care. Over five years, the site has evolved into a valued resource for thousands of quality improvement professionals, business coalitions, and journalists. Given The Commonwealth Fund’s new priorities, 2014 will be the last year of the foundation’s support for WhyNotTheBest.org. In the coming year, the IPRO team will focus on exploring options for ensuring the site’s long-term sustainability, while also continuing to update its quality-of-care data and engage target audiences through social networking and enhanced user support.

Martha Hostetter, M.F.A.
Partner
3165 Coleridge Road
Cleveland Heights, OH 44118
mh@cmwf.org

Advancing Medicare

BOARD GRANTS

Acumen, LLC
$220,084

Slowing Medicare Spending: Analysis of Trends and Their Policy Implications

In recent years, Medicare spending per beneficiary has grown at historically low rates, and significantly slower than private insurance spending per person. Continuing this trend is crucial for the long-term viability of the program. To inform policies aimed at sustaining slower Medicare growth for the long term, a research team will assess recent Medicare spending trends and examine geographic areas and health service sectors where spending is high or growth more rapid. The analyses will focus on markets where payment reforms have taken hold as well as those where postacute care costs appear to be significantly higher than expected. Data and programming support will be provided by the consulting firm Acumen.

Thomas DeLeire, Ph.D.
500 Airport Blvd, Suite 365
Burlingame, CA 94010
tdeleire@acumenllc.com

Johns Hopkins University
$399,525

Medicare at 50

This project will produce a series of papers to mark Medicare’s 50th anniversary and frame the debate over the program’s future direction. The six papers, which will be prepared by Karen Davis and commissioned experts, will: 1) review Medicare’s signal accomplishments; 2) examine the Affordable Care Act’s implications for Medicare’s future; 3) offer options for redesigning Medicare to strengthen its beneficiary protections and encourage better health care choices; 4) describe approaches to improving care for high-need, high-cost beneficiaries; 5) highlight Medicare’s role in developing health care payment and delivery system reforms; and 6) discuss policies to improve Medicare’s financing and ensure its long-term solvency.

Karen Davis, Ph.D.
Eugene and Mildred Lipitz Professor and Director, Roger C. Lipitz Center for Integrated Health Care
Johns Hopkins Bloomberg School of Public Health
624 N. Broadway, Hampton House 693
Baltimore, MD 21205
kadavis@jhsph.edu

Vanderbilt University
$231,547

Slowing Medicare Spending: Analysis of Trends and Their Policy Implications

In recent years, Medicare spending per beneficiary has grown at historically low rates, and significantly slower than private insurance spending per person. Continuing this trend is crucial for the long-term viability of the program. To inform policies aimed at sustaining slower Medicare growth for the long term, a research team will assess recent Medicare spending trends and examine geographic areas and health service sectors where spending is high or growth more rapid. The analyses will focus on markets where payment reforms have taken hold as well as those where postacute care costs appear to be significantly higher than expected. Data and programming support will be provided by the consulting firm Acumen.

Melinda Buntin, Ph.D.
Chair
2525 West End Avenue, Suite 1207
Nashville, TN 37203
melinda.buntin@vanderbilt.edu

SMALL GRANTS

Bailit Health Purchasing, LLC
$34,539

Aligning Provider Compensation Models with External Value-Based Payment Incentives: Current and Innovative Practice

In our fee-for-service dominated health care system, provider organizations have traditionally utilized production-based compensation models to distribute funds internally to physicians and other staff. However, a growing number of organizations are participating in a variety of alternative payment models with private and public payers, including shared savings, bundled payments, and pay-for-performance approaches. These models place a greater emphasis on more efficient delivery of care, with larger payments often linked to meeting higher quality standards. Success under these new payment models depends on the performance of the individual frontline providers within each of these organizations, however, the compensation models at many of these organizations remain largely productivity-based. This disconnect creates conflicting and confusing incentives for physicians, mitigating the effectiveness of payment reforms. In order to support the goals of the new payment reform efforts, this project will conduct a literature review and interviews with at least 20 delivery system leaders to identify best practices in utilizing intra-organizational financial compensation models, as well as non-financial influences (e.g., sharing quality report cards), to motivate changes in individual provider practice patterns that are aligned with more efficient and higher quality care. The resulting paper will provide insights critical to achieving maximum impact in payment reform, which will only become more imperative as an increasing number of providers participate in these alternative payment models.

