Commonwealth Fund

The Commonwealth Fund

Basic facts
Location:| New York, New York
Type:| 501(c)(3)
Affiliation:| Nonpartisan
Top official:| David Blumenthal
Founder(s):| Anna Harkness
Year founded:| 1918
Employees:| 55
Website:| Official website
Budget
2015:| $32.3 million

## Contents

* 1 Mission
* 2 Background
* 3 Finances
* 4 Board members
* 5 Studies
* 5.1 Aiming Higher
* 5.2 Mirror, Mirror on the Wall
* 5.2.1 Criticism
* 6 See also
* 7 External links
* 8 Footnotes

The Commonwealth Fund is a nonpartisan, nonprofit 501(c)(3) organization that advocates a "high-performing healthcare system," with a focus on improving healthcare for low-income and marginalized individuals. As part of its work, the organization releases an annual report that scores states on the performance of their healthcare systems and makes updates to a report comparing the United States' healthcare system as a whole to those of other countries. The Commonwealth Fund also financed research for the development of the Affordable Care Act. Its 2015 expenditures amounted to about $32.3 million.

## Mission[edit]

The mission of the Commonwealth Fund is written on its website as follows:

“  | The mission of The Commonwealth Fund is 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.[1] | ”

|
|

—The Commonwealth Fund[2]

The Commonwealth Fund's New York City headquarters

## Background[edit]

The Commonwealth Fund was founded in 1918 by Anna Harkness with an endowment of $10 million. Her idea was to establish a philanthropic organization that would "do something for the welfare of mankind." Her son, Edward Harkness, served as the foundation's first president.[3]

The organization focuses on healthcare and "has always focused particularly on the challenges vulnerable populations face in receiving high-quality, safe, compassionate, coordinated, and efficiently delivered care," according to its website. Its work has ranged from providing funding for the construction of rural hospitals to funding the establishment of medical schools. In addition, according to its website, the Commonwealth Fund "underwrote a considerable part of the research underlying the development of the reforms in the Patient Protection and Affordable Care Act of 2010," also known as Obamacare. The foundation also releases publications and research reports, including its annual International Health Policy Survey and its annual Scorecard on State Health System Performance.[3]

## Finances[edit]

The following is a breakdown of the Commonwealth Fund's finances from its 2015 audited financial statement. Between 2014 and 2015, the organization earned about $37.2 million from investments, while it spent about $32.3 million, yielding growth in net assets from $734.1 million to nearly $739 million.[4]

Finances of the Commonwealth Fund, 2014 and 2015

Category  | 2015  | 2014
Total assets | $768,757,200 | $762,520,636
Total liabilities | $29,782,815 | $28,424,005
Investment gains and revenues | $37,227,974 | $92,047,038
Total expenses | $32,350,220 | $30,777,222
Net assets | $738,974,385 | $734,096,631
Note: The "net assets" amount equals total assets minus total liabilities. For 2015, "investment gains and revenues" and "total expenses" represent changes between 2014 and 2015 net assets.

## Board members[edit]

* * *

* * *

Healthcare policy in the U.S.
Obamacare overview
Obamacare lawsuits
Medicare and Medicaid
Healthcare statistics

Obamacare glossary • Effect of Obamacare • Centers for Medicare and Medicaid Services

As of January 2016, the following individuals were listed on the Commonwealth Fund's website as its board of directors:[5]

* Benjamin K. Chu, M.D., Chairman
* Cristine Russell, Vice Chairman
* Maureen Bisognano
* David Blumenthal, M.D.
* Mitchell J. Blutt, M.D.
* Sheila P. Burke, R.N., M.P.A. (FAAN)
* Michael V. Drake, M.D.
* Margaret A. Hamburg, M.D.
* Kathryn D. Haslanger
* Jane E. Henney, M.D.
* Robert C. Pozen
* Mark D. Smith, M.D.
* Simon Stevens
* William Y. Yun

## Studies[edit]

### Aiming Higher[edit]

The Commonwealth Fund releases an annual publication entitled Aiming Higher: Results from a Scorecard on State Health System Performance. The report scores states based on the performance of their healthcare systems with the goal of helping "policymakers, health system leaders, and the public identify opportunities and set goals for improvement."[6]

The scorecard measures values for 42 indicators that are grouped into five categories: access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and equity. Examples of indicators include the percentages of uninsured adults and children, the percentage of adults with a usual source of medical care, the number of Medicare 30-day hospital readmissions, and the rate of infant mortality. States are ranked on each indicator. Rankings are then averaged for all indicators within one of the five groupings, and those five rankings are averaged for the final score. Each indicator and grouping are weighted equally.[6][7]

