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Health Care Delivery System Reform

Health care in the United States is beset with a host of long-standing problems, from rising costs and fragmented care delivery to uneven quality 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 quality, equity, health outcomes, and cost-effectiveness. By encouraging health care providers to offer their patients the right care at the right time, a switch to value-based payment also will encourage needed innovation in care delivery.

For a number of reasons, previous efforts to transform health care delivery and payment have generally fallen short of their goal to substantially reduce health care spending while improving quality and outcomes. In some cases, incentives were misaligned; in others, the attempts were short-lived or incomplete.

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.

Strengthening primary health care. Primary health care is the foundation of a high-performing health system. There is a great deal of evidence showing that high-quality primary care — comprehensive, coordinated, and continuous — 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 residents of rural areas, this level of primary care is simply not available, largely because of decades of underinvestment and missing incentives.

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 comprehensive, team-based care that addresses behavioral health and social needs as well as technologies that help providers meet patients where they are, including in their homes and communities.

Program Contact:

Corinne Lewis, Program Officer, Delivery System Reform

2022 Program Funding Priorities

  • Policy solutions to improve value-based payment, particularly to advance equity, in the Medicare and Medicaid programs 

  • Research examining the impact of primary care payment reform and compensation needed to improve primary care access and quality 

  • Models of primary care that integrate behavioral health and social services 

Our Experts

Corinne Lewis

Program Officer, Delivery System Reform

Celli Horstman

Senior Research Associate, Delivery System Reform

Alexandra Bryan

Program Assistant, Delivery System Reform