Any institution in existence for close to a hundred years has likely borne witness to a lot of transition. That is particularly true for a philanthropy, like The Commonwealth Fund, whose purpose is to bring about positive social change. In the Fund’s case, that change, emanating from our founder’s charge to “do something for the welfare of mankind,” is focused on creating a high performance health system for all Americans.

Since 1918, when Anna Harkness established the Fund, there have been transitions aplenty. Just over the past year alone, those changes—occurring within our foundation, across the U.S. health care system, and throughout our nation as a whole—have been real and meaningful. And as I write, we are still in the early months of a new year, 2016, that is shaping up to be every bit as momentous.

As my colleague David Squires and I wrote in a recent blog post, 2015 saw a health system in transition on many levels. A historic slowdown in health spending showed signs of reaching its end, as drug expenditures in particular drove new cost growth. Millions more Americans got new coverage under the Affordable Care Act (ACA), even as numerous states’ health insurance CO-OPs failed and consolidation among big carriers changed the insurance landscape. Hospital-acquired infections continued to decline, even as new research—including some from The Commonwealth Fund—indicated mortality rates for middle-aged white Americans are on the rise.

The Commonwealth Fund’s programmatic work is designed not only to support changes that can help the nation achieve high performance in health care but also to continually assess the impact of those changes. In 2015, a series of survey reports documented the changes health reform is bringing to the U.S. health insurance system. And a collection of reports looked at the ACA five years after its enactment, focusing on accomplishments and remaining challenges both in insurance coverage and the way we pay for and deliver care.

Last year also shed light on the past and future of Medicare and Medicaid, which both turned 50 years old in 2015. In a series of Fund briefs and blog posts, as well as our first e-book, we tackled the many changes in both programs over the decades and what may lie ahead.

In a health system undergoing not just transition but, in some areas, transformation, there was no shortage of topics to explore in 2015. As you will read in other parts of this annual report, our staff and grantees produced the latest in our series of state scorecards and examined international experiences to inform our own efforts to transform the U.S. health system. Our reports studied how primary care providers in the U.S. are adjusting to the ACA, and how primary care physicians around the globe are grappling with the challenges of older, sicker populations. We examined how community health centers are increasingly taking on the characteristics of patient-centered medical homes, and how they’re using mobile phones to serve patients. Reports profiled innovation centers and innovative communities seeking to become the laboratories of change.

The only thing transitioning as quickly as the health care system may be the ways we communicate with our audiences. We changed how we present information through innovative tools like our Quality-Spending Interactive and our interactive maps on Medicaid expansion and state marketplace implementation. And we made extensive use of social media platforms like Facebook and Twitter.

Within Harkness House, the New York City home of The Commonwealth Fund, we’ve had some important transitions of our own over the past year. We were thrilled to welcome Margaret A. Hamburg, M.D., former commissioner of the U.S. Food and Drug Administration (FDA), to the Board of Directors. In 2009, Dr. Hamburg became the second woman to serve as FDA commissioner, a position she held until April 2015. Now foreign secretary for the National Academy of Medicine, Dr. Hamburg brings with her a wealth of experience and deep commitment to improving health and health care. Her knowledge of health care issues will be an invaluable asset to the organization’s continuing efforts to monitor health care reforms locally, nationally, and internationally and to ensure best practices benefit all Americans.

The Commonwealth Fund has undergone other important staff and leadership changes, as well. Kathleen Regan succeeded John E. Craig, Jr., as The Commonwealth Fund’s executive vice president and chief operating officer. With three decades of experience in health care–related investment banking, private equity, and finance, Kathy’s skills in investment and management, and her commitment to improving the U.S. health care system, make her a perfect fit for this critical position at our foundation.

Eric C. Schneider, M.D., also joined The Commonwealth Fund in 2015, as senior vice president for policy and research, to guide our policy research strategy, evaluate research designs used in Fund projects and initiatives, evaluate completed projects, and provide scientific review of our publications. As a health services researcher and physician, Eric brings to bear his wide range of experience in health policy, quality measurement, and health care improvement. His expertise in the use of data and rigorous analytic methods to improve the quality of care will be vital to leading initiatives that further the Fund’s mission.

Finally, 2015 was not without bittersweet transitions as well, as we said farewell to longtime program officers Anne-Marie J. Audet, M.D., Stuart Guterman, and Mark Zezza.