Michael Bailit, M.B.A.
President
56 Pickering Street
Needham, MA 02492
mbailit@bailit-health.com

The Brookings Institution
$39,979

Policy Implications of Medicare Physician Payment Data Transparency

The Centers for Medicare and Medicaid Services (CMS) recently released data on the reimbursement of over 880,000 physicians and other entities that submitted bills to Medicare for professional services during the year 2012. These data open up new possibilities for better understanding of Medicare payment policies and their implications, and already the media and other investigative journalists have focused attention on apparent peculiarities in the distribution and concentration of Medicare payments. This creates both an opportunity to identify potential policy improvements and the danger of mistakenly inferring causality from descriptive data. This project will develop a set of issue briefs based on the CMS data release that carefully analyze specific policy implications and, based on the experience and advice of an array of experts, develop a list of topics that can productively be addressed to improve Medicare payment.

Kavita Patel, Ph.D., M.D.
Managing Director and Fellow
1775 Massachusetts Avenue N.W.
Washington, D.C. 20036-2188
kpatel@brookings.edu

The Brookings Institution
$50,000

Translating Intentions into Action: Lessons from Non-Participants of the Medicare Bundled Payment for Care Improvement

The Medicare Bundled Payment for Care Improvement Initiative (BPCI) tests four bundled payment models, each varying in its definition of services, providers, and conditions covered. Retrospective versus prospective payments are also being tested. While over 100 participants (partnering with over 400 provider organizations) were selected for the initial pilot phase, some providers decided not to move forward even though they sent a letter of intent. This project will explore the concerns of providers who dropped their interest in BPCI’s Model 2, which includes post-acute care for select diagnosis-related groups, or Model 4, which uses prospective payments. The project will also investigate experiences of providers that are participating in bundled payment programs with private payers. Although, BPCI is just beginning, many policy experts have already been calling for Medicare to expand such programs. Hence, it is important to gain insights on the aspects of bundled payments that have been well-received by providers, as well as those viewed as more challenging.

Lane Koenig, Ph.D.
President
15245 Shady Grove Road, Suite 365
Rockville, MD 20850
lane.koenig@knghealth.com

Mathematica Policy Research, Inc.
$49,835

What We Know About How Physicians Respond To Payment, Structure, and Incentives: Implications for Predicting the Cost of the SGR Fix

Earlier this year, legislatures reached a bipartisan agreement to fix the Sustainable Growth Rate (SGR) Formula, the mechanism in law (but annually overridden and postponed by Congress since 2002) to control Medicare spending on physician services. All agree that the way physicians are paid under Medicare is in need of major reform. However, the “SGR fix” legislation failed to go forward when leaders in the Republican and Democratic parties could not agree on how best to pay for it. Because the SGR formula currently calls for a 25 percent reduction to the physician reimbursement schedule, repealing and replacing it with a permanent and practical fix would actually increase costs to the federal budget. Moreover, CBO historically is very conservative in attributing any cost savings to new, but unproven, payment and delivery reforms, such as those at the core of many SGR reform proposals. The cost estimates are clearly critical to any potential passage of a SGR fix. Mathematica will take a critical view of how these cost estimates are made in order to identify key policy and research questions that need to be addressed in order to generate the most reliable estimates.

James Reschovsky, Ph.D.
Senior Fellow
1100 1st Street N.E., 12th Floor
Washington, D.C. 20002-4221
jreschovsky@mathematica-mpr.com

Controlling Health Care Costs

BOARD GRANTS

Health Care Cost Institute, Inc.
$50,000

Tracking Private and Medicare Costs by Clinical Condition

Policymakers and health system leaders need better information about which clinical conditions account for a majority of total public and private health care spending. Effective policies also require a clear understanding of what contributes to wide geographic variation in spending across the country and to differences in growth rates for Medicare and private payers. This project aims to create a set of indicators that can be used to identify and track trends in health spending by clinical condition or episode of care. Results from analyses will inform the development of bundled payment systems and other policies to slow spending growth while preserving access to care. Findings also will offer insights about the impact of medical technology on spending growth.

David Newman, Ph.D., J.D.
Executive Director
1310 G Street NW, Suite 720
Washington D.C., 20005
dnewman@healthcostinstitute.org

Yale University
$116,502

Tracking Private and Medicare Costs by Clinical Condition

Policymakers and health system leaders need better information about which clinical conditions account for a majority of total public and private health care spending. Effective policies also require a clear understanding of what contributes to wide geographic variation in spending across the country and to differences in growth rates for Medicare and private payers. This project aims to create a set of indicators that can be used to identify and track trends in health spending by clinical condition or episode of care. Results from analyses will inform the development of bundled payment systems and other policies to slow spending growth while preserving access to care. Findings also will offer insights about the impact of medical technology on spending growth.

