Funder’s Forum: The Commonwealth Fund A conversation with David Blumenthal

The Commonwealth Fund
August 2014

The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. The fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. Foundation Center asked David Blumenthal, M.D., its president:

Question How did the Commonwealth Fund arrive at its current funding strategies and what strategies have been helpful in pursuing its program areas?

“The Commonwealth Fund has a 95-year history of promoting and supporting change in the U.S. health care system — change that has had real and positive impact on the lives of millions of people, whether through improved access to primary care and hospital services, new treatments and therapies, or improvements in insurance coverage and care delivery. The health system has entered a period of tumultuous change, caused in part by the Affordable Care Act and other recent policy initiatives, but also by a range of secular trends in our nation and the world. Because of these momentous developments, when I took over as the fund's president in January 2013, I knew some things at the Commonwealth Fund would need to evolve.

“We embarked on a process we called a 'strategic refresh.' To begin with, we started from the assumption that the Commonwealth Fund's primary mission of promoting a high performing health system is sound. That mission resonated strongly with my values and experience; I had no desire to change it, nor did the staff.

“Given the fund's past success, we knew from the outset that we would not be undertaking a wholesale revision of the fund's portfolio. We did try, however, to examine in a rigorous, disciplined way the full range of opportunities facing the fund at this critical and transformative time in the history of our health care system. So in our new program focus, there are important elements of continuity but, also, areas of change.

“I brought my own unique experience to the refresh process. That experience is varied and overlaps in many ways with past leaders of the fund. But at least two things set me apart from my recent predecessors. One is that I have spent a good part of my professional life at the front lines of the health care delivery system — both as a physician and as a manager. This experience has sensitized me to the fact that decisions at the sharp end of health care — in the daily interactions and behaviors of providers and consumers of care — profoundly influence the overall performance of our nearly three trillion dollar system. These decisions obligate resources, match resources to need, and determine the effect of medical services on individual and population well-being.

“Another different experience I bring to the fund is my intense recent exposure to the world of health information technology. That exposure has convinced me that valid, timely information is foundational to providing high quality, efficient care and to effective policy and management. The decisions clinicians, patients, consumers, managers, and policymakers make are only as good as the information at their disposal at the time they make critical choices.

“The process itself revolved around two intensive off-site days and an enormous amount of work to prepare for and glean the lessons of those two days of discussion and deliberation. To conserve resources and take advantage of our talented staff, we did most of the background work for the refresh internally at the fund. We prepared an environmental scan documenting the current problems of the health care system, and likely future trends. We reviewed the activities of other relevant philanthropies and federal agencies. I personally did a 'listening tour' in which I spoke with nearly 30 health care opinion leaders and groups about what the fund should do next.

“We also prepared a 'logic model' of the health care system, which was designed to provide a common framework for thinking about how the fund could pick its programs for maximum positive effect. Though relatively simple, it helped to ensure that we thought rigorously and comprehensively about the opportunities facing the fund at this time, the likely impact of each factor on health system performance, whether the fund had the ability and resources to work effectively in that area, how the activity accorded with fund traditions and values, and whether other funders were already working in this area.

“Throughout the refresh process, we accepted and embraced the traditional methods the fund has used to promote constructive change in the nation's health care system. These methods have consisted first and foremost of the fund's ability to develop trusted, relevant information, and to communicate that information effectively to private managers and public decision makers when and where they are ready to receive it.

“To be more explicit, our work going forward will focus on four programmatic areas, some familiar and some new — Health Care Coverage and Access; Health Care Delivery System Reform; International Health Policy and Practice Innovations; and Breakthrough Health Care Opportunities. And those programs will be supported and complemented by a set of special initiatives: Advancing Medicare, Controlling Health Costs, Tracking Health System Performance, and Engaging Federal and State Health Policymakers.

“We think it is important to engage all the key health care stakeholders in our work: not only consumers and health care providers, but also others that can affect leverage points for change: policymakers, employers, entrepreneurs, software developers, insurers, health system leaders, advocates, and so many more. But the cornerstones of the fund's work, as always, are scientific integrity, a commitment to improving the equity, efficiency, and quality of care, a special concern for the nation's most vulnerable populations, and a focus on practical, constructive change.”

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The Commonwealth Fund