THE COMMONWEALTH

FUND

The Commonwealth Fundand

The Harkness Fellowships in Health Care Policy and Practice

International Forum on Quality and Safety in HealthcareParis, FranceApril 11, 2014

Robin OsbornVice President and Director

International Health Policy and Practice Innovations

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Harkness Alumni PanelistsDale Bramley, M.B., Ch.B., M.P.H., FAFPHM

2003-04 Harkness Fellow (New Zealand)

Placement: Mount Sinai-New York University Medical Center and Health System

Project: “Indigenous Disparities in Health Status: A Cross-Country Comparison of New Zealand, Australia, Canada and the United States”

Current Position: Chief Executive Officer, Waitemata District Health Board

Email: dale.bramley@waitematadhb.govt.nz

Derek Feeley

2005-06 Harkness/Health Foundation Fellow (United Kingdom)

Placement: Kaiser Permanente, Veterans Health Administration

Project: “Developing Health Services fit for 2020 – Improving the Management of Complexity in Chronic Disease”

Current Position: Executive Vice President, Institute for Healthcare Improvement

Email: dfeeley@IHI.org

Martin Hefford, P.G.dip, M.A.

2003-04 Harkness Fellow (New Zealand)

Placement: Kaiser Permanente

Project: “Using Financial Incentives to Promote Evidence Based Interventions in Primary Healthcare: Early Results from the California Pay for Performance Program”

Current Position: Chief Executive Officer, Compass Health

Email: martin.hefford@compasshealth.org.nz

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The Commonwealth Fund

Established by Anna M. Harkness in 1918, 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.

The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy.

An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.

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Patient Protection and Affordable Care ActMarch 23, 2010

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Realizing the Potential of Health Reform

Examples of Fund Projects

Integrated Care and Accountable Care Organizations (ACOs)

• Tracking the development of ACOs through case studies and national surveys, and evaluating their impact on quality, cost, and reducing disparities

• Grants to analyze models for integrating care, including through multi-payer initiatives, “hybrid” integrated systems, and coordinating care for patients dually covered by Medicaid and Medicare

• Series of reports on expansion of coverage, health insurance exchanges, and delivery system innovations

• Series of reports on implications of U.S. health reform for specific populations, including women, young adults, and small businesses

• Series of longitudinal surveys of young adults, low-income adults, and older adults between 2011 and 2015 to measure changes and trends in insurance coverage

Scorecard on Local Health System Performance, 2012

Annual Congressional Retreat• 3-day Briefing for Members of

Congress • Topics: payment reform, insurance

exchanges, price variation, ACOs, public health

High Need/High Cost Patients• Identifying promising models of health

care delivery for better managing patients with high needs.

• Grants to define subpopulations to proactively identify those at high risk of becoming high cost.

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International Program in Health Policy & Practice Innovations

The Commonwealth Fund’s international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.

International Symposium on Health Policy: Ministers’ Policy Roundtable

Adults, 2013Easy getting after-hours care

without going to the ER

UK

NO

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SW

IZA

US

US

CA

N FRS

WE

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20

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60

80

100

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49 4639 38 36 35

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Base: Needed care after hours.

• The Hon. Daniel Bahr (Minister of Health, Germany) • John K. Iglehart (Health Affairs) • The Hon. Una O’Brien CB (Permanent Secretary, Dept.

of Health, England)

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Harkness Fellowships in Health Care Policy and Practice

United States

AustraliaCanada

Germany

New Zealand

Netherlands

France(being launched

2015-16)

United Kingdom

NorwaySweden

Switzerland(under discussion)

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Harkness Fellows can expect to:

• Spend 12 months in the United States

• Conduct research on a key health care delivery or policy issue

• Gain an in depth understanding of the U.S. health care system

• Learn about the Australian, Canadian, Dutch, French, German, New Zealand, Norwegian, Swedish, Swiss, and U.K. health care systems

• Work with leading policy experts and senior policymakers

• Get a firsthand look at innovative U.S. programs

• Enhance methodological skills

• Develop networks of valuable contacts for ongoing cross-national exchange and collaboration

A chance to Think Big about some of the most important challenges in health care policy and practice

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Relationship with The Commonwealth Fund Adds Value to the Fellowship

• Nationally recognized Fund staff provide expertise across a range of fields in health policy and practice