Zack Cooper, Ph.D.
Assistant Professor
P.O. Box 2038
New Haven, CT 06520
zack.cooper@yale.edu

SMALL GRANTS

The Commonwealth Fund
$34,350

Cost Control Advisory Group

To help The Commonwealth Fund’s programs obtain and benefit from external expertise, the Breakthrough Opportunities program and Cost Control initiative will convene two high level advisory groups that will meet in person and through teleconference at several points throughout the calendar year. The groups will contribute to each program’s evolution through the generation of ideas and potential topics, and as potential authors and reviewers of fund-supported papers.

Stuart Guterman
Vice President, Medicare & Cost Control
1150 17th Street, N.W., Suite 600
Washington, D.C. 20036
sxg@cmwf.org

OptumInsight, Inc.
$10,000

Tracking Private and Medicare Costs by Clinical Condition

This grant will provide additional programming and analytic support to a previously approved project investigating the drivers of cost growth in private insurance and Medicare-enrolled populations. More specifically, through funding for data licensing software and additional analytic work, this small grant will support the analyses of health care spending and utilization trends by clinical episode groups. Health care spending analyses tend to be organized based on the site of care received (such as a hospital or nursing home), however, this conceptualization contributes to the fragmented nature of payment for care and impedes transitions towards patient-centered care. The episodic approach that this project will support is more consistent with how care is actually delivered and better aligns with the direction of payment and delivery reform, which aims to encourage greater coordination of care across the health care system. This work will provide a new analytic perspective that is more clinically relevant and actionable for health care system leaders and policymakers.

Jennifer Pearse
jennifer.j.pearse@optum.com

Project HOPE - The People-to-People Health Foundation, Inc.
$39,993

Health Affairs Briefing on Market Consolidation

The Fund has supported two papers: “Seeking Lower Prices Where Providers are Consolidated” by Paul Ginsburg and “Inflection Point: How Competition Policy Can Improve Health Care Markets” by William Sage. The issues addressed in the two papers are important to the progress of antitrust and market issue in health care policy. Health Affairs will convene a half day briefing promote the work done by these papers and further the spread of this information.

John Iglehart
Editor Emeritus, Health Affairs
7500 Old Georgetown Road, Suite 600
Bethesda, MD 20814
jiglehart@projecthope.org

Engaging Federal and State Health Policymakers

BOARD GRANTS

Alliance for Health Reform
$279,663

Health Policy Briefings, Roundtables, and Congressional Staff Retreat, 2014

Alliance for Health Reform briefings and roundtables are a valuable resource for congressional staff, journalists, and members of the broader Washington policy community seeking timely health policy information and analysis. In the coming year, the Alliance will conduct seven Commonwealth Fund——sponsored briefings or roundtables. Each event will be coordinated with the release of a major Fund report or relevant reform-related topic and comoderated by a Fund program officer. Each February, the congressional staff retreat provides an opportunity for 50 to 75 senior health staff from both parties to engage in an informal, off-the-record exchange of ideas with a variety of health policy experts. The retreat, a partnership with the Catholic Health Association of the United States and the Alliance, has proven to be an effective way for linking influential policy staff with Fund staff, grantees, and other policy experts.

Edward Howard, J.D.
Executive Vice President
1444 Eye Street NW, Suite 910
Washington, DC 20005-6573
edhoward@allhealth.org

Alliance for Health Reform
$386,544

Commonwealth Fund Bipartisan Congressional Retreat, 2014

The Commonwealth Fund’s annual Bipartisan Congressional Retreat is a direct way to reach one of the Fund’s most influential audiences, highlight key research and analysis, and build working relationships. At the time the next retreat is held, in January 2014, the health insurance marketplaces will have become operational, a number of states will have expanded Medicaid eligibility, and the pressure to control health costs is likely to be particularly intense. The retreat will allow participants to take stock of the reform law’s implementation, discuss areas where changes might be needed, and examine broader health policy issues and trends. In response to issues raised by the Senate Ethics Committee, the retreat venue will be moved from Ft. Lauderdale, Florida, to Houston, Texas.

Edward Howard, J.D.
Executive Vice President
1444 Eye Street NW, Suite 910
Washington, DC 20005-6573
edhoward@allhealth.org

Center for Health Policy Development
$251,619

Continuing the Dialogue: Federal-State Discourse to Promote a High Performance Health System, Phase 2

To align their policy goals and maximize efforts to improve health system performance, federal and state officials must communicate and collaborate. The series of federalstate discourses launched in 2013 by the National Academy for State Health Policy (NASHP) and supported by The Commonwealth Fund have demonstrated the value of bringing together representatives of leading states and federal agencies to discuss health system reform issues. In the next phase, NASHP will convene four meetings to enable selected federal and state officials to work side-by-side on strategies for aligning their efforts to improve health system performance. In addition to providing federal agencies with state feedback useful in developing system improvement policies, the meetings are an opportunity for states to learn how they can leverage federal resources and policies to transform their own health systems. NASHP will expand its dissemination activities to ensure lessons from the meetings are available to a broader audience.

