Health Services Research Shaping Public Policy and Private Practice: How Private Foundations Contribute

1. Health Services ResearchShaping Public Policy and Private Practice: How Private Foundations Contribute Karen Davis President The Commonwealth Fund June 9, 2008 kd@cmwf.org

2. Major Health Services ResearchContributions in Last 40 Years • Insurance Coverage • Access to care; consequences of being uninsured; disparities • Impact of Medicare and Medicaid in improving access, financial protection • Analysis of state reforms • Simulation of impact of policy solutions • Cost and Quality • Health expenditures; economic cost of illnesss • Measurement of quality, patient experiences, public reporting • Wide variation in cost and quality • Prospective payment – RBRVS, DRGs • HMOs, managed care • Aligning incentives to reward excellence and efficiency • International • Comparative health system performance and lessons for U.S.

3. Commonwealth Fund Sponsored Health Services Research:Selected Examples • Performance measurement and public reporting-- patient-centered care (H-CAHPS, CAHPS); patient-centered medical homes; racial/ethnic disparities • Business case for quality and pay for performance -- Berwick/Leatherman business case for quality, tracking and evaluation of pay for performance initiatives • International surveys and OECD working group on quality indicators -- comparative data on health system performance; learning from international innovations • Getting to universal coverage and health system reform -- Building Blocks/Creating Consensus, Bending the Curve, Commission on a High Performance Health System national and state scorecards; Lewin Group cost estimating capacity • Medicare -- Part D and Medicare Advantage

4. Commonwealth Fund Sponsored Health Services Research:Selected Examples 6. Hospital readmissions, transitional care – measures of transitional care, effective strategies for reducing avoidable hospitalizations • Long-term care – voluntary efforts to improve nursing home quality, restraint reduction, culture change, Advancing Excellence Campaign, Pioneer Network, • Child development – Assuring Better Child Health and Development, North Carolina model, Healthy Steps • Insurance – gap between reality and rhetoric of private markets, e.g. Medicare Advantage; consumer-directed health plans; better understanding of instability and inadequacy of insurance; problems with the individual insurance market • Building the field of young investigators -- minority fellows, Harkness fellows, Picker/Commonwealth Fund patient-centered care scholars; support of AcademyHealth young investigator awardees; support of article of year award authors

5. Future Challenges • Importance of actionable research • What works to improve health system performance • What are best practices, effective solutions • What leads to diffusion or implementation of better forms of organization, delivery of care, payment • Learning from excellence within the U.S. and around the world • Pilots and rapid feedback vs. formal demonstrations – both have their place • Communication and reaching audiences in a position to effect change

6. Professional Commonwealth Fund Staff Meghan Bishop Melinda Abrams Anne Beal Sara Collins Michelle Doty Mary Jane Koren Stu Guterman Anne Gauthier Jennifer Kriss Rachel Nuzum Robin Osborn Cathy Schoen Ed Schor Tony Shih Stephen C. Schoenbaum Visit the Fund at:www.commonwealthfund.org