The 2015 edition of the report was the first one to attempt to measure the effect of the Affordable Care Act on state healthcare systems. The organization found that "[o]n most of the 42 indicators, more states improved than worsened." The report stated that the most noticeable influence on this change was the Affordable Care Act. To continue improvement, it recommended that states expand public health initiatives, purchase insurance for low-income individuals that qualify for Medicaid, invest in health information technology, and establish new regulations and rules for the healthcare and insurance industries.[7]

The tables below display the state-by-state results of the 2015 edition of Aiming Higher. The first table contains the overall ranking for each state, as well as the average ranking for each group of indicators and each state's 2014 ranking. The second tables shows the distribution of each state's indicators by quartile (from the top 20 percent to the bottom 20 percent) and their change over the time period between the 2015 edition and the 2014 edition. Click [show] on the tables to view the data. To read the full report, click here.

Commonwealth Fund state health system performance rankings, 2015

State  | 2015 scorecard ranks  | 2014 rank
Overall rank  | Access and affordability  | Prevention and treatment  | Avoidable use and cost  | Healthy lives  | Equity
Alabama | 47 | 32 | 37 | 46 | 46 | 42 | 46
Alaska | 32 | 44 | 37 | 10 | 32 | 29 | 31
Arizona | 33 | 43 | 47 | 10 | 29 | 24 | 36
Arkansas | 49 | 44 | 47 | 38 | 49 | 51 | 50
California | 23 | 30 | 37 | 14 | 7 | 22 | 26
Colorado | 8 | 26 | 9 | 5 | 2 | 11 | 12
Connecticut | 5 | 5 | 9 | 28 | 2 | 3 | 6
Delaware | 15 | 9 | 9 | 24 | 33 | 14 | 10
District of Columbia | 20 | 7 | 21 | 45 | 22 | 9 | 21
Florida | 37 | 40 | 37 | 33 | 22 | 31 | 41
Georgia | 46 | 41 | 45 | 28 | 39 | 45 | 45
Hawaii | 3 | 11 | 18 | 1 | 6 | 1 | 5
Idaho | 25 | 46 | 31 | 3 | 17 | 22 | 31
Illinois | 26 | 19 | 21 | 44 | 22 | 24 | 26
Indiana | 43 | 34 | 34 | 36 | 42 | 47 | 43
Iowa | 9 | 7 | 9 | 18 | 16 | 15 | 10
Kansas | 28 | 23 | 16 | 31 | 27 | 36 | 23
Kentucky | 40 | 28 | 20 | 49 | 44 | 45 | 42
Louisiana | 48 | 38 | 43 | 50 | 48 | 44 | 48
Maine | 11 | 16 | 1 | 21 | 29 | 15 | 7
Maryland | 18 | 5 | 14 | 42 | 20 | 13 | 17
Massachusetts | 4 | 1 | 2 | 31 | 4 | 2 | 2
Michigan | 31 | 15 | 16 | 38 | 38 | 31 | 26
Minnesota | 1 | 3 | 8 | 8 | 1 | 9 | 1
Mississippi | 51 | 48 | 47 | 51 | 51 | 49 | 51
Missouri | 36 | 33 | 21 | 38 | 40 | 28 | 34
Montana | 28 | 39 | 31 | 5 | 22 | 36 | 29
Nebraska | 13 | 23 | 13 | 14 | 14 | 20 | 17
Nevada | 43 | 50 | 51 | 18 | 36 | 39 | 46
New Hampshire | 5 | 9 | 4 | 18 | 7 | 5 | 2
New Jersey | 20 | 21 | 21 | 36 | 12 | 17 | 15
New Mexico | 33 | 46 | 45 | 10 | 34 | 20 | 36
New York | 13 | 14 | 28 | 26 | 13 | 5 | 19
North Carolina | 37 | 30 | 31 | 26 | 36 | 43 | 36
North Dakota | 26 | 25 | 19 | 22 | 27 | 36 | 14
Ohio | 33 | 16 | 21 | 38 | 41 | 41 | 31
Oklahoma | 50 | 48 | 44 | 46 | 46 | 49 | 49
Oregon | 15 | 28 | 36 | 2 | 14 | 11 | 24
Pennsylvania | 20 | 12 | 7 | 33 | 34 | 19 | 22
Rhode Island | 5 | 4 | 3 | 22 | 10 | 7 | 9
South Carolina | 40 | 41 | 28 | 24 | 43 | 48 | 36
South Dakota | 15 | 22 | 14 | 8 | 29 | 17 | 12
Tennessee | 43 | 34 | 37 | 42 | 44 | 39 | 40
Texas | 40 | 51 | 50 | 33 | 22 | 31 | 44
Utah | 18 | 36 | 28 | 5 | 4 | 24 | 19
Vermont | 1 | 2 | 4 | 13 | 9 | 3 | 2
Virginia | 23 | 19 | 21 | 28 | 20 | 24 | 24
Washington | 10 | 16 | 37 | 4 | 10 | 8 | 15
West Virginia | 39 | 26 | 21 | 48 | 50 | 31 | 34
Wisconsin | 11 | 13 | 4 | 14 | 18 | 29 | 7
Wyoming | 28 | 36 | 34 | 14 | 18 | 35 | 29