Jill Rosenthal, M.P.H.
Program Director
National Academy for State Health Policy
10 Free Street, 2nd Floor
Portland, ME 04101
jrosenthal@nashp.org

National Association of Medicaid Directors
$142,612

State Medicaid Leaders and Payment and Delivery Reform: Emerging Issues in a Time of Change

Given the pending surge in Medicaid enrollment and the complex needs of many beneficiaries, reforming health care payment and delivery is essential to the program’s long-term sustainability at the state and federal levels. As the sole entity representing the nation’s Medicaid programs, the National Association of Medicaid Directors (NAMD) is uniquely positioned to support these reform efforts. In this project, NAMD staff will create three work groups of state Medicaid officials focusing on payment reform and changing clinical practice, the data needed for effective reform implementation, and Medicaid’s role in multipayer initiatives. NAMD will also continue to serve as an important disseminator of Fund research related to Medicaid.

Kathleen Nolan, M.P.H.
Director of State Policy & Programs
444 North Capitol Street NW, Suite 524
Washington, DC 20001
kathleen.nolan@medicaiddirectors.org

National Conference of State Legislatures
$225,000

Creating State Legislative Champions for Health System Reform, 2014

State legislatures play important roles in implementing and sustaining health system reforms. As the principal membership organization for state legislators across the country, the bipartisan National Conference of State Legislatures (NCSL) is uniquely qualified to reach key legislators and staff in every state. This grant will enable NCSL to engage this target audience in dialogue about promising health system reforms and policy innovations, through a session at NCSL’s national legislative summit and through other meetings, publications, and materials. Fund support also will help NCSL maintain its health reform legislative database and respond to inquiries. This assistance will be invaluable to creating champions of health system reform in states.

Laura Tobler, M.P.P.
Program Director
7700 E. 1st Place
Denver, CO 80230
laura.tobler@ncsl.org

National Governors Association Center for Best Practices
$200,000

A 50-State Meeting on Health System Transformation

With the health insurance marketplaces and Medicaid expansion set to bring affordable health coverage to millions more Americans starting in January 2014, many states are eager to identify long-term, transformative ways to reduce health spending while also improving quality of care. Building on a Commonwealth Fund-sponsored meeting of policymakers from 16 states in May 2013, the National Governors Association Center for Best Practices will convene officials from all 50 states, along with federal officials and outside experts, for a day-and-a-half meeting to facilitate state efforts to plan and implement health system transformation. This grant will support the attendance of three officials from each state and produce a brief that lays out the principal challenges states face and strategies for moving forward.

Frederick Isasi, J.D., M.P.H.
Division Director
444 North Capital Street, Suite 267
Washington, DC 20001-1512
fisasi@nga.org

SMALL GRANTS

Alliance for Health Reform
$49,946

2014 Mid-Year Event and Stakeholder Engagement

In addition to the two board grant proposals submitted for review at the July board meeting, a small grant is needed to the Alliance for Health Reform to pilot additional activities to engage members of Congress and their staff in innovative ways. The Alliance proposes to host a mid-year event for members of Congress to re-engage with attendees and establish connections with members who have not attended by updating them on a key health policy issue. In addition to the mid-year event, the Alliance will also engage with congressional staff, media, and other opinion leader audiences in new ways such as targeted, invite-only briefings, webinars, or “office hours.”

Edward Howard, J.D.
Executive Vice President
1444 Eye Street N.W., Suite 910
Washington, D.C. 20005-6573
edhoward@allhealth.org

Alliance for Health Reform
$29,726

Support for Bipartisan Congressional Retreat

Edward Howard, J.D.
Executive Vice President
1444 Eye Street N.W., Suite 910
Washington, D.C. 20005-6573
edhoward@allhealth.org

The Commonwealth Fund
$14,050

Commonwealth Fund Strategy Session: Engaging Federal and State Policymakers

The Commonwealth Fund’s program on Federal and State Engagement proposes to convene a meeting to bring together senior leaders from national organizations currently working with the Fund to engage and support federal and state policymakers in their efforts around health system transformation. The discussion will identify areas of synergy between projects and remaining gaps, as well as feature a session on the most current thinking around measuring policy impact; all organizations will leave better equipped to measure the policy impact of their work and to help the Fund measure its impact overall.

