Ensuring properly coordinated care for patients treated by multiple health care providers in various settings is one of the priority areas identified by The Commonwealth Fund's Commission on a High Performance Health System. Under a grant from the Fund, researchers at the University of Colorado Health Sciences Center are testing the Care Transitions Measure, a new patient survey designed to pinpoint care coordination problems that occur when elderly patients are transferred from one health care setting to another. In the photo, a patient at St. Joseph's Hospital in Bellingham, Wash., receives guidance in filling out the questionnaire.

Photo: Peter Yates/Redux Plus




President's Message
Aiming High: Targets for the U.S. Health System
1. Long, Healthy, and Productive Lives
2. The Right Care
3. Coordinated Care over Time
4. Safe Care
5. Patient-Centered Care
6. Efficient, High-Value Care
7. Universal Participation
8. Affordable Care
9. Equitable Care
10. Knowledge and Capacity to Improve Performance

Policy Options for Improving Health System Performance

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oundations, historically, have responded to voids in public policy by supporting commissions to investigate the state of affairs and chart a course for change. The Flexner Commission, sponsored by the Carnegie Foundation for the Advancement of Teaching, transformed the quality of medical education with its 1910 report. The Committee on the Cost of Medical Care, sponsored by the Milbank Memorial Fund, the Rockefeller Foundation, and the Carnegie Corporation, issued a report in 1932 that was instrumental in the formation of Blue Cross and the financing of health services through prepayment. The Commission on Hospital Care, funded by The Commonwealth Fund, the W. K. Kellogg Foundation, and the National Foundation on Infantile Paralysis in 1942, was pivotal to the enactment of the 1946 Hill-Burton Act, which helped build and modernize the nation's system of hospitals.(1)
Feeling that the time is again ripe for foundation leadership, The Commonwealth Fund has established the Commission on a High Performance Health System. The Commission's goal is to move the nation toward a health care system that provides better access, higher quality, and greater efficiency, with particular focus on the most vulnerable members of our society. The specific objectives of the Commission are to define the characteristics of a high performance health system; identify and analyze promising approaches being used across the country and around the world; set realistic benchmarks and targets for tracking change over time; and recommend immediate and long-term practical steps and policy measures. The coming year will be devoted to a fact-finding process and the release of a national scorecard on the performance of the U.S. health system.

TEN PRIORITY AREAS
The Commission has just begun its work, yet it has already identified ten priorities for its own deliberations-and, ultimately, for a health system aligned to achieve the goal of high performance. Survey results, policy research, and the promising approaches of innovators show that these are areas of great concern, where positive change could make a real difference to patients, payers, and the future of the system itself.
In short, a high performance health system would be organized around ten core values:
1.Long, healthy, and productive lives.
2.The right care.
3.Coordinated care over time.
4.Safe care.
5.Patient-centered care.
6.Efficient, high-value care.
7.Universal participation.
8.Affordable care.
9.Equitable care.
10.Knowledge and capacity to improve performance.
The following sections explain why each area is important and action is urgently needed.
 
 
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Karen Davis
President