• Through the Fund’s grants, Fellows can connect to many of the country’s most innovative projects and research

• The Fund opens doors and provides entrée to its networks of health leaders and experts for Fellows

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The Harkness Fellowship awards up to U.S. $119,000 which covers the following:

• Roundtrip airfare to the United States• Living allowance• Funds for project-related travel, research, and conferences • Travel to attend the Harkness Fellowship seminars• Health insurance• U.S. and state taxes

The Harkness Fellowship Award

• PLUS: a family supplement up to U.S. $55,000 (including airfare, living allowance, and health insurance) for Fellows accompanied by a partner and/or children up to age 18

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Partnerships to Expand Harkness Fellowships

• Canada: Canadian Foundation for Healthcare Improvement

• Germany: B. Braun–Stiftung

• Netherlands: Ministry for Health, Welfare, and Sport

• Norway: Research Council of Norway

• Sweden: Ministry of Health and Social Affairs

• United Kingdom: The Nuffield Trust and NHS National Institute for Health Research

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Examples of Harkness Fellows’ Placements• Harvard University, Boston

• Stanford University, San Francisco

• University of California, San Francisco

• Johns Hopkins University, Baltimore

• Columbia University, New York City

• RAND/University of California, Los Angeles

• Veterans Health Administration, Washington, D.C.

• Kaiser Permanente, San Francisco

• Group Health Cooperative, Puget Sound

• Institute for Healthcare Improvement (IHI), Boston

• Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health & Human Services, Washington, D.C.

• Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health & Human Services, Washington, D.C.

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Prominent U.S. Mentors are a Key Feature of the Program

Donald Berwick, MDInstitute for Healthcare Improvement

Carolyn Clancy, MDAgency for Healthcare Research and Quality

Thomas H. Lee, MDPartners Community Healthcare, Inc.

• John Hobbs (NZ)• Tom Marshall (UK)• Emma Stanton (UK)• Jonny Taitz (AUS)• Alexandra Norrish (UK)• Nikola Biller-Andorno

(SWIZ)

• Peter Sprivulis (AUS)• Rae Lamb (NZ)• Timothy Wilson (UK)

• Adam Elshaug (AUS)• Ansgar Gerhardus (GER)• Sonj Hall (AUS)• Kathryn Rowan (UK)• Cynthia Farquhar (NZ)

David Blumenthal, MDMassachusetts General Hospital/ Harvard Medical School

• Robin Gauld (NZ)• James Mountford (UK)• Russell Gruen (AUS)• Stephen Davies (UK)• Katharina Janus (GER)

Sherry Glied, PhDMailman School of Public Health, Columbia University

• Mirella Cacace (GER)• Katharina Janus (GER)• Adam Oliver (UK)

Andrew Bindman, MDUCSF/San Francisco General Hospital

• Christopher Millett (UK)• Peter McNair (AUS)• Bruce Guthrie (UK)• Elana Taipapaki Curtis (NZ)• Colin Tukuitonga (NZ)• Julia Murphy (UK)

Benjamin Chu, MD/Murray Ross, PhD Kaiser Permanente Southern California/Kaiser Foundation Health Plan

• Diane Gray (UK)• Antoinette De Bont (NETH)• Dawn Dowding (UK)• Derek Feeley (UK) • Richard Gleave (UK) • Martin Hefford (NZ)

• Bert Vrijhoef (NETH)• Rhiannon Edwards (UK)• Malcolm Battersby(AUS)• Richard Hamblin (UK)• Ngaire Kerse (NZ)• Linda Gask (UK)

Edward Wagner, MDGroup Health Cooperative at Puget Sound

Elliott S. Fisher, MDDartmouth Institute for Health Policy & Clinical Practice

• Daniela Koller (GER)

• Sara Kreindler (CAN)

• Kimberlyn McGrail (CAN)

• Michael Schull (CAN)

2013–14 Harkness Orientation at the Fund

2013–14 Harkness Fellows

Sherry Glied (former Assistant Secretary for

Planning and Evaluation)

Keynote Speaker

Elizabeth Bradley (Yale), Tom Delbanco (Beth Israel Deaconess

Medical Center), Joseph Newhouse (Harvard)

Aziz Sheikh (UK), Beatrice Podtschaske (GER)

Harkness Mentors

Imogen Mitchell (AUS), Jan Frich (NOR)

