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?
Tackling the Cost Conundrum
A Stronger Safety Net
Reform Across States & Communities
Charting Innovation
The International Experience
Medicare & Medicaid: Looking Back, Moving Forward
More About Our Programs & Initiatives
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.
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.
Dr. Chu is group president of Kaiser Foundation Health Plan and Hospitals in Southern California and Georgia.
Ms. Russell is an award-winning freelance journalist who has written about science, health, and the environment for more than three decades.
Ms. Bisognano, a prominent authority on improving health care systems, is president emerita and senior fellow of the Institute for Healthcare Improvement.
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.
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.
Ms. Burke is a faculty member and former executive dean at the Harvard Kennedy School of Government.
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.
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.
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.
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.
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.
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.
Mr. Stevens is the CEO of National Health Service, England. He previously served as executive vice president of UnitedHealth Group.
Mr. Yun is president of Franklin Templeton Investments and president of Fiduciary Trust, with overall responsibility for all investment management and research activities.
Benjamin K. Chu, M.D., Chairman
David Blumenthal, M.D..
Jane E. Henney, M.D.
Cristine Russell
William Y. Yun
Sheila Burke
Jane E. Henney, M.D., Chairman
Sheila Burke
Kathryn Haslanger
Mark Smith, M.D.
William Y. Yun
William Y. Yun, Chairman
Maureen Bisognano
David Blumenthal, M.D.
Mitchell Blutt, M.D.
Benjamin K. Chu, M.D.
Robert C. Pozen
Simon Stevens
Cristine Russell, Chairman
David Blumenthal, M.D.
Sheila Burke
Benjamin K. Chu, M.D.
Michael V. Drake, M.D.