The Commonwealth Fund Connection

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

The Innovation Center at One Year

One year ago, the Center for Medicare and Medicaid Innovation was launched to find new ways to reduce costs and improve the quality of health care. In a new blog post, Mark Zezza, Melinda Abrams, and Stuart Guterman of The Commonwealth Fund review the Innovation Center's performance to date and point to areas for future development. "The Innovation Center is off to a good start, but it needs to build on its momentum as it attempts to move the country toward a new health care delivery system," the authors write.

You can also view the archive of a Nov. 30 webinar on the Innovation Center, cosponsored by The Commonwealth Fund and AcademyHealth, which looked at the Innovation Center’s priorities, explored how it can best conduct rigorous, rapid-cycle evaluation, and examined the role of health care providers in identifying and rolling out innovations.

Final Rules for ACOs

Accountable care organizations (ACOs)—groups of health care providers that work together to provide coordinated, efficient care—are an important part of the effort to reform health care delivery. This fall, the Centers for Medicare and Medicaid Services released its final rule for implementing a new program that will enable ACOs to share in Medicare savings. A new paper by Mark Zezza, Ph.D., senior policy analyst for Health Care Delivery Policy at The Commonwealth Fund, offers a detailed summary of the final rule, which grants more flexibility to participating health care providers.

Visit the ACO Resource Page, which offers a wide range of blog posts and publications about ACOs.

Eliminating Central Line–Associated Bloodstream Infections: Lessons from Top Hospitals

One of the most common types of infections acquired in health care settings is the central line–associated bloodstream infection (CLABSI), which can develop when a central venous catheter is not inserted or maintained properly. About 43,000 CLABSIs occurred in hospitals in 2009—and nearly one of five infected patients died as a result. A new case study series examines the strategies and procedures adopted by hospitals that reported no CLABSIs in their intensive care units in 2009. Among the lessons identified were: the importance of following evidence-based protocols to prevent infection; the need for dedicated teams to oversee all central line insertions; the value of participation in statewide, national, or regional CLABSI collaboratives or initiatives; and the necessity for close monitoring of infection rates, giving feedback to staff, and applying internal and external goals.

Read the case studies from the four hospitals—Bronson Methodist Hospital of Kalamazoo, Mich.; Englewood Hospital and Medical Center of Englewood, N.J.; Presbyterian Intercommunity Hospital of Whittier, Calif.; and Southern Ohio Medical Center of Portsmouth, Ohio. You can also view comparative performance data for these and other hospitals on WhyNotTheBest.org.

Study: Patients More Likely to Take Vital Meds When Copays Waived
Patients discharged from the hospital after experiencing a heart attack were more likely to take medications prescribed for their condition when copayments were eliminated, a Commonwealth Fund–supported study concludes. Compared with patients whose health plan coverage included cost-sharing for routinely prescribed drugs like statins and beta blockers, the patients with full coverage also experienced fewer heart attacks, strokes, and other vascular events during the study period.
Is the Pre-Existing Condition Insurance Plan Working?
A recent government report on the Pre-Existing Condition Insurance Plan (PCIP)—created to provide temporary access to health coverage for people with medical conditions—found overall enrollment is lower than projected. In a new blog post, Jean Hall, Ph.D., an associate research professor at the University of Kansas, takes a close look at the drivers of PCIP enrollment and changes under way to attract more enrollees. "While the PCIP is not enrolling everyone potentially eligible, enrollment continues to grow and the program will continue to provide critically needed coverage to thousands of people until the major coverage provisions of the Affordable Care Act go into effect in 2014," Halls writes.
Building Medical Homes: Lessons from Eight States
Many states are strategically engaging public and private payers in the design of medical home programs to achieve better health outcomes, increase patient satisfaction, and lower per capita health care costs in public health insurance programs. The eight states profiled in this report, co-published by the National Academy for State Health Policy and The Commonwealth Fund, have all played critical roles in convening stakeholders, helping physician practices improve performance, and addressing antitrust concerns that arise when multiple payers come together to create a medical home program.
Moving from Research to Large-Scale Change in Child Health Care
Evidence-based practices for improving child health care often are not implemented on a large scale. A recent Commonwealth Fund–supported study in Academic Pediatrics, written by David A. Bergman, M.D., and Arne Beck, Ph.D., outlines how the field of "dissemination, diffusion, and implementation science" provides a framework for empowering health care organizations to adopt innovations, gradually introduce changes, and ensure sustainability.
WhyNotTheBest.org Interactive Map

Enhancements to the WhyNotTheBest.org interactive map enable robust explorations of health system performance at the national, state, county, and regional levels. Using new map overlays, users can zoom in on communities involved in key delivery system reform efforts, such as the Beacon Communities or areas where patient-centered medical homes have taken hold, as well as flag health care providers that have been recognized for delivering high-quality care.

New performance data have also been added to the map, including:

  • health information technology measures tracking whether hospitals have adopted basic or comprehensive electronic medical record systems;
  • prevention quality indicators tracking hospital admissions by county for conditions such as diabetes and asthma;
  • inpatient quality indicators showing county rates for coronary artery bypass grafts and other procedures;
  • patient safety indictors showing county rates for bloodstream infections and other complications of hospital care;
  • population health measures by region assessing the number of Medicare beneficiaries with various conditions, such as heart failure; and
  • utilization and cost measures by region assessing standardized costs for imaging, lab tests, or emergency department visits among Medicare beneficiaries.
Fellowship in Minority Health Policy Open to Applicants
The Commonwealth Fund/Harvard University Fellowship in Minority Health Policy is designed to prepare physicians for leadership roles in promoting health policies and practices that improve access to high-quality care for minority, disadvantaged, and vulnerable populations. The application deadline for the 2012–13 fellowship is January 3, 2012. For more information, please visit: http://www.commonwealthfund.org/Fellowships/Minority-Health-Policy-Fellowship.aspx.
2012–13 Harkness Fellowships Open to Applicants

Applications for the 2012–13 Harkness Fellowships remain open to individuals from the Netherlands and Canada. The Commonwealth Fund's Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career professionals—academic researchers, government policymakers, clinicians, managers, and journalists—to spend up to 12 months in the United States conducting a policy-oriented research study.

Deadlines for receipt of applications are as follows:

  • The Netherlands: January 4, 2012.
  • Canada: February 14, 2012.

Note that the application process for Australia, Germany, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom is now closed.