Rachel Nuzum
Vice President, Federal and State Health Policy
1150 17th Street, N.W., Suite 600
Washington, D.C. 20036
rn@cmwf.org

Health Policy Alternatives, Inc.
$7,500

Funding Moderator for October 18th Convening of Groups with Comprehensive Cost Control Proposals

Using extensive analysis conducted by The George Washington University (GWU), in September the Fund released an online tool and accompanying blog post outlining areas of consensus among seven leading cost containment proposals released over the last year. In conjunction with the Robert Wood Johnson Foundation, we are conducting an invitation-only meeting of groups who have released proposals to discuss areas of consensus and determine if there is interest and momentum around continuing to work together on specific policy areas.

Jack Ebeler
Principal
400 North Capitol Street, NW, Suite 799
Washington, D.C. 20001
je.hpa@sso.org

Communications

BOARD GRANTS

The Commonwealth Fund
$1,296,290

Supporting the Fund’s Communications and Publishing Capacity to Reach Change Agents and Inform Public Discourse

The Commonwealth Fund’s communications department partners and contracts with numerous organizations and individuals to disseminate the foundation’s work to policymakers, stakeholders, and the public at large. In 2010, the Board of Directors, recognizing that these relationships constitute extramural expenses, approved packaging the costs as an annual authorization to the Fund. The renewal of this authorization for fiscal year 2013-14 will permit the continuation and enhancement of the foundation’s communications activities and partnerships in four main areas: publications development and dissemination; media services; Web design and content development; and licensing. It will also support a major redesign of the Fund’s website, the first since 2007.

Barry Scholl
Senior Vice President for Communications and Publishing
1 East 75th Street
New York, NY 10021
bas@cmwf.org

Project HOPE - The People-to-People Health Foundation, Inc.
$200,000

Dissemination of Policy Information on Innovation and Health Reform Implementation, 2014

Since 2002, The Commonwealth Fund has partnered with Health Affairs, one of the foremost health policy journals, to support its efforts to inform discourse, foster opportunities to disseminate Fund-supported research faster and more frequently through an online publishing partnership, and help raise the Fund’s professional and public profile. With the Affordable Care Act nearing full implementation, this grant will aid in publishing and disseminating relevant content on the law’s impact and on innovation throughout the health system to leaders in policy and care delivery.

Alan R. Weil, J.D., M.P.P.
Editor in Chief, Health Affairs
7500 Old Georgetown Road, Suite 600
Bethesda, MD 20814
alanweil@projecthope.org

SMALL GRANTS

Center for Excellence in Health Care Journalism
$45,000

Support for the Association of Health Care Journalists’ Health Journalism 2014, Regional Health Journalism Workshop, and the Aging and Long-Term Care Online Learning Center

This $45,000 grant supports three projects of the Association of Health Care Journalists for 2013: the annual Health Journalism Conference, a Regional Health Journalism Workshop, and the Aging and Long-Term Care Online Learning Center. The funds partially support meeting- and marketing-expenses as well as some personnel expenses. The Commonwealth Fund receives VIP passes to both events and will be listed as a sponsor on all printed materials plus the Online Learning Center.

Len Bruzzese
Executive Director
10 Neff Hall
Columbia, MO 65211
bruzzesel@missouri.edu

CUNY TV Foundation
$49,500

Talking Health TV Series on CUNY-TV

This $49,500 grant supports production and broadcast of three episodes of CUNY-TV’s Talking Health series. The funds cover expenses for production (pre and post), distribution, DVD manufacturing, and web streaming. The Commonwealth Fund receives sponsorship recognition on air, on the DVDs, and on website versions——which are also posted on the Fund site.

Robert Isaacson
President and Treasurer
365 Fifth Avenue, Suite 1400
New York, NY 10016
bob@cuny.tv

Society of American Business Editors and Writers, Inc.
$35,000

SABEW Business of Health Care Workshops and Symposium

A project of the Society of American Business Editors and Writers (SABEW), the Business of Health Care 2014 Workshops and Symposium aim to educate experienced business journalists and editors on the implementation of the Affordable Care Act and other reforms. A symposium and three workshops will give journalists covering health reform an opportunity to learn about how the law will affect business owners, employees, and other interested parties. The Fund has collaborated with SABEW on various projects since 2007, and first supported the Business of Health Care symposium in 2012.