Distribution of rankings and change over time, 2015

State  | Number of indicators scored  | Top quartile  | 2nd quartile  | 3rd quartile  | Bottom quartile  | Indicators with trend data  | Number improved  | Number worsened  | Net change
Alabama | 41 | 4 | 4 | 12 | 21 | 35 | 7 | 5 | 2
Alaska | 39 | 9 | 11 | 5 | 14 | 34 | 11 | 5 | 6
Arizona | 42 | 6 | 12 | 12 | 12 | 36 | 12 | 3 | 9
Arkansas | 42 | 2 | 7 | 9 | 24 | 36 | 11 | 2 | 9
California | 42 | 16 | 9 | 12 | 5 | 36 | 11 | 2 | 9
Colorado | 42 | 19 | 16 | 5 | 2 | 36 | 9 | 1 | 8
Connecticut | 42 | 24 | 9 | 7 | 2 | 36 | 8 | 4 | 4
Delaware | 41 | 14 | 9 | 16 | 2 | 35 | 8 | 3 | 5
District of Columbia | 38 | 15 | 5 | 9 | 9 | 32 | 12 | 2 | 10
Florida | 42 | 4 | 16 | 11 | 11 | 36 | 10 | 1 | 9
Georgia | 42 | 1 | 11 | 16 | 14 | 36 | 11 | 2 | 9
Hawaii | 40 | 25 | 8 | 4 | 3 | 34 | 6 | 4 | 2
Idaho | 41 | 16 | 10 | 2 | 13 | 35 | 8 | 4 | 4
Illinois | 42 | 8 | 13 | 14 | 7 | 36 | 8 | 2 | 6
Indiana | 42 | 0 | 10 | 22 | 10 | 36 | 6 | 3 | 3
Iowa | 42 | 14 | 17 | 11 | 0 | 36 | 9 | 2 | 7
Kansas | 42 | 5 | 18 | 18 | 1 | 36 | 10 | 1 | 9
Kentucky | 42 | 3 | 9 | 12 | 18 | 36 | 13 | 3 | 10
Louisiana | 42 | 4 | 5 | 6 | 27 | 36 | 16 | 3 | 13
Maine | 42 | 20 | 12 | 7 | 3 | 36 | 6 | 3 | 3
Maryland | 42 | 14 | 12 | 13 | 3 | 36 | 11 | 2 | 9
Massachusetts | 42 | 26 | 7 | 6 | 3 | 36 | 11 | 4 | 7
Michigan | 42 | 8 | 14 | 12 | 8 | 36 | 8 | 2 | 6
Minnesota | 42 | 31 | 6 | 2 | 3 | 36 | 8 | 4 | 4
Mississippi | 41 | 4 | 1 | 5 | 31 | 35 | 11 | 4 | 7
Missouri | 42 | 3 | 10 | 24 | 5 | 36 | 9 | 1 | 8
Montana | 42 | 12 | 12 | 9 | 9 | 36 | 10 | 3 | 7
Nebraska | 42 | 15 | 17 | 7 | 3 | 36 | 5 | 2 | 3
Nevada | 42 | 7 | 5 | 10 | 20 | 36 | 12 | 3 | 9
New Hampshire | 41 | 20 | 17 | 2 | 2 | 35 | 8 | 4 | 4
New Jersey | 42 | 16 | 9 | 6 | 11 | 36 | 9 | 2 | 7
New Mexico | 41 | 7 | 10 | 9 | 15 | 35 | 9 | 3 | 6
New York | 42 | 12 | 13 | 11 | 6 | 36 | 8 | 1 | 7
North Carolina | 42 | 5 | 10 | 19 | 8 | 36 | 10 | 1 | 9
North Dakota | 40 | 13 | 7 | 12 | 8 | 35 | 11 | 5 | 6
Ohio | 42 | 1 | 18 | 13 | 10 | 36 | 7 | 2 | 5
Oklahoma | 42 | 3 | 3 | 12 | 24 | 36 | 14 | 2 | 12
Oregon | 42 | 15 | 15 | 6 | 6 | 36 | 11 | 3 | 8
Pennsylvania | 41 | 11 | 14 | 13 | 3 | 35 | 5 | 3 | 2
Rhode Island | 41 | 22 | 13 | 4 | 2 | 36 | 14 | 3 | 11
South Carolina | 42 | 4 | 13 | 9 | 16 | 36 | 6 | 1 | 5
South Dakota | 41 | 15 | 14 | 6 | 6 | 36 | 9 | 2 | 7
Tennessee | 42 | 1 | 8 | 14 | 19 | 36 | 13 | 0 | 13
Texas | 42 | 4 | 7 | 13 | 18 | 36 | 6 | 4 | 2
Utah | 42 | 18 | 8 | 8 | 8 | 36 | 5 | 2 | 3
Vermont | 41 | 23 | 12 | 5 | 1 | 35 | 8 | 4 | 4
Virginia | 42 | 3 | 21 | 15 | 3 | 36 | 6 | 2 | 4
Washington | 42 | 18 | 13 | 5 | 6 | 36 | 11 | 3 | 8
West Virginia | 42 | 5 | 9 | 11 | 17 | 36 | 11 | 5 | 6
Wisconsin | 42 | 15 | 17 | 10 | 0 | 36 | 5 | 3 | 2
Wyoming | 41 | 13 | 11 | 7 | 10 | 35 | 10 | 7 | 3

