Robin Osborn Vice President and Director International Health Policy and Practice Innovations

1. The Commonwealth FundandThe Harkness Fellowships in Health Care Policy and PracticeInternational Forum on Quality and Safety in HealthcareParis, FranceApril 11, 2014 Robin Osborn Vice President and Director International Health Policy and Practice Innovations

2. Harkness Alumni Panelists Dale Bramley, M.B., Ch.B., M.P.H., FAFPHM 2003-04 Harkness Fellow (New Zealand) Placement: Mount Sinai-New York University Medical Center and Health System Project: “Indigenous Disparities in Health Status: A Cross-Country Comparison of New Zealand, Australia, Canada and the United States” Current Position: Chief Executive Officer, Waitemata District Health Board Email: dale.bramley@waitematadhb.govt.nz Derek Feeley 2005-06 Harkness/Health Foundation Fellow (United Kingdom) Placement: Kaiser Permanente, Veterans Health Administration Project: “Developing Health Services fit for 2020 – Improving the Management of Complexity in Chronic Disease” Current Position: Executive Vice President, Institute for Healthcare Improvement Email: dfeeley@IHI.org Martin Hefford, P.G.dip, M.A. 2003-04 Harkness Fellow (New Zealand) Placement: Kaiser Permanente Project: “Using Financial Incentives to Promote Evidence Based Interventions in Primary Healthcare: Early Results from the California Pay for Performance Program” Current Position: Chief Executive Officer, Compass Health Email: martin.hefford@compasshealth.org.nz

3. The Commonwealth Fund Established by Anna M. Harkness in 1918, the mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.

4. Patient Protection and Affordable Care ActMarch 23, 2010

5. Examples of Fund Projects Realizing the Potential of Health Reform Scorecard on Local Health System Performance, 2012 • Series of reports on expansion of coverage, health insurance exchanges, and delivery system innovations • Series of reports on implications of U.S. health reform for specific populations, including women, young adults, and small businesses • Series of longitudinal surveys of young adults, low-income adults, and older adults between 2011 and 2015 to measure changes and trends in insurance coverage Annual Congressional Retreat Integrated Care and Accountable Care Organizations (ACOs) • 3-day Briefing for Members of Congress • Topics: payment reform, insurance exchanges, price variation, ACOs, public health • Tracking the development of ACOs through case studies and national surveys, and evaluating their impact on quality, cost, and reducing disparities • Grants to analyze models for integrating care, including through multi-payer initiatives, “hybrid” integrated systems, and coordinating care for patients dually covered by Medicaid and Medicare High Need/High Cost Patients • Identifying promising models of health care delivery for better managing patients with high needs. • Grants to define subpopulations to proactively identify those at high risk of becoming high cost.

6. International Program in Health Policy & Practice Innovations The Commonwealth Fund’s international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries. Adults, 2013 Easy getting after-hours care without going to the ER International Symposium on Health Policy: Ministers’ Policy Roundtable Percent • The Hon. Daniel Bahr (Minister of Health, Germany) • John K. Iglehart (Health Affairs) • The Hon. Una O’Brien CB (Permanent Secretary, Dept. of Health, England) Base: Needed care after hours.

7. Harkness Fellowships in Health Care Policy and Practice Canada Germany Australia Switzerland (under discussion) New Zealand United States United Kingdom Netherlands France (being launched 2015-16) Norway Sweden

8. Harkness Fellows can expect to: • Spend 12 months in the United States • Conduct research on a key health care delivery or policy issue • Gain an in­ depth understanding of the U.S. health care system • Learn about the Australian, Canadian, Dutch, French, German, New Zealand, Norwegian, Swedish, Swiss, and U.K. health care systems • Work with leading policy experts and senior policymakers • Get a firsthand look at innovative U.S. programs • Enhance methodological skills • Develop networks of valuable contacts for ongoing cross-national exchange and collaboration A chance to Think Big about some of the most important challenges in health care policy and practice

9. Relationship with The Commonwealth Fund Adds Value to the Fellowship • Nationally recognized Fund staff provide expertise across a range of fields in health policy and practice • Through the Fund’s grants, Fellows can connect to many of the country’s most innovative projects and research • The Fund opens doors and provides entrée to its networks of health leaders and experts for Fellows

