The Fund's total programmatic spending over the five-year period 2006–10 is expected to be $158.8 million. Of that amount, it is anticipated that 65 percent, or $102.7 million, will be spent as grants, allocated across program areas as follows: 49 percent to promoting a high performance health system; 32 percent to addressing the health care needs of special populations; 13 percent to international health policy and practice; and 6 percent to communications and other continuing programs. The foundation expects to spend approximately 7 percent of its extramural program budget on surveys, which have proven to be useful in informing policy debates and developing programs. Reflecting the foundation's value-added approach to grantmaking, 35 percent of the total budget will be devoted to intramural units engaged in research, program development, and management; collaborations with grantees; and dissemination. This allocation includes $10.3 million to communicate the results of Fund-sponsored work and funds to operate programs directly managed by the foundation.

In all its work, the Fund seeks particularly to target issues that affect vulnerable populations. It also aims to achieve a balance between information-generating and action-oriented activities, and between public- and private-sector work. Other concrete objectives that help guide the foundation's grantmaking strategy include: keeping its doors open to new talent, working in partnership with other funders, being receptive to new ideas, undertaking appropriate risks, and contributing to the resolution of health care problems in its home base, New York City, while pursuing a national and international agenda.

The Fund regularly reviews its major programs and activities to assess their effectiveness and reexamine their strategies. At its April 2006 Retreat, the Board of Directors closely examined the work of the Picker/Commonwealth Program on Quality of Care for Frail Elders, assisted by an external review by Health Policy Alternatives, Inc., led by Michael Hash. The external reviewers concluded that the program, through its support for action-oriented policies and projects, is having a positive impact as it draws attention to practical approaches for improving nursing home quality and bringing about culture change in favor of resident-centered care. The reviewers reported that a consensus exists among experts that the Fund's investment in this area is critical and should be continued; furthermore, they noted that those most familiar with the field of nursing home quality and culture change stress the uniqueness of the foundation's contributions in this area.