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Jan 24, 2024

Message from the President: Navigating a Sea of Change in Health Care

By Joseph R. Betancourt, M.D., M.P.H.

The health care landscape in 2023 was one of significant shifts with a common theme: incremental progress, paired with loss and anxiety.

North Carolina at long last expanded Medicaid eligibility, providing critical coverage to thousands of residents, and enrollment in the Affordable Care Act’s marketplaces grew to a record level. At the same time, millions of Americans, including an unacceptable number of children, lost their coverage because of Medicaid “redeterminations” — the unwinding of policies put into place during the pandemic.

Medicare’s first-ever foray into drug price negotiations under Part D marked a crucial step in the evolution of pharmaceutical pricing in the United States. Still, prescription drug costs — especially for promising new therapies like Ozempic — continued to soar.

Enrollment in Medicare Advantage plans continued to expand. While these private plans offer seniors additional services, they also raise concerns about government overpayment and questionable insurer practices.

Primary care, once the stable foundation of our health care system, found itself in a precarious position, like a worsening patient moving from the hospital bed to the ICU. Declining access to primary care, coupled with workforce shortages, has made the condition — and prognosis — critical.

The behavioral health crisis finally received long-needed attention and resources, yet especially among young people, it showed no signs of abating. And New York City, like much of the U.S., experienced a day straight out of an apocalyptic sci-fi movie when wildfire smoke drifted in from Canada, providing a stark reminder that climate change is real and worsening.

Private equity in health care slowly moved from the shadows to the spotlight, raising new questions about whether “value” is really aligned with patients’ well-being.

Despite the progress we’ve made on getting people insured, it became crystal-clear that coverage doesn’t equal meaningful access to care. If people can’t navigate the health care system — and, to make matters worse, can’t afford all the additional and increasing costs they seem to be incurring despite having insurance — then yes, Houston, we have a problem.

Finally, and sadly, the persistence of high Black infant mortality rates in the U.S., now approaching those of some developing nations, highlighted the woeful health disparities our country faces. Despite spending the most on health care of any wealthy nation, Americans continue to get shortchanged when it comes to the return on that investment.

A Year of Impact at the Commonwealth Fund

Navigating this sea of change, the Commonwealth Fund remained guided by a clear vision and an unrelenting drive to make a difference. Our dedicated team of experts remained at the forefront of health care policy and practice, actively contributing to critical debates, helping to frame pivotal issues, and offering actionable models and solutions. We produced insightful, impactful research and analysis, and remain a trusted source for federal and state policymakers and legislators, as well as health care leaders nationally and internationally. As a team, our accomplishments this year were manifold:

  • We continued to build the evidence base and support activities around Medicaid expansion and welcomed North Carolina’s decision to join the ranks of expansion states.
  • On the Medicare front, new Fund research raised concerns about whether financial incentives are influencing the advice that insurance brokers and agents provide, rather than what’s in the beneficiary’s best interest. These findings shaped new Medicare rules to protect people when selecting Medicare Advantage plans.
  • Our efforts in the area of health care cost control significantly informed discourse on pharmaceutical pricing — contributing to the development of policies included in the Inflation Reduction Act — as well as on Medicare drug negotiations.
  • Through development of new evidence and policy analysis, we informed the Center for Medicare and Medicaid Innovation’s new strategy on primary care.
  • By surveying people on the affordability of health care, the Fund shed light on the pressing issue of access to meaningful health care coverage.
  • Our work focused on health equity, particularly reducing Black maternal mortality, captured the attention of both national media and federal policymakers.
  • Our cross-national surveys provided critical insights into the crisis facing the clinician workforce globally and its impact on the quality of patient care.
  • The Fund’s work on climate change, particularly our partnership with the Bipartisan Policy Center and our participation in White House roundtables, helped advance conversations about the role of health care systems in reducing carbon emissions.
  • In the area of behavioral health, grantee and staff activities informed federal efforts to expand equitable access to mental health and substance use treatment services through changes in the Medicare and Medicaid physician fee schedules.
  • In public health, we documented COVID-19’s impact on political polarization around a once-bipartisan issue and identified ways our nation can be better prepared to ensure the health of the American public.
  • Our fellowships in minority health policy and health equity leadership, one based at Harvard and the other at Yale, continue to educate and inspire young clinician–leaders across the U.S. The two programs combined have 11 fellows and 173 alumni. Meanwhile, our long-running Harkness Fellowships, an international program focused on health care policy and practice, boasts a network of nearly 300 alumni; among its 12 current fellows is the first one from Singapore.
  • The Fund supported education for more than 20 health reporting fellows, as well as for health journalism nationwide, resulting in nearly 700 stories on topics like mental health care in Washington state, Black maternal health in Iowa, and reproductive health care in the Gulf South.

A year of accomplishments, to be sure. But while there’s so much to be proud of, I’m most proud of our team at the Commonwealth Fund. They are our most important asset, and their commitment to achieving impact toward our mission of affordable, equitable, high-quality care for all is awe-inspiring.

Embracing Change and Leadership

Last November, we bid goodbye to Dr. Michael Drake after 14 years on the Commonwealth Fund’s board of directors and eight years as chair. Dr. Drake, president of the University of California system, was a colleague and friend of mine for over 20 years, an important partner to me over the past year, and an inspiring leader of the Fund, including through the COVID-19 pandemic. We are sad to see him go but deeply appreciative of his service. He will always be part of our family.

On a historic note, Dr. Peggy Hamburg, an internationally recognized authority in medicine and public health and copresident of the InterAcademy Partnership at the Nuclear Threat Initiative, assumed the role of Commonwealth Fund board chair — the first female chair in the Fund’s history. This year, we also have the pleasure of welcoming one of the nation’s most influential health care leaders, Dr. Jaewon Ryu, president and CEO of Geisinger. We are excited about how this board will help lead us into the future.

Learning and Leading

In my inaugural year as Commonwealth Fund president, I embarked on a journey characterized by listening, learning, and values-based leadership. My mission was clear: to lead with unwavering passion while imbuing every action with humility and upholding the Fund’s commitment to excellence. This year was about immersing myself in the Fund’s storied history, drawing on the wealth of knowledge of our board and team and honing our expertise across research programs and philanthropic endeavors. Listen, learn, lead was my mantra. It was truly an amazing year for me.

In many ways, 2023 was just the tip of the iceberg, given how contentious and unpredictable the 2024 election year promises to be. We are already preparing for how the Commonwealth Fund can best contribute to what undoubtedly will be another year of disruption and transformation in health care and health policy. In addition to our targeted programmatic work, our teams will focus on primary care, the health care workforce, and the commercial drivers of health care, and we are exploring what our role might be in the rapidly evolving field of artificial intelligence. We will stay the course with our important work on coverage — including Medicare, Medicaid, and commercial insurance — as well as climate change and behavioral health. Health equity will continue to be at the core of all our work, and, beyond our programmatic efforts, we will ensure equity is embedded throughout the Fund. Our international work, so foundational to who we are, gets better by the year — prompting us to consider how we can make an impact more locally, in New York, as well. In the months ahead, being deliberate and planful, yet also nimble, will be critical.

I begin the year with the same feeling I have had every day over this past year: deep gratitude for this opportunity, excitement about the future, and a profound sense of responsibility to ensure the Fund is ever more impactful. We will be ready for 2024, and we will adapt to all the new challenges it will bring. We hope you will join us.