Site Visits to Walgreens and Montefiore Medical Center

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Harkness Fellows Breakfast with Health Ministers at the International Symposium

The Hon. Tony Ryall, Minister of Health, New Zealand, with Sue Wells

The Hon. Daniel Bahr, Minister of Health, Germany, with Tobias Esch

Una O’Brien CB, Permanent Secretary, Department of Health, England, with

Felix Greaves

The Hon. Lena Furmark, State Secretary, Ministry of Health and Social Affairs, Sweden,

with Charlotta Levay 15

Harkness/IHI Fellows Summit

Maureen Bisognano, President and CEO, Institute for Healthcare Improvement (IHI) with

2011-12 Harkness Fellows

• Visit to the Institute for Healthcare Improvement in Boston

• Briefing on IHI’s world-renowned programs and pioneering techniques to improve quality, outcomes and efficiency

• Networking with IHI Quality Improvement Fellows and Staff

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Harkness FellowsWashington Policy Briefing, March 2014

Karen IgnagniAmerica’s Health Insurance

Plans

Robert Reischauer Urban Institute

An “Inside the Beltway” Look at Policymaking with Multiple Stakeholders, and a Wide Range of Viewpoints, including:

• Democratic vs. Republican perspectives on health reform

• Perspectives from government agencies, members of Congress, industry lobbyists, States, and political strategists

• Site Visit to VA Hospital, Kaiser Center for Total Health

Karen B. DeSalvoOffice of the National

Coordinator for Health Information Technology

Congressman Tom Price (R-Georgia)

Richard KronickAgency for Healthcare Research and Quality

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Robert A. PetzelU.S. Department of

Veterans Affairs

Joe V. SelbyPatient-Centered Outcomes

Research Institute

Harkness Fellows’ Canadian Policy Briefing, May 2013

Site visit to Seaton House Men's Shelter (associated with St. Michael’s

Hospital), Toronto

Keynote Speech:“A National Strategy for Improving Mental Health Services in Canada: The Plan and its Prospects”

• Helen Angus, Associate Deputy Minister, Ontario Ministry of Health and Long-Term Care

• Vickie Kaminski, President & CEO, Eastern Health, Newfoundland and Labrador

• André Picard, The Globe and Mail

• Michael Nashat, Board Member, Pharmacy Council, Ontario Ministry of Health and Long-Term Care; Director, OnPharm

David Goldbloom, Chairman, Mental Health Commission of Canada

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A seminar series designed to provide Harkness Fellows with:

Harkness Fellowship Leadership Seminar Series

John Rowe, MD Former Chairman & CEO of Aetna

Thomas ZeltnerFormer Swiss Secretary of

State for Health

Mark McClellan, MD, PhD Former Administrator for Centers for Medicare and

Medicaid Services

Understanding of the principles of effective leadership

Opportunity for candid discussion with influential U.S. policy leaders and guest policymakers from Fellows’ home countries

Focus on ‘lessons learned’ from real world experience

Karen DavisPresident of the

Commonwealth Fund

Don Berwick, MDFormer Administrator, Centers for Medicare

and Medicaid Services

Carolyn Clancy, MDAgency for Healthcare Research and Quality

Thomas Lee, MDCEO of Partners

Community Healthcare, Inc.

2012-13 Leadership SpeakersPast Leadership Speakers

Julio Frenk, MD, Former Minister of

Health, Mexico

David Blumenthal, MDPresident of the

Commonwealth Fund/ Former National

Coordinator for Health Information Technology

Kenneth Kizer, MDFormer Under

Secretary, Veterans Health

Administration

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Harkness Fellows’ Publications

• Over 2,300 peer-reviewed publications, 1998-2013

• Health Affairs, British Medical Journal, JAMA, Lancet, Health Policy, New England Journal of Medicine, Quality and Safety in Health Care, Journal of Health Politics, Policy and Law, Canadian Medical Association Journal, Health Services Journal

• Reports to Health Ministers and Congress

Examples of Harkness Fellows in Leadership Positions• Mark Booth (2006-07 AUS), First Assistant Secretary, Primary and Ambulatory Care

Division, Australian Department of Health and Ageing

• Dale Bramley (2003-04 NZ), Chief Executive Officer, Waitemata District Health Board

• Derek Feeley (2005-06 UK), Executive Vice President, Institute for Healthcare Improvement