10. The Harkness Fellowship Award • The Harkness Fellowship awards up to U.S. $119,000 • which covers the following: • Roundtrip airfare to the United States • Living allowance • Funds for project-related travel, research, and conferences • Travel to attend the Harkness Fellowship seminars • Health insurance • U.S. and state taxes • PLUS: a family supplement up to U.S. $55,000 (including airfare, living allowance, and health insurance) for Fellows accompanied by a partner and/or children up to age 18

11. Partnerships to Expand Harkness Fellowships • Canada: Canadian Foundation for Healthcare Improvement • Germany: B. Braun–Stiftung • Netherlands: Ministry for Health, Welfare, and Sport • Norway: Research Council of Norway • Sweden: Ministry of Health and Social Affairs • United Kingdom: The Nuffield Trust and NHS National Institute for Health Research

12. Examples of Harkness Fellows’ Placements • Harvard University, Boston • Stanford University, San Francisco • University of California, San Francisco • Johns Hopkins University, Baltimore • Columbia University, New York City • RAND/University of California, Los Angeles • Veterans Health Administration, Washington, D.C. • Kaiser Permanente, San Francisco • Group Health Cooperative, Puget Sound • Institute for Healthcare Improvement (IHI), Boston • Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health & Human Services, Washington, D.C. • Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health & Human Services, Washington, D.C.

13. Prominent U.S. Mentors are a Key Feature of the Program • John Hobbs (NZ) • Tom Marshall (UK) • Emma Stanton (UK) • Jonny Taitz (AUS) • Alexandra Norrish (UK) • Nikola Biller-Andorno (SWIZ) • Mirella Cacace (GER) • Katharina Janus (GER) • Adam Oliver (UK) • Robin Gauld (NZ) • James Mountford (UK) • Russell Gruen (AUS) • Stephen Davies (UK) • Katharina Janus (GER) David Blumenthal, MD Massachusetts General Hospital/ Harvard Medical School Thomas H. Lee, MD Partners Community Healthcare, Inc. Sherry Glied, PhD Mailman School of Public Health, Columbia University • Christopher Millett (UK) • Peter McNair (AUS) • Bruce Guthrie (UK) • ElanaTaipapaki Curtis (NZ) • Colin Tukuitonga (NZ) • Julia Murphy (UK) • Bert Vrijhoef (NETH) • Rhiannon Edwards (UK) • Malcolm Battersby(AUS) • Richard Hamblin (UK) • NgaireKerse (NZ) • Linda Gask (UK) • Peter Sprivulis (AUS) • Rae Lamb (NZ) • Timothy Wilson (UK) Donald Berwick, MD Institute for Healthcare Improvement Andrew Bindman, MD UCSF/San Francisco General Hospital Edward Wagner, MD Group Health Cooperative at Puget Sound • Daniela Koller (GER) • Sara Kreindler (CAN) • KimberlynMcGrail (CAN) • Michael Schull (CAN) • Diane Gray (UK) • Antoinette De Bont • (NETH) • Dawn Dowding (UK) • Derek Feeley (UK) • Richard Gleave (UK) • Martin Hefford (NZ) • Adam Elshaug (AUS) • AnsgarGerhardus • (GER) • Sonj Hall (AUS) • Kathryn Rowan (UK) • Cynthia Farquhar (NZ) Carolyn Clancy, MD Agency for Healthcare Research and Quality Benjamin Chu, MD/Murray Ross, PhDKaiser Permanente Southern California/ Kaiser Foundation Health Plan Elliott S. Fisher, MD Dartmouth Institute for Health Policy & Clinical Practice 13

14. 2013–14 Harkness Orientation at the Fund Imogen Mitchell (AUS), Jan Frich (NOR) Aziz Sheikh (UK), Beatrice Podtschaske (GER) Keynote Speaker 2013–14 Harkness Fellows Harkness Mentors Site Visits to Walgreens and Montefiore Medical Center Elizabeth Bradley (Yale), Tom Delbanco (Beth Israel Deaconess Medical Center), Joseph Newhouse (Harvard) Sherry Glied (former Assistant Secretary for Planning and Evaluation) 14