### Mirror, Mirror on the Wall[edit]

The Commonwealth Fund occasionally publishes updates to a report entitled Mirror, Mirror on the Wall, an analysis of how the United States' healthcare system compares to that of other countries. Reports have been released in 2004, 2006, 2007, 2010 and 2014. The Commonwealth Fund has ranked the United States last in each report.[8]

In the 2014 edition of the report, 11 countries were ranked on 80 measures that were grouped into five areas: quality, access, efficiency, equity and healthy lives. In addition to the United States, the countries studied were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. For the analysis, the Commonwealth Fund primarily used information from three telephone surveys it conducted of patients and physicians worldwide about their experiences with and views of medical practices and the healthcare systems in their countries. The report stated that these surveys were used because many measures of healthcare are not consistent across countries. It also used data from its national health system scorecard, detailed in the section above, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD). The results of the analysis were reported in Time, The Atlantic, U.S. News & World Report, The Washington Post, and The Guardian.[8][9][10][11][12][13]

The report ranked the United States last in the efficiency, equity and healthy lives categories. The country was ranked ninth on access and roughly in the middle of the pack on quality. Its highest rank was third place in effective care, a subgroup of indicators that fell under the quality grouping. The United Kingdom was ranked first overall. The organization determined that although the United States had higher per-capita healthcare spending than the other countries studied, its healthcare system performed worse and did not "achieve better health outcomes" than those countries. It also stated that the "most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage."[8]

The goal of the report was to provide the opportunity for the United States and other countries studied to identify where other countries perform well and learn from their "best practices." In particular, the report singled out the United Kingdom, Switzerland, France and Sweden as countries for the United States to look to. The report noted that the information used for the report comes from the years prior to the full implementation of the Affordable Care Act, and the authors expect the country's future scores to improve as a result of the law.[8]

The table below outlines the Commonwealth Fund's rankings for the United States and 10 other countries that are detailed in its 2014 Mirror, Mirror report. The table also contains information on 2011 health spending per capita for each country studied. For Australia, this data is from 2010. Click [show] on the table to view the data. To read the full report, click here.

Distribution of rankings and change over time, 2015

Category  | Australia  | Canada  | France  | Germany  | Netherlands  | New Zealand  | Norway  | Sweden  | Switzerland  | United Kingdom  | United States
OVERALL RANKING | 4 | 10 | 9 | 5 | 5 | 7 | 7 | 3 | 2 | 1 | 11
Quality care | 2 | 9 | 8 | 7 | 5 | 4 | 11 | 10 | 3 | 1 | 5

Effective care
| 4 | 7 | 9 | 6 | 5 | 2 | 11 | 10 | 8 | 1 | 3

Safe care
| 3 | 10 | 2 | 6 | 7 | 9 | 11 | 5 | 4 | 1 | 7

Coordinated care
| 4 | 8 | 9 | 10 | 5 | 2 | 7 | 11 | 3 | 1 | 6

Patient-centered care
| 5 | 8 | 10 | 7 | 3 | 6 | 11 | 9 | 2 | 1 | 4
Access | 8 | 9 | 11 | 2 | 4 | 7 | 6 | 4 | 2 | 1 | 9