• Andreas Gerber (2007-08 GER), Head, Department of Health Economics, IQWiG

• Richard Gleave (2007-08 UK), Chief Operating Officer, Public Health England

• Martin Hefford (2003-04 NZ), Chief Executive Officer, Compass Health

• Rae Lamb (2001-02 NZ), Aged Care Commissioner, Australian Department of Health and Ageing

• Geraint Lewis (2007-08 UK), Chief Data Officer, NHS England

• Martin Marshall (1998-99 UK), Chair, Health Care Improvement, University College London

• Stephanie Stock (2007-08 GER), Professor, Department of Health Economics and Clinical Epidemiology, University of Cologne

• Diane E. Watson (2006-07 CAN), Chief Executive, National Health Performance Authority, Australia

• Jennifer Zelmer (2002-03 CAN), Executive Vice President for Clinical Adoption and Innovation, Canada Health Infoway 21

Reaching a Washington Policy AudienceHarkness Alumni Washington Policy Forum, May 2011

Robin Osborn, Donald M. Berwick (CMS), Karen Davis

• 24 Harkness alumni from AUS, GER, NETH, NZ, CAN, and UK, highlighted health care policy and delivery system innovations for key US policymakers

• Alumni produced 14 research papers (10 co-authored)

• International innovations included: individual financial incentives, shared services/networks for primary care, after-hours care arrangements, medical home models, mobile health interventions, translating research into practice, and patient safety in primary care

“I was so glad I could make it. It was a joy to see once again the energy and brilliance of the Harkness Fellows. What a gift to us all that program is!” -- Donald Berwick , Administrator, Centers for Medicare and Medicaid Services

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David Blumenthal (formerly ONCHIT), Elizabeth Fowler (National Economic Council), Sherry Glied (ASPE)

Martin Marshall (UK),Stephanie Stock (GER),

Jako Burgers (NETH)

10-Year Review of Harkness Fellowships: Almost All Fellows (91%) Regard the Harkness Fellowship as

Extremely or Very Valuable to their Career Advancement

70%

21%

9% 0%Extremely Valuable

Very Valuable

Moderately Valuable

Not Very Valuable

Source: 1998-2008 Harkness Impact Survey (n=75)23

“I was a bit concerned that my daughter would not make friends easily - how wrong I was! We all had a great time. Also many fellows tended to have young children - I would encourage prospective fellows with older children to also take up the opportunity.”

- Mark Booth (New Zealand), a 2006-07 Commonwealth Fund Harkness Fellow, Assistant Secretary, Department of Health and Ageing, Australia.

- Family: Spouse, two children ages 14 and 18.

“Loved the school and the whole experience. They really grew through it. The school drove them academically and in every other way (very focused on high performance!). My daughter made wonderful friends (first grade), and had a strong American accent by the time we departed for home (lost it in two weeks). The transition home was very smooth, back into our house which was rented to visiting academics on sabbaticalhomes.com.”

- Robin Gauld, Ph.D. (New Zealand), a 2008-09 Harkness Fellow, is associate professor of health policy in the Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand, and director of the newly-formed Centre for Health Systems, Otago Medical and Business Schools.

- Family: Spouse, two children ages 6 and 10.

How Do The Harkness Fellowships Work For Families?

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Who Should Apply?

• Academic researchers, government policymakers and analysts, clinical leaders, health care and insurance industry managers, and journalists

• Applicants should be mid-career and Fellows are typically between late 20’s and mid-40’s

• Applicants must be citizens of Australia, Canada, France, Germany,

the Netherlands, New Zealand, Norway, Sweden, or the United Kingdom, or have permanent residency and lived in that country for at least three years.

• All applicants must submit a formal application that includes a research proposal which falls within the scope of The Commonwealth Fund’s principal areas of interest

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Applying for the 2015-16 Harkness Fellowships in Health Policy and Practice

For applicants from Australia and New Zealand – the deadline is September 15, 2014

For applicants from Canada, Germany, the Netherlands, Norway, Sweden, and the U.K. – the deadline is November 17, 2014

For applicants from France – the deadline is December 15, 2014

For more details and application form, please visit: www.commonwealthfund.org/fellowships

For questions about the program, eligibility, and proposed projects, please contact:

Robin Osborn (ro@cmwf.org)Vice President and Director

International Health Policy and Practice InnovationsThe Commonwealth Fund