15. Harkness Fellows Breakfast with Health Ministers at the International Symposium The Hon. Daniel Bahr, Minister of Health, Germany, with Tobias Esch Una O’Brien CB, Permanent Secretary, Department of Health, England, with Felix Greaves The Hon. Lena Furmark, State Secretary, Ministry of Health and Social Affairs, Sweden, with CharlottaLevay The Hon. Tony Ryall, Minister of Health, New Zealand, with Sue Wells 15

16. Harkness/IHI Fellows Summit • Visit to the Institute for Healthcare Improvement in Boston • Briefing on IHI’s world-renowned programs and pioneering techniques to improve quality, outcomes and efficiency • Networking with IHI Quality Improvement Fellows and Staff Maureen Bisognano, President and CEO, Institute for Healthcare Improvement (IHI) with 2011-12 Harkness Fellows 16

17. Harkness FellowsWashington Policy Briefing, March 2014 • An “Inside the Beltway” Look at Policymaking with Multiple Stakeholders, and a Wide Range of Viewpoints, including: • Democratic vs. Republican perspectives on health reform • Perspectives from government agencies, members of Congress, industry lobbyists, States, and political strategists • Site Visit to VA Hospital, Kaiser Center for Total Health Karen B. DeSalvo Office of the National Coordinator for Health Information Technology Congressman Tom Price (R-Georgia) Joe V. Selby Patient-Centered Outcomes Research Institute Karen Ignagni America’s Health Insurance Plans Robert A. Petzel U.S. Department of Veterans Affairs Richard Kronick Agency for Healthcare Research and Quality Robert Reischauer Urban Institute 17

18. Harkness Fellows’ Canadian Policy Briefing, May 2013 Keynote Speech: “A National Strategy for Improving Mental Health Services in Canada: The Plan and its Prospects” David Goldbloom, Chairman, Mental Health Commission of Canada Site visit to Seaton House Men's Shelter (associated with St. Michael’s Hospital), Toronto • Helen Angus, Associate Deputy Minister, Ontario Ministry of Health and Long-Term Care • Vickie Kaminski, President & CEO, Eastern Health, Newfoundland and Labrador • André Picard, The Globe and Mail • Michael Nashat, Board Member, Pharmacy Council, Ontario Ministry of Health and Long-Term Care; Director, OnPharm 18

19. Harkness Fellowship Leadership Seminar Series Past Leadership Speakers 2012-13 Leadership Speakers A seminar series designed to provide Harkness Fellows with: Don Berwick, MD Former Administrator, Centers for Medicare and Medicaid Services Mark McClellan, MD, PhD Former Administrator for Centers for Medicare and Medicaid Services Thomas Lee, MD CEO of Partners Community Healthcare, Inc. David Blumenthal, MD President of the Commonwealth Fund/ Former National Coordinator for Health Information Technology Kenneth Kizer, MD Former Under Secretary, Veterans Health Administration Julio Frenk, MD, Former Minister of Health, Mexico • Understanding of the principles of effective leadership • Opportunity for candid discussion with influential U.S. policy leaders and guest policymakers from Fellows’ home countries • Focus on ‘lessons learned’ from real world experience Thomas Zeltner Former Swiss Secretary of State for Health Karen Davis President of the Commonwealth Fund John Rowe, MD Former Chairman & CEO of Aetna Carolyn Clancy, MD Agency for Healthcare Research and Quality 19

20. Harkness Fellows’ Publications • Over 2,300 peer-reviewed publications, 1998-2013 • Health Affairs, British Medical Journal, JAMA, Lancet, Health Policy, New England Journal of Medicine, Quality and Safety in Health Care, Journal of Health Politics, Policy and Law, Canadian Medical Association Journal, Health Services Journal • Reports to Health Ministers and Congress