In the coming months, elections will transform the nation once again, with still unforeseeable consequences for the U.S. health system. By the next time I write an annual report message, we will have a new president, a new Congress, and, very likely, a new configuration of justices on the Supreme Court. History tells us that the months immediately following a presidential election—commonly known as “the transition”—are usually the window during which new administrations can develop plans to pursue major health policy goals. There is still much to be done to achieve a high performance health system in our country. I look forward to working with The Commonwealth Fund’s Board, staff, and stakeholders to support that transition in pursuit of our shared mission.



The Affordable Care Act and Its Impact: What Do We Know So Far?

Monitoring States’ Medicaid Choices States have considerable flexibility in choosing whether and how to expand eligibility for Medicaid under the Affordable Care Act. With Commonwealth Fund support, the work of George Washington University’s Sara Rosenbaum—one of the nation’s foremost experts on Medicaid—has informed federal and state policymakers about the program’s ongoing transformation, how it varies by state, and what it means for low-income Americans.

The Affordable Care Act at 5 Through careful review of the evidence to date and hearing the personal stories of ordinary Americans, The Commonwealth Fund takes stock of health reform’s impact on health care in the U.S.—from insurance coverage to the delivery of care.

Affordable Care Act Tracking Survey Responses to the latest in this series of Commonwealth Fund surveys indicate that most Americans enrolled though the federal and state-based insurance marketplaces are satisfied with their insurance and getting care they weren’t able to afford before. But out-of-pocket costs are a serious concern for some enrollees.

The Changing Landscape of Coverage and Access Commonwealth Fund researchers find that uninsured rates for working-age adults in 2014 declined in nearly every state compared with 2013. Still, wide variation in coverage and access to care persists across the U.S., with states not expanding Medicaid faring the worst.

Tracking ACA Implementation Since 2011, Kevin Lucia’s research team at the Georgetown University Health Policy Institute has been tracking implementation of the Affordable Care Act’s marketplaces and insurance market reforms, providing valuable information on states’ progress to the media, federal officials, and members of Congress. The Commonwealth Fund presents these findings in blog posts, briefs and reports, and interactive maps.

Tackling the Cost Conundrum

Are Quality and Spending Related? Quality of care in the United States varies widely from region to region, as does the cost of care. Spending is not always associated with higher quality or with better health outcomes. To help local leaders determine the “relative value” of care, The Commonwealth Fund created an interactive tool that helps illuminate the relation between quality and spending.

The Real Drivers of U.S. Health Spending Much higher spending on health care in the U.S. relative to other advanced nations is largely a result of greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions, Commonwealth Fund research finds.

A Stronger Safety Net

Health Centers as Medical Homes The share of the nation’s community health centers—cornerstones of health care systems in underserved areas—that possess medical home capability nearly doubled between 2009 and 2013, a Commonwealth Fund survey finds. Still, many centers report greater difficulty coordinating care with external providers, particularly specialists.

Getting Mobile A survey of 200 leaders at community health centers and clinics assessed how safety-net providers are using cell phones to support patient engagement. Among the findings: only a quarter of participants reported using cell phones in care delivery, mostly for appointment reminders.

Reform Across States & Communities

Focus on Behavioral Health What are state Medicaid agencies doing to remove barriers to better integration of physical and behavioral health care? Deborah Bachrach and her team at Manatt, Phelps & Phillips explored strategies for improving outcomes and lowering costs for medically complex patients.

Arkansas Experiments In 2010, Arkansas officials faced a triple threat: a deficit in Medicaid dollars, a population suffering from pervasive chronic disease, and a fragmented provider community. The state responded with a sweeping initiative encompassing a new episode-based payment system, “health homes” for people with complex health care needs, and other reforms.

All Health Care Is Local In many U.S. communities, poverty is all too often a reliable indicator of health outcomes and overall health system performance. But there are exceptions, as our interactive feature, based on findings from The Commonwealth Fund’s Scorecard on Local Health System Performance, reveals.

Charting Innovation

Where Innovation Happens At the growing number of health care innovation centers across the U.S., collaborative teams of tech entrepreneurs, designers, and clinicians working on the front lines of care are developing, testing, and spreading new approaches to delivering patient care. Use our interactive slideshow and other resources to learn more about these new centers and the innovation process.