Warren Watson
Executive Director
Cronkite School
555 North Central Avenue, Suite 416
Phoenix, AZ 85004-1248
watson.sabew@asu.edu

Strengthening the Foundation and Nonprofit Sectors

BOARD GRANTS

AcademyHealth
$128,706

Rent and Services

AcademyHealth is a national membership organization devoted to increasing the contribution of health services research to the improvement of the U.S. health care system. Through professional, educational, and dissemination activities, it seeks to: expand and improve the scientific basis of the field; enhance the capabilities and skills of researchers; translate research findings into useful information for clinical, managerial, and policy decision-making; strengthen communication and interaction between health services researchers and policymakers; identify areas in which additional research is needed to inform decisions; and promote the use of research findings in public and private decision-making.

Lisa Simpson, M.B., B.Ch., M.P.H., F.A.A.P.
President and Chief Executive Officer
1150 17th Street N.W., Suite 600
Washington, D.C. 20036
lisa.simpson@academyhealth.org

AcademyHealth
$15,000

General Support

AcademyHealth is a national membership organization devoted to increasing the contribution of health services research to the improvement of the U.S. health care system. Through professional, educational, and dissemination activities, it seeks to: expand and improve the scientific basis of the field; enhance the capabilities and skills of researchers; translate research findings into useful information for clinical, managerial, and policy decision-making; strengthen communication and interaction between health services researchers and policymakers; identify areas in which additional research is needed to inform decisions; and promote the use of research findings in public and private decision-making.

Lisa Simpson, M.B., B.Ch., M.P.H., F.A.A.P.
President and Chief Executive Officer
1150 17th Street N.W., Suite 600
Washington, D.C. 20036
lisa.simpson@academyhealth.org

The Center for Effective Philanthropy
$7,500

General Support

The Center for Effective Philanthropy, Inc., is a nonprofit organization that provides management and governance tools to define, assess, and improve overall foundation performance. The Center collects comparative data on foundations, which are then used for research publications that inform foundation leaders, assessment tools that allow foundations to compare strengths and weaknesses, and programming that brings together executives to share approaches for gauging and improving performance.

Phil Buchanan, M.B.A.
President
675 Massachusetts Avenue, 7th Floor
Cambridge, MA 02139
philb@effectivephilanthropy.org

Communications Network
$3,500

General Support

The Communications Network is a nonprofit organization dedicated to advancing, promoting, and encouraging the adoption of effective communications practices in philanthropy. Through face-to-face and online professional development programs, an annual national conference of communications professionals, and the commissioning and dissemination of research by The Commonwealth Fund and others, the Network seeks to elevate the quality of communications practice within foundations and the grantee organizations they support.

Bruce S. Trachtenberg
Advisor
1365 York Avenue, 28H
New York, NY 10021
bsttrach@gmail.com

Digital Divide Data
$50,000

Grant Archives Digitization

This grant will support the transfer, processing, and storage of additional Commonwealth Fund materials at the Rockefeller Archive Center, which has housed the Fund’s archives since 1985. It will also fund the completion of a project with Digital Divide Data that began in April 2013. Part one was to scan microfilm records, which are a portion of The Commonwealth Fund’s historical records stored at the Rockefeller Archive Center. The second part of this project takes the scanned records and converts them to searchable digital records that will be integrated into the Fund’s grants management system.

Jeremy Hockenstein
Chief Executive Officer and Co-Founder
115 West 30th Street, Suite 400
New York, NY 10001
jeremy@digitaldividedata.org

Foundation Center
$15,000

General Support

The Foundation Center is one of the nation’s leading authorities on institutional philanthropy. As a primary source of independent information on foundation giving, the Center maintains an up-to-date, comprehensive, and centralized computer database of information on more than 100,000 foundations, corporate donors, and grantmaking public charities in the United States, as well as 2.5 million recent grants. It provides free education and training on the grantseeking process through its five national libraries (one in New York City) and national network of more than 475 funding information centers located in public libraries, community foundations, and educational institutions.

Bradford Smith
President
79 Fifth Avenue
New York, NY 10003-3076
bks@fdncenter.org

Grantmakers in Aging, Inc.
$6,500

General Support

John Feather, Ph.D.
Chief Executive Officer
2001 Jefferson Davis
Highway, Suite 504
Arlington, VA 22202
jfeather@giaging.org

Grantmakers In Health
$15,000

General Support

Grantmakers In Health (GIH) is a nonprofit, educational organization that facilitates communication, collaborative program planning, and funding among corporations and foundations in health philanthropy. GIH also helps to strengthen the grantmaking community’s knowledge, skills, and effectiveness. The organization pursues its mission through annual meetings, issue-focused forums, workshops, publications, continuing education and training, technical assistance, and studies of health philanthropy. The organization publishes GIH Bulletin, a monthly newsletter with information on new grants, publications, studies, job opportunities, and people in the field of health philanthropy. Annually, GIH conducts more than 20 meetings and conferences on topics of interest to foundation professionals. The Fund has been a member of GIH since its inception in 1982.

