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Archived: Health System Performance Assessment and Tracking

This program is now closed.

To advance its goal of a high performance U.S. health care system, The Commonwealth Fund gathers and disseminates evidence of excellence in health care from across the country and the world. This work is intended to show what is possible to achieve, and to stimulate health care providers, policymakers, and stakeholders to take action to improve performance in all facets of care. 

The Fund’s capacity for Health System Performance Assessment and Tracking enables it to:

  • track and compare health system performance, by identifying benchmarks for patient care experiences, health outcomes, and cost that states, health care providers, and others can use to set improvement targets
  • assess trends in health insurance coverage, affordability, access to care, and patient-reported quality of care
  • monitor public- and private-sector actions to transform health care delivery, including payment innovations, health information technology adoption, and the organization of care.

The Fund’s Health System Performance Assessment and Tracking activities are closely coordinated with Fund initiatives in Delivery System Innovation and Improvement, Health Reform Policy, and International Health Policy and Innovation.

Health system performance scorecards. Since 2006, The Commonwealth Fund and its Commission on a High Performance Health System have tracked the performance of U.S. health care through a series of national, state, and, starting in 2012, local scorecards. The National Scorecard on U.S. Health System Performance (2006, 2008, and 2011), focuses on health care outcomes, quality, access, efficiency, and equity and compares U.S. average performance to benchmarks set within the U.S. and internationally. The State Scorecard on Health System Performance (2007 and 2009) assesses states’ performance on health care relative to achievable benchmarks for 38 indicators of access, quality, avoidable hospital use/costs, and health outcomes, and the potential gain if each state reached levels of performance achieved by leading state. The Scorecard on Local Health System Performance (2012) examines performance of 306 local areas across 43 indicators related to access, prevention and treatment, potentially avoidable hospital use and cost, and healthy lives. This scorecard enables comparison of performance within and across states. Profiles, that compare each area to benchmarks set by top performing communities, and data are available on an interactive map on the Fund Web site.

The State Scorecard on Long-Term Services and Supports (2011) assesses performance of nursing homes, home health agencies, and state programs across four dimensions: access and affordability, choice of setting and provider, quality of life and quality of care, and support for family caregivers.

The State Scorecard on Child Health System Performance (2011) examines states’ performance on 20 key indicators of children’s health care access, health system equity, affordability of care, prevention and treatment, and the potential to lead healthy lives. Nearly 7,500 hospital executives, quality improvement professionals, medical directors, and others use The Commonwealth Fund’s online resource for health care quality benchmarking,, to compare their organization’s performance against peers, learn from case studies of top performers, and access innovative improvement tools. With an array of custom benchmarks available, users can compare their organization’s performance to the leaders and to national and state averages.

Surveys. The Fund conducts a wide range of surveys, both in the United States and abroad, to monitor trends in health care access and affordability, the delivery of patient-centered coordinated care, and the spread of health information technology with information exchange in physician practices. Fund surveys also explore public views on health care matters, and assess the policy perspectives of health care leaders. Recent and ongoing surveys include:

  • Commonwealth Fund Biennial Health Insurance Survey (2001, 2003, 2005, 2007, 2010, 2012). Over the years, these surveys have produced a wealth of information about the extent and quality of health care coverage in the United States. Specific topics covered in past surveys include: the stability, affordability, and quality of adults’ health insurance coverage; cost-related difficulties in accessing care; experiences in the individual market; medical bill problems; and medical debt.
  • The Commonwealth Fund Health Insurance Tracking Surveys of U.S. Adults. This series of online longitudinal surveys tracks the effects of the Affordable Care Act over the next three years as it is implemented and establishes baseline measures prior to 2014, when the major provisions of the law go into effect. Throughout this transformational period in U.S. health care, these surveys will provide a flexible, policy-relevant survey tool to supplement the Fund’s long-standing national Biennial Health Insurance Survey.
  • Commonwealth Fund International Health Policy Survey (annual). Now including 11 industrialized countries, this rotating series of annual surveys explore such topics as health system performance; access, coordination, and responsiveness from the perspective of the general population; seriously or chronically ill adults; and primary care physicians. The 2012 survey focused on primary care physicians. Visit the Fund’s online International Health Policy Center for more information.
  • Commonwealth Fund Survey of Public Views of the U.S. Health Care System (2006, 2008, 2011). The public views survey assessed the public’s experiences and perspectives on the organization of the nation’s health care system and ways to improve patient care.
  • Commonwealth Fund Survey of Young Adults (2009). Young adults ages 19 to 29 are one of the largest uninsured segments of the population. This nationally representative survey found that nearly half have gone without insurance at some time during the year.
  • Commonwealth Fund National Survey of Federally Qualified Health Centers (2009). With the likely increase in demand for community
    health center services following enactment of health reform legislation, this survey explored these clinics’ ability to provide access to care, coordinate care across settings, engage in quality improvement and reporting, adopt and use health information technology, and serve as patient-centered medical homes.
  • Commonwealth Fund 2009 Survey of Clinic Patients in New Orleans. One of the many things Hurricane Katrina devastated when it hit New Orleans in 2005 was the city’s health care system. To find out how well community clinics were serving their high-need populations, The Commonwealth Fund conducted interviews with patients at 27 clinics in 2009. The findings were encouraging.

To access all Fund surveys, visit Surveys at

Multinational comparisons of health system data. Comparing the health care system in the United States with the systems of other industrialized countries reveals striking differences in spending, availability and use of services, and health outcomes. Each year, the Fund produces a chartbook depicting key health data for the 30 member nations of the Organization for Economic Cooperation and Development (OECD), as well as analyses based on those data. Visit the Fund’s online International Health Policy Center for more information.

State Trends in Private Insurance Premium and Deductibles (2009, 2010, 2011, 2012). The Commonwealth Fund also produces an annual report that tracks employer-sponsored health insurance plan costs and benefits in each state. The report focuses on premiums, employee shares of premiums, and plan deductibles. The newest analysis, released in December 2012, covers the period 2003 to 2011. An accompanying data brief focuses on insurance cost trends in major metropolitan areas.