The Commonwealth Fund Connection

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

  • January 23, 2012 Issue
Lower Health Care Spending: A New Era in American Health Care?

Health care spending in 2009 and 2010 grew at the slowest rates in 50 years. This startling news, reported by the Centers for Medicare and Medicaid Services (CMS), was largely attributed to the shrinking economy. In a new blog post, Commonwealth Fund president Karen Davis, Ph.D., says that overlooked in the discussion is the lower spending that is projected through the end of the decade.

"Either the original estimates were too high," Davis says, "or the tectonic plates underlying the health system are beginning to shift in anticipation of new incentives under health reform or in response to health care leaders' efforts to transform care over the last decade. Predictions that the Affordable Care Act would fail to control costs and, in fact, accelerate spending have not been borne out by the early experience."

Case Study Series Examines the Development of New ACOs

A new case study series focuses on four sites involved in pilots of accountable care organizations (ACOs), part of a program led by the Engelberg Center for Health Care Reform at Brookings and The Dartmouth Institute for Health Policy and Clinical Practice. The pilot sites, chosen for their experience in managing financial risk, investment in health information technology, and commitment to improving clinical care quality, include:

  • HealthCare Partners, a medical group and independent practice association (IPA) in Los Angeles that will provide care coordination for 50,000 Anthem preferred provider organization (PPO) members.
  • Monarch HealthCare, a large IPA in Orange County, Calif., that plans to provide care coordination and care navigation support for 25,000 Anthem PPO members.
  • Norton Healthcare, an integrated delivery system in the Louisville, Ky., area that is partnering with Humana to design an ACO serving about 7,000 Norton and Humana self-insured employees.
  • Tucson Medical Center, a locally governed, nonprofit, community-based acute care hospital system in Tucson, Ariz., that will work with its seven affiliated physician groups and United Healthcare to establish a virtually integrated ACO.

To learn more about how health care organizations have made the transition to an ACO and hear from some of the ACO sites, listen to the discussion and view the presentation slides from a Jan. 19 webinar on ACO formation.

Affordable Care Act: Opportunities for Safety Nets

The Affordable Care Act has the potential to help safety-net providers deliver accessible, high-quality care to vulnerable populations, according to The Commonwealth Fund's Pamela Riley, M.D., M.P.H., Julia Berenson, M.Sc., and Cara Dermody. In a new blog post, they say that "safety-net providers should take advantage of provisions that promote coordination and integration of care, capitalize on investments in the capacity of the safety net, and strive to fully understand and adapt to upcoming changes to safety net financing and payment." In a related blog post, Mary Takach, M.P.H., Katharine Witgert, M.P.H., and Catherine Hess, M.S.W., of the National Academy for State Health Policy explore how these providers will be affected by participation in accountable care organizations. You can also listen to a podcast on what health reform means for safety-net providers.

CMS to Pilot Bundled Payments

The Centers for Medicare and Medicaid Services has begun reviewing applications for a new payment initiative that will test four different models of "bundled payment" for Medicare providers. In a new blog post, The Commonwealth Fund's Mark Zezza, Ph.D., Stuart Guterman, and Jennie Smith take a look at how the three-year project, which will allow physicians, hospitals, and post–acute care providers to receive a single payment for an episode of care, will support the delivery of efficient and high-value care.

Paying for "End-Of-Life' Drugs in Australia, Germany, and the United Kingdom

A new issue brief explores the coverage policies in Australia, Germany, and the United Kingdom for potentially life-extending—but expensive—medicines that may offer only modest benefits near the end of life. The costs of these drugs can stretch the budgets of payers as well as patients, an issue the United States will need to grapple with as health reform extends coverage to more Americans.

Incorporating Clinical Decision Support into Nursing Home HIT

Interventions to Reduce Acute Care Transfers (INTERACT) is a quality improvement project designed to help reduce rates of unnecessary hospitalizations among nursing home residents. Nursing home staff use tools to identify changes in residents' health for six conditions that can lead to hospitalizations: dehydration, fever, mental status changes, heart failure, lower respiratory infections, and urinary tract infections. INTERACT’s paper-based tools have proven effective in trials, but they may have greater impact if they were integrated into nursing homes’ health information technology (HIT) systems. This Commonwealth Fund–supported study (Annals of Long Term Care, Nov. 10, 2011) examines the steps to doing so.

Wellness Incentives and Equity

The Affordable Care Act gives employers greater ability to use incentives—such as reducing employees' share of health insurance premiums—to encourage their workers to adopt healthy behaviors. Receipt of these incentives may hinge on employees' participation in wellness programs, such as exercise or smoking cessation classes, or achievement of certain outcomes, such as reducing blood pressure or body mass index. In this study (American Journal of Public Health, Jan. 2012), Harald Schmidt, M.A., a 2009–10 Commonwealth Fund Harkness Fellow, explores whether such incentives may inadvertently introduce inequities across different groups of employers.

Leveraging the Medicaid Primary Care Rate Increase

In 2013 and 2014, Medicaid will reimburse primary care providers at the same rates as Medicare providers—a "bump" in pay that is fully funded by the federal government under the Affordable Care Act. A new Commonwealth Fund–supported policy brief from the Center for Health Care Strategies provides states with practical advice on how to measure the impact of this rate increase on health care access, utilization, and quality—and how to build a case for sustaining the increase beyond 2014.

Advance Screening Today—U.S. Health Care: The Good News

The Commonwealth Fund, CUNY–TV, and Columbia Journalism Review invite you to an advance screening of the new documentary U.S. Health Care: The Good News, with correspondent T. R. Reid. This documentary examines how some doctors and hospitals are accomplishing what many thought impossible—providing quality health care at a reasonable cost. The film will be followed by a panel discussion on the New York City perspective on achieving a high performance health system. The event is today, with a reception beginning at 4:30 pm and the screening at 5:45pm. To learn more or to register, visit

ACHE Names Karen Davis an Honorary Fellow

Karen Davis, president of The Commonwealth Fund, has been selected as an honorary fellow of the American College of Healthcare Executives (ACHE). Honorary fellowship is a special category of ACHE membership. It recognizes individuals who have rendered distinguished service in the health care field or in related areas and who would not normally be ACHE members. Davis will receive her honorary fellowship on March 18, 2012, at the Convocation Ceremony during ACHE’s 55th Congress on Healthcare Leadership in Chicago.

Join a Long-Term Care Policy Seminar

We invite you to join the AcademyHealth Long-Term Care Interest Group Policy Seminar, sponsored by The Commonwealth Fund, on February 15, 2012. The seminar, held in conjunction with the National Health Policy Conference, will focus on states’ efforts to rebalance long-term care supports and services toward residents living in the community. Chuck Milligan, J.D., M.P.H., deputy secretary of health care financing, Maryland Department of Health and Mental Hygiene, will present on this issue and the implications of the Affordable Care Act. To learn more and register, visit

Join a Webinar on the Effects of Medical Homes

Melinda Abrams, M.S., vice president and director of the Patient-Centered Coordinated Care Program at The Commonwealth Fund, will moderate a webinar on January 24, 2:00 p.m.–3:00 p.m., EST, examining how medical homes affect key outcomes. Debbie Peikes, M.P.A., Ph.D., senior researcher at Mathematica Policy Research and visiting lecturer at Princeton University's Woodrow Wilson School, will present the latest research on this topic. To learn more and to register, visit

2012–13 Harkness Fellowships Open to Applicants from Canada

Applications for the 2012–13 Harkness Fellowships remain open to individuals from Canada until February 14, 2012. 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. Note that the application process for Australia, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom is now closed.

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