Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System

The Commonwealth Fund is a private foundation with a commitment to promoting a high performance health system that achieves better access, improved quality and greater efficiency, particularly for the most vulnerable populations. Substantive areas of expertise, grant making and literature contributions include health insurance coverage, payment and delivery system reform, international health policy as well as health reform implementation. The Confronting Costs report is an important component of the work of the Commission on a High Performance Health System and the Commonwealth Fund.

Objective: To propose a set of policy options designed to both stabilize health spending and target spending to ensure access to care and improved health outcomes. The report endorses the goal of holding future growth in total health spending to a rate no greater than gross domestic product.

Process: Deliberations by Commissioners (see roster) at regular meetings during 2011 and 2012. General recommendations developed by consensus, with additional illustrative detail developed to enable estimates of potential savings in relation to the baseline.

Methodology: Estimates of potential savings of policies in each of three categories—provider payment reform, encouraging high-value choices, improved health care markets— developed by Actuarial Research Corporation (see technical report), based on policy specifications developed by Commission staff and evidence of potential impact from the literature.

Total savings: Potential systemwide savings of $2.004 trillion from 2014 through 2023; federal government, $1.036 trillion; state and local government, $242 billion; private employers, $189 billion; households, $537 billion.

Other related work:

For additional recommendations from the Commission, please see:

Commonwealth Fund Commission on a High Performance Health System, The Path to a High Performance U.S. Health System (New York: The Commonwealth Fund, February 2009)

For more detailed description of policies in this report, please see:

Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System, The Commonwealth Fund Commission on a High Performance Health System, February 2013.

S. Guterman, M.A. Zezza, and C. Schoen, "Paying for Value: Replacing Medicare's Sustainable Growth Rate Formula with Incentives to Improve Care," Commonwealth Fund Issue Brief, March 2013.

K. Davis, C. Schoen, and S. Guterman, "Medicare Essential: A Policy Proposal to Enhance Benefits, Improve Care, and Lower Health System Costs," Health Affairs 32(5):900-909.

Commission Members

David Blumenthal, M.D., M.P.P., Chair of the Commission and President, The Commonwealth Fund

Maureen Bisognano, M.Sc., President and Chief Executive Officer, Institute for Healthcare Improvement

Sandra Bruce, M.S., President and Chief Executive Officer, Resurrection Health Care

Christine K. Cassel, M.D., President and Chief Executive Officer, American Board of Internal Medicine and ABIM Foundation

Michael Chernew, Ph.D., Professor, Department of Health Care Policy, Harvard Medical School

John M. Colmers, M.P.H., Vice President, Health Care Transformation and Strategic Planning, Johns Hopkins Medicine

Patricia Gabow, M.D., Chief Executive Officer, Denver Health

George C. Halvorson, Chairman and Chief Executive Officer, Kaiser Foundation Health Plan Inc.

Jon M. Kingsdale, Ph.D., Managing Director, Wakely Consulting Group

Gregory P. Poulsen, M.B.A. , Senior Vice President, Intermountain Health Care

Neil R. Powe, M.D., M.P.H., M.B.A., Chief, Medical Services, San Francisco General Hospital, Constance B. Wofsy Distinguished Professor and Vice-Chair of Medicine, University of California, San Francisco

Louise Y. Probst, R.N., M.B.A., Executive Director, St. Louis Area Business Health Coalition

MartĂ­n J. SepĂșlveda, M.D., FACP, IBM Fellow and Vice President, Integrated Health Services, IBM Corporation

David A. Share, M.D., M.P.H., Vice President, Value Partnerships, Blue Cross Blue Shield of Michigan

Glenn D. Steele, Jr., M.D., Ph.D., President and Chief Executive Officer, Geisinger Health System

Alan R. Weil, J.D., M.P.P., Executive Director, National Academy for State Health Policy

Stuart Guterman, Executive Director, Vice President for Payment and System Reform The Commonwealth Fund

Cathy Schoen, M.S., Research Director, Senior Vice President for Policy, Research, and Evaluation, The Commonwealth Fund

Rachel Nuzum, M.P.H., Senior Policy Director, Vice President for Federal and State Health Policy, The Commonwealth Fund