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New Agenda for a Changing Health System


The Commonwealth Fund has a 95-year history of promoting and supporting change in the U.S. health care system—change that has had real and positive impact on the lives of millions of people, whether through improved access to primary care and hospital services, new treatments and therapies, or improvements in insurance coverage and care delivery.

This is a humbling legacy for any aspiring new leader of The Commonwealth Fund. When I arrived in January, I understood that I was now the steward of a high-performing philanthropy and change agent. But I was also aware that to preserve this legacy, the Fund had to be exquisitely sensitive to its changing environment. It had to be true to its fundamental purposes and history, but also nimble and flexible in how it pursued those purposes.

The U.S. health care system has entered a period of tumultuous change, caused in part by the Affordable Care Act and other recent policy initiatives, but also by a range of secular trends in our nation and the world. Because of these momentous developments, I knew some things at The Commonwealth Fund would need to evolve. But as I said in an earlier blog post, change could not happen without deep study and reflection.

Today, we announced a revised direction for The Commonwealth Fund. The new focus is the result of eight months of staff work and dozens of conversations with outside experts—leaders in the worlds of policy, care delivery, academia, and philanthropy, to name just a few. It explicitly takes into account the rapidly changing environment that defines our health care system—shifting demography, rising costs, the ongoing implementation of the health reform law, the spread of information technology—and it offers a “next step” on the path toward high performance.

Though much will change, much will also be retained.

For starters, The Commonwealth Fund’s primary mission of promoting a high-performing health system will remain the foundation’s touchstone. My decision to come and lead the Fund was due in large part to how strongly that mission resonated with my values and experience. I had no desire to change it, nor did our Board of Directors or the rest of the Fund’s staff.

Another thing that will not change is how the Fund goes about promoting improvement in the nation’s health care system. These methods have consisted first and foremost of developing trusted, relevant information, and communicating that information effectively to private managers and public decision-makers when and where they are ready to receive it.

To be more explicit, our work going forward will focus on four programmatic areas, some familiar and some new—Health Care Coverage and Access; Health Care Delivery System Reform; International Health Policy and Practice Innovations; and Breakthrough Health Care Opportunities. And those programs will be supported and complemented by a set of special initiatives: Advancing Medicare, Controlling Health Costs, Tracking Health System Performance, and Engaging Federal and State Health Policymakers.

You can read more about our new direction here, but in this post I wanted to share some personal reflections. I brought to this planning process my own perspective and experience as a frontline physician and teacher of young doctors, as well as my tenure as national coordinator for health information technology. My work as a primary care physician and teacher has sensitized me to the fact that decisions at the “sharp end” of health care—in the daily interactions and behaviors of providers and consumers of care—profoundly influence the overall performance of our nearly $3 trillion system. How could it be otherwise? These decisions obligate resources, match resources to need, and determine the effect of medical services on individual and population well-being.

My intense recent exposure to the world of health information technology has convinced me that valid, timely information is foundational to providing high-quality, efficient care and to effective policy and management. The decisions made by clinicians, patients, consumers, managers, and policymakers are only as good as the information they have at the time they make their choices.

These interactions, between patient/consumer and provider, sit at the center of all the influences (we sometimes call them levers) that The Commonwealth Fund or others might employ to improve the performance of our health care system. Those influences or levers create opportunities for constructive change.

And so, many of our programs will look for ways to engage consumers and health care providers in improving care, but they will also endeavor to draw in all the other types of stakeholders that can affect leverage points for change: policymakers, employers, entrepreneurs, software developers, insurers, health system leaders, advocates, and so many more.

As The Commonwealth Fund approaches a century of work in enhancing the common good, I feel confident that, with the contributions of a talented staff and the guidance of our dedicated Board, we will continue to help move the nation toward a better, more affordable, and more equitable health care system for all. I look forward to engaging with all of you to help bring that vision to reality.

Publication Details



D. Blumenthal, A New Agenda for a Changing Health System, The Commonwealth Fund, September 2013.