The Commonwealth Fund Connection

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

Impact of Health Reform Bills on Coverage, Affordability, and Costs
New Commonwealth Fund report analyzes the provisions of the health reform bills passed by the U.S. House of Representatives and Senate that seek to expand and improve health insurance coverage. Although there are some key differences between the bills’ approaches, both would significantly reform health insurance, providing coverage to more than 30 million uninsured Americans and substantially improving the affordability of coverage for small businesses and for people who now buy insurance on their own. An updated companion report analyzes the bills’ implications for health system reform, while an updated third Fund report provides an overview of the bills’ provisions.
Person-Centered Care for Nursing Home Residents: The Culture Change Movement
In a Health Affairs "Web First" article published Jan. 7, The Commonwealth Fund's Mary Jane Koren, M.D., takes a look at "culture change" in long-term care—how the growing movement to transform America's nursing homes got started, and where it might be headed.
Health Insurance Exchanges in Health Care Reform: Legal and Policy Issues
This Commonwealth Fund report describes design and function issues raised by health insurance exchanges, prior experience with exchanges, the provisions of the pending House and Senate bills that affect exchanges, and policy issues raised by the legislation.
COBRA Subsidies for Laid-Off Workers: An Initial Report Card
Enrollment in COBRA continuation coverage has increased substantially, thanks to new COBRA subsidies approved by Congress in 2009 , according to this Commonwealth Fund study. Implementation has gone smoothly, and most eligible people have heard about the subsidy, but many of those who are eligible still cannot afford to purchase COBRA coverage.
Medicare Advantage Reforms: Comparing House and Senate Bills
This Commonwealth Fund issue brief compares approaches to reducing payments to private Medicare Advantage plans and other provisions in the House and Senate bills that aim to improve the value that Medicare obtains for the dollars it spends.
Role for a Labor–Management Partnership in Nursing Home Person-Centered Care
This Commonwealth Fund–supported study in the Gerontologist looks at a partnership that was formed between a New York City nursing home union and 40 nursing homes to help implement "person-centered care" at the facilities. Results showed an improvement in quality of life, with residents gaining more autonomy and privacy and many employees experiencing greater job satisfaction.
Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices
In small- and medium-sized physician practices, electronic medical record systems can help coordinate patient care within practice offices, according to this Commonwealth Fund–supported Journal of General Internal Medicine study. However, because of interoperability issues, electronic systems are less able to support coordination between clinicians and across settings.
Preventing Readmissions with Improved Hospital Discharge Planning
In this Commonwealth Fund–supported study in the New England Journal of Medicine, researchers conclude that to substantially reduce readmission rates, new strategies to improve transitional care in the ambulatory sector are needed.
WhyNotTheBest.org: New Data and Improved User Interface

Visit WhyNotTheBest.org to access new types of hospital performance data through an improved comparison tool. In addition to the process-of-care "core" measures and patient experience measures, the redesigned site now includes new hospital performance data—on readmission rates, mortality rates, and reimbursement, all as reported by the Centers for Medicare and Medicaid Services.

WhyNotTheBest.org also features new case studies of high-performing hospitals. Two focus on pneumonia care—Parkview Medical Center: Underscoring the Importance of Communication in Pneumonia Care  and St. Luke's Medical Center: Bottom-Up Approach to Quality Improvement in Pneumonia Care—and one features a hospital that has greatly improved surgical care, Texas Health Harris Methodist–Cleburne: A System Approach to Surgical Improvement.

Mary Jane Koren in Long-Term Care Discussion
In a Health Affairs–sponsored discussion panel broadcast by C-SPAN, Mary Jane Koren and other experts offered their thoughts on culture change and other long-term care issues. To watch the archived video, visit: http://www.c-span.org/Watch/Media/2010/01/05/HP/A/28006/Health+ Affairs+and+SCAN+Foundation+Discussion+on+LongTerm+Care.aspx.
Stu Guterman on Overhauling Health Care
Read a Q&A from a January 4 discussion with The Commonwealth Fund’s Stuart Guterman about health reform on Delaware’s WHYY.org at http://whyy.org/cms/news/featured/2010/01/04/digest-this-overhauling-healthcare/26803.
Ed Schor on Integrated Systems of Care

In a Commonwealth Fund e-forum, Fund vice president Edward Schor, M.D., describes how primary care practices can gain assistance in becoming medical homes through shared practice supports, such as technical assistance for implementing electronic medical records or the sharing of clinical services, like a community-based care coordination system. By linking practices and providers through these shared resources, communities can begin building integrated systems of care for their citizens, leading to higher overall health system performance and better outcomes for patients.