21. Examples of Harkness Fellows in Leadership Positions • Mark Booth (2006-07 AUS), First Assistant Secretary, Primary and Ambulatory Care Division, Australian Department of Health and Ageing • Dale Bramley (2003-04 NZ), Chief Executive Officer, Waitemata District Health Board • Derek Feeley (2005-06 UK), Executive Vice President, Institute for Healthcare Improvement • Andreas Gerber (2007-08 GER), Head, Department of Health Economics, IQWiG • Richard Gleave (2007-08 UK), Chief Operating Officer, Public Health England • Martin Hefford (2003-04 NZ), Chief Executive Officer, Compass Health • Rae Lamb (2001-02 NZ), Aged Care Commissioner, Australian Department of Health and Ageing • Geraint Lewis (2007-08 UK), Chief Data Officer, NHS England • Martin Marshall (1998-99 UK), Chair, Health Care Improvement, University College London • Stephanie Stock (2007-08 GER), Professor, Department of Health Economics and Clinical Epidemiology, University of Cologne • Diane E. Watson (2006-07 CAN), Chief Executive, National Health Performance Authority, Australia • Jennifer Zelmer (2002-03 CAN), Executive Vice President for Clinical Adoption and Innovation, Canada Health Infoway

22. Reaching a Washington Policy AudienceHarkness Alumni Washington Policy Forum, May 2011 • 24 Harkness alumni from AUS, GER, NETH, NZ, CAN, and UK, highlighted health care policy and delivery system innovations for key US policymakers • Alumni produced 14 research papers (10 co-authored) Robin Osborn, Donald M. Berwick (CMS), Karen Davis David Blumenthal (formerly ONCHIT), Elizabeth Fowler (National Economic Council), Sherry Glied(ASPE) Martin Marshall (UK), Stephanie Stock (GER), Jako Burgers (NETH) • International innovations included: individual financial incentives, shared services/networks for primary care, after-hours care arrangements, medical home models, mobile health interventions, translating research into practice, and patient safety in primary care • “I was so glad I could make it. It was a joy to see once again the energy and brilliance of the Harkness Fellows. What a gift to us all that program is!” • -- Donald Berwick , Administrator, Centers for Medicare and Medicaid Services

23. 10-Year Review of Harkness Fellowships: Almost All Fellows (91%) Regard the Harkness Fellowship as Extremely or Very Valuable to their Career Advancement Source: 1998-2008 Harkness Impact Survey (n=75)

24. How Do The Harkness Fellowships Work For Families? • “I was a bit concerned that my daughter would not make friends easily - how wrong I was! We all had a great time. Also many fellows tended to have young children - I would encourage prospective fellows with older children to also take up the opportunity.” • Mark Booth (New Zealand), a 2006-07 Commonwealth Fund Harkness Fellow, Assistant Secretary, Department of Health and Ageing, Australia. • Family: Spouse, two children ages 14 and 18. • “Loved the school and the whole experience. They really grew through it. The school drove them academically and in every other way (very focused on high performance!). My daughter made wonderful friends (first grade), and had a strong American accent by the time we departed for home (lost it in two weeks). The transition home was very smooth, back into our house which was rented to visiting academics on sabbaticalhomes.com.” • Robin Gauld, Ph.D. (New Zealand), a 2008-09 Harkness Fellow, is associate professor of health policy in the Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand, and director of the newly-formed Centre for Health Systems, Otago Medical and Business Schools. • Family: Spouse, two children ages 6 and 10.

25. Who Should Apply? • Academic researchers, government policymakers and analysts, clinical leaders, health care and insurance industry managers, and journalists • Applicants should be mid-career and Fellows are typically between late 20’s and mid-40’s • Applicants must be citizens of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, or the United Kingdom, or have permanent residency and lived in that country for at least three years. • All applicants must submit a formal application that includes a research proposal which falls within the scope of The Commonwealth Fund’s principal areas of interest

26. Applying for the 2015-16 Harkness Fellowships in Health Policy and Practice For applicants from Australia and New Zealand – the deadline is September 15, 2014 For applicants from Canada, Germany, the Netherlands, Norway, Sweden, and the U.K. – the deadline is November 17, 2014 For applicants from France – the deadline is December 15, 2014 For more details and application form, please visit: www.commonwealthfund.org/fellowships For questions about the program, eligibility, and proposed projects, please contact: Robin Osborn (ro@cmwf.org) Vice President and Director International Health Policy and Practice Innovations The Commonwealth Fund