The Potential of Digital Health Technologies ranging from smartphones and tablet computers to remote sensors and monitoring devices are being used to deliver care, information, and support to patients where and when they need it. Commonwealth Fund researchers explore the promise of technology-enabled care delivery and the further development of game-changing digital health tools.

The International Experience

Comparing Health Care Around the Globe Believing the U.S. can learn a lot by examining other health systems, their performance in relation to ours, and their health care delivery and payment innovations, The Commonwealth Fund launched a new website, international.commonwealthfund.org. Visitors learn how nations across continents deliver and finance care, control costs, and improve quality. Interactive features also allow for deep dives into health system statistics and survey data.

Physician Preparedness Reports from more than 11,000 primary care doctors in 10 high-income nations indicate that practices across the globe struggle to coordinate care and communicate with other health and social service providers—both key to managing complex patients. The latest in The Commonwealth Fund’s ongoing series of international surveys finds nearly a quarter of U.S. primary care doctors feel they are underprepared to manage care for patients with multiple chronic illnesses, and four of five have the same concerns for patients with severe mental illness.

Care Models for the U.S.? A Dutch home-care service garners international attention for its use of independent nurse teams to deliver high-quality, low-cost care and support services to frail patients. A program in Brazil deploys teams of trained laypeople to provide critical screenings, appointment reminders, and other services to residents in their local communities. The Commonwealth Fund believes it’s worth studying and learning from innovative care delivery models like these as the U.S. seeks ways to obtain greater value from its health care dollars.

Medicare & Medicaid: Looking Back, Moving Forward

Medicare at 50: The Commonwealth Fund marks the Medicare program’s 50th anniversary with a series of six papers written by nationally recognized experts. Available as an e-book, the collection, together with an interactive timeline, examines Medicare’s past and present and offers options for addressing the needs of future generations of beneficiaries.

Medicaid at 50: Medicaid also celebrates a 50th birthday in 2015. A series of posts to the Commonwealth Fund Blog by Cindy Mann and Deborah Bachrach charts a path forward for the federal–state program, which has evolved into the nation’s largest health insurer. In an issue brief, Commonwealth Fund President David Blumenthal, M.D., and colleagues pose the question, Does Medicaid make a difference? According to their Fund research, 95 percent of adults who have Medicaid and are covered all year have a regular doctor, and 55 percent report receiving excellent or very good care—experiences similar to those of Americans with private coverage.

More About Our Programs & Initiatives

Health Care Coverage and Access Supporting efforts to ensure universal, affordable health coverage and timely access to needed care—all at a cost the nation can afford.

Health Care Delivery System Reform Identifying and assessing promising models and needed reforms to improve health system performance for high-need, high-cost patients and society’s most vulnerable populations.

International Health Policy and Practice Innovations Building an international network of experts for cross-national learning, benchmarking U.S. health system performance, and fostering the transfer of innovations from abroad.

Breakthrough Health Care Opportunities Seeking out, developing, and testing transformative approaches that could disrupt the status quo in health care.

Tracking Health System Performance Providing policymakers, providers, and the public with health system performance benchmarks and improvement targets to inspire and inform future action.

Federal and State Engagement Helping congressional members and staff, federal and state officials, and stakeholders across the political spectrum in their efforts to achieve a high performance health system.

Controlling Health Care Costs Explaining the drivers of prices and spending in health care markets and identifying effective approaches to addressing them.

Advancing Medicare Identifying ways Medicare can serve its more than 50 million elderly and disabled beneficiaries more effectively, efficiently, and equitably.


Summary of Endowment Performance

Over the course of the fiscal year ending June 30, 2015, the average market value of The Commonwealth Fund's endowment rose from $724.4 million to $747.1 million.

Despite the financial market crisis of 2008—09, the Fund over the last decade has preserved the purchasing power of its endowment while maintaining the foundation's commitment to balancing financial stewardship with its mission. During the 2014—15 fiscal year, the Fund expended $32.4 million, and during the last 10 years nearly $345 million, to advance a high performance health care system for all.

The performance of the endowment is measured against both a passive benchmark reflecting target portfolio allocations and a benchmark consisting of the Fund's spending rate plus inflation. The net return on the Fund's endowment over the 12 months ending June 30, 2015, was 6.4 percent—exceeding both of these benchmarks. Over 10 years, the Fund's investment returns modestly outperformed those of the market, as measured by the passive benchmark, and have kept pace with spending plus inflation.

