The Commonwealth Fund Connection

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

New Survey: 9 Million U.S. Adults Who Lost a Job with Health Benefits Became Uninsured

In the last two years, an estimated 9 million working-age adults became uninsured after losing a job with health benefits, according to The Commonwealth Fund's 2010 Biennial Health Insurance Survey. The results underscore the great difficulties unemployed Americans face today in finding affordable health care coverage—only a quarter of people who lost their employer health benefits found another source of insurance, and just 14 percent elected COBRA coverage. But the report also discusses the promise of the health reform law to shore up families' health security.

Several Affordable Care Act provisions are already bringing some relief, like allowing young adults to stay on their parents' plans until age 26. And once the law is fully implemented, nearly all 52 million adults who were uninsured for a time in 2010 will have access to comprehensive health coverage through an expanded Medicaid program, or through tax credits to purchase private health plans fortified by consumer protections.

Also check out a blog post and an interactive feature that enables you to explore the survey findings.

Profiles in Innovation
The new Center for Medicare and Medicaid Innovation, created by the Affordable Care Act, is fostering innovation in health care delivery to achieve the "Triple Aim"—improving population health, improving patients' care experiences, and lowering health care costs. With support from The Commonwealth Fund and others, the new issue of Health Affairs takes a detailed look at how 15 innovators in health care delivery, ranging from health care systems to health plans, are working to overcome multiple challenges in pursuit of these goals.
Committed to Safety: Four New Case Studies

It has been just over a decade since the Institute of Medicine (IOM) issued To Err Is Human, the landmark report that vividly documented the scope of patient safety problems within the U.S. health care system. A series of Commonwealth Fund case studies released on the fifth anniversary of that report highlighted health care organizations that had taken promising steps toward creating an organizational culture of safety—one of the IOM's key recommendations. In a follow-up to that earlier series, The Commonwealth Fund released a new set of case studies exploring the progress made by four of these early leaders:

  • Johns Hopkins Medicine, an academic medical center and nonprofit integrated health care system in Maryland that set a goal in 2002 of making its care the safest in the world.
  • Sentara Healthcare, an integrated system serving parts of Virginia and North Carolina that developed a program to foster a culture of safety throughout its member hospitals.
  • OSF HealthCare, a system based in Illinois and Michigan that has promoted a collaborative approach to ensuring patient safety.
  • U.S. Department of Veterans Affairs, which formed the National Center for Patient Safety to instill an organizational culture of safety in its nationwide network of hospitals and clinics.
Toward a High-Performing System of Long-Term Services and Supports
In a Commonwealth Fund–supported article in the new issue of Health Affairs, researchers discuss how the Affordable Care Act can help people with limitations or disabilities remain in their homes and communities, instead of nursing homes and hospitals.
What Makes a Difference in Heart Attack Care?
When treating heart attack patients, simply following evidence-based practices or protocols, like administering a beta blocker, may not be enough. A study in the March 15 issue of Annals of Internal Medicine, supported by The Commonwealth Fund, examined 11 hospitals in either the top or bottom 5 percent of performers on 30-day risk-standardized mortality for acute myocardial infarction and found no substantial differences in the use of such protocols.
Advancing Foundations' Accountability and Performance
All private foundations are intimately familiar with Form 990-PF, the federal tax return from which the Internal Revenue Service obtains the information it needs to exercise its regulatory responsibilities. In addition to being long and complex, the 990-PF is expensive to file, costing foundations an estimated $675 million in 2008. In a new essay for the 2010 Commonwealth Fund Annual Report, executive vice president and chief operating officer John E. Craig, Jr., argues that the 990-PF has failed to keep up with the evolution of the foundation sector over the last four decades. And as an instrument of basic regulation and tax collection—and a tool for promoting improved foundation performance—it is "seriously flawed."
Sharing Resources to Deliver High-Value Primary Care
The new health reform legislation ensures that up to 20 million low-income Americans will gain insurance coverage through Medicaid by 2019. To serve these beneficiaries, it will be essential for Medicaid to purchase high-value primary care that drives better outcomes, greater patient satisfaction, and more efficient use of resources. A new Commonwealth Fund report explores how a system of shared supports can help ensure that smaller independent physician practices serving Medicaid patients are able to deliver a full range of services.
Recent Commonwealth Fund–Supported Articles

In recent studies, Commonwealth Fund–supported researchers explored:

  • The current state of health policy education for medical students (New England Journal of Medicine, March 10). Based on a national survey of U.S. medical school deans, the authors found significant variation among educational approaches, with an average of just 14 hours of instruction over four years. "Health policy literacy," they conclude, "should no longer be considered an ancillary skill, but rather a core competency of a 21st-century physician."
  • Communication about health care cost reduction strategies among health plans, employers, and physicians (Annals of Internal Medicine, March 15). As payers discuss the need to reduce health care costs, physicians may hear an indiscriminate call for cutting services and prioritizing dollars over patients. Focusing instead on identifying overuse and underuse of services can raise practitioners' comfort level, the author says.
Implementing the Medicaid Primary Care Rate Increase: A Roadmap for States
Under the Affordable Care Act, between 16 million and 20 million more Americans will become eligible for Medicaid, starting in 2014. To help meet this demand, the reform law requires state Medicaid agencies to increase primary care provider reimbursement to the level of Medicare rates in 2013 and 2014 and provides federal funding to cover the additional cost. With Commonwealth Fund support, the Center for Health Care Strategies has created a guide, Implementing Medicaid Primary Care Rate Increase: A Roadmap for States, outlining key implementation and planning activities that states can undertake now to prepare for these changes.
New 'Talking Health' Episode: Health Care Costs
The premiere of the Commonwealth Fund–supported CUNY TV program "Talking Health," "Health Care: Cost vs. Income," is now available on commonwealthfund.org. The show aired on CUNY TV on March 15 and will air again March 22. Moderated by Trudy Lieberman, the program focuses on how effectively the health reform law will reduce health care costs for individuals, businesses, and providers. The guests are Katherine Swartz, professor of health policy and economics at the Harvard School of Public Health; Stephen Rosenthal, president and chief operating officer of CMO-The Care Management Company, a subsidiary of Montefiore Medical Center in the Bronx; and T. R. Reid, a former reporter for the Washington Post and author of the best-selling book, The Healing of America.
New Fact Sheets: How All-Payer Claims Databases Can Improve Quality, Costs
With Commonwealth Fund support, the National Association of Health Data Organizations is developing a series of fact sheets and a best practices guide about all-payer claims databases, which provide crucial information on the health care services rendered for different patient populations and different payers. The four fact sheets published to date include: All-Payer Claims Databases, All-Payer Claims Databases in Public Health and Medicaid, Standardization of Data Collection in All-Payer Claims Databases, and Key State Health Care Databases for Improving Health Care Delivery. The issue brief, All-Payer Claims Databases: State Initiatives to Improve Health Care Transparency, can be found on the Fund's Web site.
The Patient-Centered Medical Home Evaluators' Collaborative
In light of the large number of medical home pilots and evaluations, The Commonwealth Fund established the Patient-Centered Medical Home Evaluators' Collaborative in 2008 to align evaluation methods, share best practices, and exchange information to improve evaluation designs. The evaluators' collaborative, co-chaired by Meredith Rosenthal, Ph.D., of the Harvard School of Public Health and Melinda Abrams of The Commonwealth Fund, is open to researchers conducting medical home evaluations. If you are interested in joining, please e-mail Georgette Lawlor (gl@cmwf.org).