Faith Mitchell, Ph.D.
President and Chief Executive Officer
1100 Connecticut Avenue, N.W., Suite 1200
Washington, D.C. 20036
fmitchell@gih.org

Grants Managers Network, Inc.
$2,500

General Support

The mission of the Grants Managers Network, Inc. (GMN) is to improve grantmaking by advancing the knowledge, skills, and ability of grants management professionals and leading grantmakers to incorporate effective practices that benefit the philanthropic community. GMN has built a professional community of more than 2,200 members from 1,200 organizations throughout the United States. Members’ services include national training and networking events, an annual conference, and the GMN Examiner newsletter and GM Guide. The organization also promotes environmentally sustainable grantmaking practices.

Michelle Greanias, M.B.A.
Executive Director
1666 K Street N.W., Suite 440
Washington, DC 20006
mgreanias@gmnetwork.org

Nonprofit Coordinating Committee of New York
$75,000

General Support

Established in 1984, the Nonprofit Coordinating Committee of New York, Inc. (NPCC), provides support services for the nearly 20,000 not-for-profit organizations in New York City and serves as an important voice on national, state, and local issues affecting the nonprofit community. The organization conducts an active government relations program; provides an extensive range of member services, including a monthly newsletter and more than 50 free workshops annually; and works with the media and public officials to promote better understanding of the sector’s role and contributions.

Michael Clark
President
135 West 36th Street, 15th Floor
New York, NY 10018
mclark@npccny.org

Philanthropy New York
$18,100

General Support

Philanthropy New York engages the larger New York philanthropic community of both established and emerging funders, serving the philanthropic community through seminars, workshops, publications, and online resources. With nearly 300 members, Philanthropy New York sponsors peer networks, including groups for business and office managers, foundation financial managers, communications professionals, and grants managers. Each group promotes information-sharing and best practices within its sector. The organization also addresses legislative and regulatory issues affecting foundations. Membership dues are based on the Fund’s annual appropriations.

Ronna Brown, J.D.
President
79 Fifth Avenue, Fourth Floor
New York, NY 10003-3076
rbrown@philanthropynewyork.org

Rockefeller Archive Center
$85,000

Transfer and Maintenance of The Commonwealth Fund’s Archives, Year 18

This grant will support the transfer, processing, and storage of additional Commonwealth Fund materials at the Rockefeller Archive Center, which has housed the Fund’s archives since 1985. It will also fund the completion of a project with Digital Divide Data that began in April 2013. Part one was to scan microfilm records, which are a portion of the Commonwealth Fund’s historical records stored at the Rockefeller Archive Center. The second part of this project takes the scanned records and converts them to searchable digital records that will be integrated into the Fund’s grants management system.

Lee Hiltzik, Ph.D.
Assistant Director and Head of Donor Relations and Collection Development
15 Dayton Avenue
Sleepy Hollow, NY 10591-1598
lhiltzik@rockarch.org

Technology Affinity Group, Inc.
$1000

General Support

Technology Affinity Group (TAG) is a membership organization of foundations that promotes understanding of how information and communications technology can help further philanthropic goals. Membership benefits include discounts to annual conferences and regional meetings, access to hundreds of documents about best practices in foundation technology management, and discounted hardware and software from vendors. Through its membership with TAG, the Fund will be able to further the foundation’s important focus on archiving and preserving digital grant documents.

Lisa Pool
Executive Director
23 Briar Road
Wayne, PA 19087
lisa@tagtech.org

SMALL GRANTS

Greater New York Hospital Association
$1,200

24th Annual Symposium on Health Care Services in New York: Research and Practice

The Greater New York Hospital Association (GNYHF) and the United Hospital Fund of New York cosponsor an annual symposium on health services research in New York. The symposium is designed to showcase research concerning a wide array of health policy and management related topics of interest to administrators, clinicians, and health policymakers in New York. This grant would allow The Commonwealth Fund to be a collaborating organization in the symposium. As such, the Fund will be involved in the planning of the meeting.

Tim Johnson
Executive Director
555 West 57th Street, 15th Floor
New York, NY 10019
tjohnson@gnyha.org

Greater New York Hospital Association
$1,200

25th Annual Symposium on Health Care Services in New York: Research and Practice

The Greater New York Hospital Association (GNYHA) and the United Hospital Fund of New York cosponsor an annual symposium on health services research in New York. The symposium is designed to showcase research concerning a wide array of health policy and management related topics of interest to administrators, clinicians, and health policymakers in New York. This grant would allow The Commonwealth Fund to be a collaborating organization in the symposium. As such, the Fund will be involved in the planning of the meeting.

