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Health Care Delivery System Reform

Health care in the United States is beset with a host of longstanding problems, from high and rising costs to fragmented care delivery, uneven quality of care, and pervasive inequities.

The Commonwealth Fund’s Health Care Delivery System Reform program seeks to address these challenges by advancing value-based care. To create a more affordable, cost-effective, and equitable delivery system, the program supports efforts in two key areas.

Accelerating effective value-based payment. In the U.S., fee-for-service care predominates, with payment tied to the volume of services provided rather than the overall value of care patients receive. Holding health care organizations accountable for the value they deliver can incentivize improvements in health care quality, equity, and cost-effectiveness and in health outcomes. By encouraging providers to offer their patients the right care at the right time, moving to value-based payment also will spark needed innovation in care delivery.

Informed by lessons from past initiatives, the Commonwealth Fund seeks to help federal and state health care programs design better models of value-based payment. The Fund is exploring ways to incorporate racial equity considerations into program design and evaluation; reform payment to address both the medical and social drivers of health; improve risk adjustment; and spread value-based payment throughout the U.S. health system by identifying and addressing barriers to participation.

Reforming primary health care payment. Primary health care is the foundation of a high-performing health system. There is a great deal of evidence showing that comprehensive, coordinated, and continuous primary care is associated with better health outcomes, lower costs, and greater equity.

But for many people in the United States, especially those with complex health and social needs or low income, people of color, and rural residents, high-quality primary care is simply not available. Decades of underinvestment and issues related to how we pay for care are two major reasons.

The Commonwealth Fund aims to strengthen and modernize primary health care, making it more accessible and better attuned to patients’ needs and preferences. Our work in this area includes promoting primary care payment reform in Medicare and Medicaid and exploring opportunities to engage safety-net providers, particularly federally qualified health centers, in payment reform.

Program Contact:

Corinne Lewis, Program Officer, Delivery System Reform

2023 Program Funding Priorities

  • Examining policy options for accelerating value-based payment, particularly those that advance equity and address participation barriers

  • Assessing primary care payment reform models in Medicare, Medicaid, and the safety net

  • Investigating the impact of primary care payment reform and the compensation required for more equitable access and improved quality

Our Experts

Corinne Lewis

Program Officer, Delivery System Reform

Celli Horstman

Senior Research Associate, Delivery System Reform

Alexandra Bryan

Senior Program Assistant, Delivery System Reform