The 90th anniversary of The Commonwealth Fund serves as an occasion to reflect on the foundation's remarkable history and its role in supporting research and innovative practices that have driven improvements in the U.S. health care system for nearly a century. Anna Harkness founded The Commonwealth Fund in 1918 with the mandate to "do something for the welfare of mankind." Her son, Edward Stephen Harkness, was the Fund's first president, and he shared his mother's commitment to building a responsive and socially concerned philanthropy. The Fund's work has always focused on the challenges vulnerable populations face in receiving high-quality, safe, compassionate, coordinated, and efficiently delivered care.
Today, the foundation—along with the Commission on a High Performance Health System, which was established by the Fund in 2005—is a leading voice for reforming the U.S. health care system to achieve coverage for all, at reasonable cost, and with services that are coordinated, patient-centered, and efficiently delivered. Since its inception, the Fund has sought to bring the international experience to bear in efforts to achieve better value for the U.S. health care dollar. The foundation combines grantmaking with intramural research and communications to help inform the health care debate and improve the performance of health care delivery.
Advancing Public Health
In its early years, public health became a major focus of the foundation's philanthropy. In the 1920s, the new field of child guidance was developed and informed by The Commonwealth Fund to provide mental health services for children. The Fund supported the first fellowships in child psychiatry and established children's community clinics. Model public health clinics established by the Fund not only set standards for public health departments across the United States, but also spurred initiatives to reduce maternal and infant mortality.
In the 1930s, the rural hospital program helped to improve services in remote areas, paving the way for the passage of the Hospital Survey and Construction (Hill-Burton) Act of 1946 that brought federal funds to build and improve community hospitals. A 1933 Commonwealth Fund publication, A Standard Classified Nomenclature of Disease, brought a common terminology to medicine, allowing hospitals to more easily compile statistics and exchange information about the prevention and treatment of disease.
The Fund also advanced medical research in significant ways. Dr. George Papanicolaou's Fund-supported research in the 1940s led to the highly effective technique for detecting cervical cancer that became known as the Pap test. In the next decade, Fund support for research that refined cardiac catheterization as a diagnostic treatment for pulmonary heart disease resulted in the 1956 Nobel Prize for the physicians.
The Fund has similarly supported medical education over the years. The foundation was an early advocate of minority medical education though scholarships and grants, as well as funding for minority medical schools. In the 1960s, the Fund supported the first training programs for physician assistants, nurse practitioners, and nurse midwives—establishing health professions that play a critical role in health care today.
In the 1970s, the Fund fostered the hospice care movement, pioneering sensitive care and support for the dying and their families through its support of the first modern hospice program, Hospice, Inc., in Connecticut. In the 1980s, it supported advanced nurse training, including business administration, to prepare nurses for positions of leadership responsibility.
Moving Toward a High Performance Health System
More recently, The Commonwealth Fund has developed pragmatic strategies for expanding health insurance to all. These approaches are designed to build on parts of our current system that work well⁸Medicare, the State Children's Health Insurance Program, employer-based coverage, and the more recently established Massachusetts health insurance connector, which enables residents to purchase affordable private or public coverage. Ideas proposed in Fund staff-authored Health Affairs articles, such as "Creating Consensus on Coverage Choices" and "Building Blocks for Reform: Achieving Universal Coverage with Private and Public Group Health Insurance," have been embraced and advanced by state and national policy leaders, including president-elect Barack Obama. Such publications spell out specific changes needed to improve health system performance and bring about universal coverage.
Through its surveys and analyses, the foundation and its Program on the Future of Health Insurance have led the field in defining gaps in insurance coverage and the concept of underinsurance. The Fund has also emerged as an evidence-based voice for preserving the role of employer-sponsored health insurance.
The Fund's Program on Medicare's Future provided original analysis and research that eventually helped inform the Medicare Part D prescription drug benefit. More recent Fund-supported Medicare research has looked at ways to protect access to care for vulnerable beneficiaries and focused on the overpayment of Medicare Advantage plans and their record of performance.
The Commonwealth Fund's Program on Health Care Quality Improvement and Efficiency has helped to promote the development and adoption of health care quality and efficiency measures and enhance the capacity of health care organizations to provide better care more efficiently. The program has been a leading force in payment reform, supporting the development, testing, and evaluation of new payment approaches that align financial incentives of hospitals and physicians with quality and efficiency.
The Picker/Commonwealth Patient-Centered Care Program of the 1990s succeeded in making the patient experience a focus of medical care through the development of hospital patient surveys. Today, the Picker/Commonwealth Fund Program on Quality of Care for Frail Elders aims to transform the nation's nursing homes and other long-term care facilities into resident-centered organizations that are good places to live and work and are capable of providing the highest-quality care.
The Patient-Centered Primary Care Program was launched in 2005 to encourage the redesign of primary care practices and health care systems around the needs of the patient. It is now supporting a number of evaluations of the medical home model.
The Fund's Child Development and Preventive Care program has successfully supported states in improving the delivery of early child development services and building the capacity of Medicaid programs to deliver care that supports healthy mental development. As a result of the Fund's work over the last decade, screening and referrals for developmental problems are now standard features of modern pediatric practice.
The Fund's new state scorecard on health system performance and the State Quality Leadership Institute have helped trigger state policy officials' interest in policy actions to improve quality and enhance value. Fund-sponsored evaluations of health reform in Massachusetts and Maine are now informing the national debate.
Commonwealth Fund-supported work has improved data collection and reporting on health disparities. It has also helped define and develop standards for cultural competence. Today, the Program on Health Care Disparities aims to improve the performance of minority serving safety-net hospitals and ambulatory care providers. In addition, the Commonwealth/Harvard Minority Health Policy Fellowships, with 80 graduates, is producing a cadre of future leaders committed to addressing disparities in health care.
On the international level, the Fund's comparative data on health system performance has stimulated high-level thinking about methods to improve policies and practices in the U.S. and other industrialized countries. And the Harkness Fellowship in Health Policy has more than 100 international alumni who continue to serve as forces for health system change in their home countries.
Finally, through its Commission on a High Performance Health System, the Fund is supporting strategies for making the U.S. health system the best it can be, learning from best practices and outstanding performance within the U.S. and around the world. Its national and state scorecards are spurring improvements in health care providers and policy.
In this time of crisis and change, The Commonwealth Fund plans to continue its great tradition of service by supporting research and finding solutions that will move the U.S. ever closer to a high performance health system.
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Written with the assistance of Christine Haran