Tim Johnson
Executive Director
555 West 57th Street, 15th Floor
New York, NY 10019
tjohnson@gnyha.org

Innovation Network, Inc.
$7,100

Evaluation Strategy Workshop

As The Commonwealth Fund completes a “strategic refresh” to refine its direction for the coming years, staff are charged with identifying approaches for measuring the impact of their work and grantmaking. To further assist staff with the development of this new measurement approach and evaluation strategy, the Center for Evaluation Innovation proposes a three-hour workshop for senior staff in programs, communications, and grants management.

Tanya Beer, M.P.A., M.A.
Associate Director
1625 K Street, N.W., Suite 1050
Washington, D.C. 20006
tbeer@evaluationinnovation.org

Independent Sector
$10,000

General Support

Diana Aviv
President and Chief Executive Officer
1602 L Street N.W., Suite 900
Washington, D.C. 20036
diana@independentsector.org

National Medical Fellowships
$7,500

General Support

Esther Dyer, D.L.S., M.L.S.
President and CEO
347 Fifth Avenue, Suite 510
New York, NY 10016-5007
erdyer@nmfonline.org

Nonprofit Coordinating Committee of New York
$40,000

General Operating Support

The Fund has awarded annual grants for general operating support to the Nonprofit Coordinating Committee of New York, Inc. since 1986. During this time, with Fund support and through the board leadership of John E. Craig, Jr., the organization has increased its services for the New York City nonprofit community, and become an important voice on national, state, and local issues affecting the nonprofit community.

Michael Clark
President
135 West 36th Street, 15th Floor
New York, NY 10018
mclark@npccny.org

New York Academy of Medicine
$6,000

General Support

Jo Ivey Boufford, M.D.
President
1216 Fifth Avenue
New York, NY 10029-5293
jboufford@nyam.org

National Academy of Social Insurance
$5,000

General Support

Pamela Larson, M.A.
Executive Vice President
1776 Massachusetts Avenue NW, Suite 615
Washington, D.C. 20036
plarson@nasi.org

New York eHealth Collaborative Inc
$5,000

General Support

David Whitlinger
Executive Director
40 Worth Street, 5th Floor
New York, NY 10013-2988
dwhitlinger@nyehealth.org

Primary Care Development Corporation
$8,000

General Support

Ronda Kotelchuck, M.R.P.
Executive Director
22 Cortlandt Street, 12th Floor
New York, NY 10007
dwhitlinger@nyehealth.org

United Hospital Fund of New York
$25,000

General Support

James R. Tallon, Jr.
President
1411 Broadway, 12th Floor
New York, NY 10018
jtallon@uhfnyc.org

Mathew Greenwald & Associates
$12,150

Commonwealth Fund 2014 Audience and Grantee Survey

At the July 2013 board meeting, the Board approved the programmatic strategic refresh that will guide the Fund’s work going forward. Along with the new grantmaking priorities, the Fund will present to the Board in November 2014 a strategy for tracking overall organizational effectiveness and individual program milestones. The 2014 Audience and Grantee Survey gathers feedback from our grantees and stakeholders and will serve as one of several data sources that will help gauge overall organizational effectiveness and provide indicators of program milestones. The survey aims to establish baseline measures so that we can track stakeholders’ awareness and perception of our work in new and existing programmatic areas.

Anne Elmlinger
Assistant Vice President
4201 Connecticut Avenue NW, Suite 620
Washington, D.C. 20008
anneelmlinger@greenwaldresearch.com

RK Evaluations and Strategies, L.L.C.
$23,000

Taking the Pulse: Bellwether Interviews to Support the Fund’s New Programs

At the July 2013 board meeting, the Board approved the programmatic strategic refresh that will guide the Fund’s work going forward. Along with the new grantmaking priorities, the Fund has set out to reassess its benchmarking activities, with an updated measurement strategy to be presented to the Board in July 2014. In addition to the traditional audience and grantee survey, which focuses on assessment of the Fund’s work and effectiveness by groups that know the Fund well, there is an opportunity to take the pulse of audiences who may or may not be familiar with the Fund, but whose focus areas align with the new program areas. This small grant would conduct and analyze approximately 35 bellwether interviews in early 2014 as part of the larger research effort by the Fund as it moves into a new area of work with a new audience.

Robin Kane, M.P.A
Principal & Founder
3155 19th Street NW
Washington, D.C. 20010
robin@rkevaluation.com

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