The Commonwealth Fund Connection

The Commonwealth Fund Connection is as a roundup of recent Fund publications, charts, multimedia, and other timely content. 

Health Care Opinion Leaders' Views on Health Reform

By an overwhelming majority, leaders in health care and health policy think the new reform law will successfully expand access to affordable health insurance to millions of Americans. The latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders survey also found that nearly all key features of the health reform law—including income-related subsidies, new insurance market rules, and innovative payment methods—are supported by a large majority of opinion leaders.

Looking toward implementation, respondents identified the nation's supply of primary care providers, states' capacity to implement reform, and enforcement of the individual mandate as areas of potential concern. Longer term, opinion leaders believe that improved affordability provisions for low- and moderate-income families, prevention and control of chronic disease, and stronger cost controls are the most important issues to be readdressed in the next two to three years.

Commentaries by Michael Leavitt , former Secretary of Health and Human Services, and Tom Daschle, former Senate Majority Leader, offer perspectives on the new law.

How IT Extension Centers Can Help Physicians Adopt Health IT
Small physician practices are less likely than large medical groups to have the resources needed to purchase health information technology (IT) systems to help them deliver safer, more efficient care. In an article in the new issue of Health Affairs, Commonwealth Fund–supported researchers report on ways in which the new regional extension centers authorized by the 2009 American Recovery and Reinvestment Act can help these practices adopt electronic health records and redesign their systems to make the most effective use of the technology.
New Chartbook: Health System Comparisons Across Nine Nations
A new chartbook uses data from the Organization for Economic Cooperation and Development to compare the health care systems of nine countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Switzerland, the United Kingdom, and the United States. Topics include: health care spending and health insurance coverage, hospitals, long-term care, physicians, pharmaceuticals, prevention, and mortality.
New Approach to Measuring Quality of Developmental Services
In this issue brief, UCLA researchers lay out a new approach to performance measurement, starting with an initial set of measures that Medicaid and other agencies could use to track the delivery and quality of developmental services for young children. The Developmental Services Quality Performance Measurement framework, which includes metrics at the individual, provider, county, health plan, and state levels, is designed to capture key components of the service-delivery pathway that are typically necessary for screening, identifying, and referring young children who have or are at risk for developmental disabilities.
Minnesota's Health Care Delivery and Payment Reforms
Minnesota's landmark health reform legislation enacted in 2008 includes a number of provisions to make health care delivery more efficient and reduce costs. In a report from The Commonwealth Fund and the National Academy for State Health Policy (NASHP), researchers provide a window into the state's efforts to transform care delivery and offer insights for other states and for federal officials charged with implementing national health reform. Authors Anne Gauthier and Ann Cullen say Minnesota's reforms lay the foundation for an expansion of the "accountable care" model of fully integrated and coordinated health care delivery. As demonstrations of accountable care organizations proceed under the new health reform law, Minnesota, the authors say, will serve as an "excellent testing ground."
Walla Walla General Hospital: Achieving High Performance in Pneumonia Care
Walla Walla General Hospital is one of the top-performing hospitals in the country on the pneumonia process-of-care, or "core," measures reported to the Centers for Medicare and Medicaid Services. A new case study attributes the hospital's success to education and reinforcement of the care standards, as well as improvements to care processes, reminders, and other supports created to give staff the tools they need to succeed.
Group Employed Model: Foundation for Health Care Delivery Reform
A new issue brief examines the group employed model, in which health care organizations hire primary and specialty physicians to work under salaries or contract, with the aim of delivering low-cost, high-quality care. Leaders of such organizations point to the keys to success of this model: physician leadership that promotes trust in the organization, integration that promotes teamwork and coordination, governance and strategy that drive results, transparency and health information technology that drive continual quality improvement, and a culture of accountability that focuses providers on patient needs and responsibility for effective care and efficient use of resources.
Lessons from a Health IT Demonstration in Nursing Homes
This case study examines the New York State Nursing Home Health Information Technology Demonstration Project, a publicly subsidized initiative to implement comprehensive, point-of-care electronic medical records in 20 New York City–area nursing homes. All participating homes successfully replaced paper records with electronic ones, and, after an intensive planning period, it took less than six months on average for facilities to make this transition.
Caution for Workplace Wellness Programs
An April 12 article in the New York Times cites an analysis coauthored by Commonwealth Fund Harkness Fellow Harald Schmidt, Wellness Programs: A Threat to Fairness and Affordable Care. The analysis explores how provisions of the new health reform legislation allowing employers to offer their employees discounted insurance premiums for participating in wellness programs and reaching health goals could shift costs to sick employees.
Improving Personal Health Records for Patient-Centered Care
Patients can use personal health records (PHRs) to communicate with physicians, enter their health data, and access information. In the United States, uptake of this technology is modest but increasing due to employer interest, health care reform, and the market entry of Google and Microsoft. In a new study, 2007–08 Commonwealth Fund Harkness Fellow Shane R. Reti and colleagues interviewed seven early adopters of PHRs, representing hospitals, ambulatory care facilities, insurers and health plans, government departments, and the commercial sectors. The authors suggest ways in which PHRs could be improved to support patient-centered care.
Timelines for Health Reform Legislation

The new health care reform law includes numerous provisions affecting health care coverage, the health care delivery system, and sources of revenue for financing of reform. Some of these provisions will go into effect immediately, while some will be implemented over the next decade. To help navigate through the legislation, we have created the following timelines:

Archived Webinar and Resources: Getting to Zero—Strategies to Eliminate CLABSIs
Listen to the presentations and discussion and view the slides from an April 14 webinar on how hospitals can "get to zero" and eliminate central line–associated bloodstream infections (CLABSIs), one of the most lethal types of complications. The event featured Lucian L. Leape, M.D., adjunct professor, Department of Health Policy and Management, Harvard School of Public Health; Peter J. Pronovost, M.D., Ph.D., director, Johns Hopkins University Quality and Safety Research Group; and Brian S. Koll, M.D., medical director and chief, infection prevention, Beth Israel Medical Center. Also available: resources on how to get started in preventing infections.
WhyNotTheBest.org News: Updated Hospital Performance Data; New Report Download Capability

We have updated WhyNotTheBest.org with the most recently available performance data for the process-of-care "core" measures and hospital patient experience measures reported by the Centers for Medicare and Medicaid Services. Users of the site can conduct side-by-side comparisons of 4,500 hospitals nationwide, track performance over time against benchmarks, and download tools to improve health care quality.

In addition, registered users can now download trend data from the performance reports. To access this new functionality, log in to the site, create a performance report or access one of your saved reports, view the report table, then click on any one of the measures. You will then be able to export the trend data as an Excel file and the most recent data as a PDF.

Webinar Today: New Joint Commission Standards to Improve Patient–Provider Communication
Join a free webinar today, April 16, from 12:30 to 1:45 p.m. EDT, about The Joint Commission's newly revised hospital accreditation standards to improve patient–provider communication. The standards were developed as part of an initiative supported by The Commonwealth Fund to increase quality and safety through effective communication, cultural competence, and patient- and family-centered care. To register, visit https://www2.gotomeeting.com/register/249580603.
NYAM Lecture Series: Health Reform and New York State
On May 12, the New York Academy of Medicine's (NYAM) Section on Health Care Delivery will present "Health Care Reform and Access to Coverage," the final lecture in its series on health care reform and New York State. For more information or to register, visit the NYAM Web site.