Cost-related access problems
| 9 | 5 | 10 | 4 | 8 | 6 | 3 | 1 | 7 | 1 | 11

Timeliness of care
| 6 | 11 | 10 | 4 | 2 | 7 | 8 | 9 | 1 | 3 | 5
Efficiency | 4 | 10 | 8 | 9 | 7 | 3 | 4 | 2 | 6 | 1 | 11
Equity | 5 | 9 | 7 | 4 | 8 | 10 | 6 | 1 | 2 | 2 | 11
Healthy lives | 4 | 8 | 1 | 7 | 5 | 9 | 6 | 2 | 3 | 10 | 11
Health spending per capita | $3,800 | $4,522 | $4,118 | $4,495 | $5,099 | $3,182 | $5,669 | $3,925 | $5,643 | $3,405 | $8,508

#### Criticism[edit]

The 2014 edition of the Mirror, Mirror report received criticism from a number of media outlets, mostly regarding the measures looked at by the Commonwealth Fund and its reliance on telephone surveys as its primary source of information:

* An article in the Washington Examiner by Philip Klein criticized the report for omitting data on medical innovation, consumer choice and five-year cancer survival rates, arguing that the United States would have ranked higher had these measures been included. Klein also argued that infant mortality is a flawed measure because it isn't measured consistently across countries, and he criticized the use of patient satisfaction surveys as too subjective to be reliable. He asserted that the focus on equity in these surveys was an "ideological decision," chosen to produce a certain outcome.[14]
* An article in The Federalist by Greg Scandlen faulted the report for placing "excessive emphasis on costs" in the section on access to care, omitting measures of the effectiveness of acute care services, and including too few measures of health outcomes. Scandlen also criticized the report for relying on patient surveys.[15]
* An article in The Economist about the report stated that "preferences and values guide conclusions," stating that the "Commonwealth Fund most values equity and access, and so rewards the systems where it finds these." The article argued that a focus on different measures, such as efficiency and patient choice, would have produced a different outcome. It also remarked on the omission of cancer survival rates and innovation.[16]
* An article by Margalit Gur-Arie on KevinMD.com, a blog for physician contributors, criticized the report for including measures she considered irrelevant--such as the ease of printing out lists of patients due for care--and using circular logic. She argued that the report's indicators were "subjectively selected by the survey designers" and that the authors omitted other factors such as physician panel size and physician salaries. Gur-Arie also faulted the report's use of telephone surveys.[17]

## See also[edit]

* Healthcare policy in the United States
* Medicaid spending by state
* Affordable Care Act

## External links[edit]

* The Commonwealth Fund
* The Commonwealth Fund, "Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally"
* The Commonwealth Fund, "Aiming Higher: Results from a Scorecard on State Health System Performance"

## Footnotes[edit]

1. ↑ Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
2. ↑ The Commonwealth Fund, "Mission Statement," accessed January 11, 2016
3. ↑ 3.0 3.1 The Commonwealth Fund, "Foundation History," accessed January 13, 2016
4. ↑ The Commonwealth Fund, "Independent Auditor’s Report," November 9, 2015
5. ↑ The Commonwealth Fund, "Board of Directors," accessed January 15, 2016
6. ↑ 6.0 6.1 The Commonwealth Fund, "Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition--Overview," accessed January 15, 2016
7. ↑ 7.0 7.1 The Commonwealth Fund, "Aiming Higher: Results from a Scorecard on State Health System Performance," accessed January 15, 2016
8. ↑ 8.0 8.1 8.2 8.3 The Commonwealth Fund, "Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally," June 16, 2014
9. ↑ Time, "U.S. Health Care Ranked Worst in the Developed World," June 17, 2014
10. ↑ The Atlantic, "U.S. Healthcare: Most Expensive and Worst Performing," June 16, 2015
11. ↑ US News & World Report, "Americans Spend More on Health Care, But Fare Worse: Report," October 8, 2015
12. ↑ The Washington Post, "Once again, U.S. has most expensive, least effective health care system in survey," June 16, 2014
13. ↑ The Guardian, "NHS comes top in healthcare survey," June 17, 2014
14. ↑ Washington Examiner, "Flawed study ranks United States as the worst health care system," June 16, 2014
15. ↑ The Federalist, "The Commonwealth Fund: American Health Care Is Awful," June 23, 2014
16. ↑ The Economist, "How to compare health-care systems," June 29, 2014
17. ↑ KevinMD.com, "Digging deeper into the Commonwealth Fund health rankings," July 22, 2014

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