The Fund has achieved strong returns in recent years through diversification and careful selection of managers in global equities, alternatives (hedge funds), and private equity pools.

Spending to Advance Mission

As a value-adding foundation, The Commonwealth Fund seeks to achieve an optimal balance between its grantmaking and intramural research, communications, and program management activities, while minimizing purely administrative costs.

To maintain its role in informing health policy and promoting a high performance health system, the Fund increased its budget modestly for the current 2015—16 fiscal year to $34.5 million.


In fiscal year 2014—15, The Commonwealth Fund made 110 grants totaling $19.4 million.
Click on a slice of the graph below for grants in that program area.



Benjamin K. Chu, M.D., Chairman

Dr. Chu is group president of Kaiser Foundation Health Plan and Hospitals in Southern California and Georgia.

Cristine Russell, Vice Chairman

Ms. Russell is an award-winning freelance journalist who has written about science, health, and the environment for more than three decades.

Maureen Bisognano

Ms. Bisognano, a prominent authority on improving health care systems, is president emerita and senior fellow of the Institute for Healthcare Improvement.

David Blumenthal, M.D.

Dr. Blumenthal is president of The Commonwealth Fund. Prior to joining the Fund in 2013, he was the Samuel O. Thier Professor of Medicine at Harvard Medical School and Chief Health Information and Innovation Officer at Partners Healthcare System in Boston. From 2009 to 2011, he served as U.S. National Coordinator for Health Information Technology.

Mitchell J. Blutt, M.D.

Dr. Blutt is founder and chief executive officer of the health care investment firm Consonance Capital. He is also clinical assistant professor of medicine at Weill Cornell Medical College and the Graduate School of Medical Sciences of Cornell University.

Sheila P. Burke, R.N., M.P.A., FAAN

Ms. Burke is a faculty member and former executive dean at the Harvard Kennedy School of Government.

Michael V. Drake, M.D.

Dr. Drake, a physician-scientist, administrative leader, and teacher, is the 15th president of Ohio State University. He is a former chancellor of the University of California, Irvine.

Margaret A. Hamburg, M.D.

Dr. Hamburg, former commissioner of the U.S. Food and Drug Administration, currently serves as foreign secretary for the National Academy of Medicine (formerly the Institute of Medicine) and sits on several other boards and advisory committees.

Kathryn D. Haslanger

Ms. Haslanger, who has spent more than 30 years in health care policy, research, and delivery, is chief executive officer of JASA (Jewish Association Serving the Aging), a New York-based nonprofit.

Jane E. Henney, M.D.

Dr. Henney has held a series of senior health policy leadership positions in the public sector over the past two decades and is former commissioner of the U.S. Food and Drug Administration.

Robert C. Pozen

Mr. Pozen, former chairman of MFS Investment Management, is a senior lecturer at Harvard Business School and a senior research fellow at the Brookings Institution.

Mark D. Smith, M.D.

Dr. Smith is a member of the clinical faculty of the University of California, San Francisco, and an attending physician at the Positive Health Program for HIV/AIDS care at San Francisco General Hospital. He was the founding president and chief executive officer of the California HealthCare Foundation.

Simon Stevens

Mr. Stevens is the CEO of National Health Service, England. He previously served as executive vice president of UnitedHealth Group.

William Y. Yun

Mr. Yun is president of Franklin Templeton Investments and president of Fiduciary Trust, with overall responsibility for all investment management and research activities.

Executive & Finance Committee

Benjamin K. Chu, M.D., Chairman

David Blumenthal, M.D..

Jane E. Henney, M.D.

Cristine Russell

William Y. Yun

Sheila Burke

Audit & Compliance Committee

Jane E. Henney, M.D., Chairman

Sheila Burke

Kathryn Haslanger

Mark Smith, M.D.

William Y. Yun

Investment Committee

William Y. Yun, Chairman

Maureen Bisognano

David Blumenthal, M.D.

Mitchell Blutt, M.D.

Benjamin K. Chu, M.D.

Robert C. Pozen

Simon Stevens

Governance & Nominating Committee

Cristine Russell, Chairman

David Blumenthal, M.D.

Sheila Burke

Benjamin K. Chu, M.D.

Michael V. Drake, M.D.