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Papers by Douglas McCarthy

To reap the benefits of an all-payer claims database, states need to cultivate relationships with... more To reap the benefits of an all-payer claims database, states need to cultivate relationships with stakeholders and learn how to use data to meet their needs.

its neighboring counties, most in rural Western Kentucky, distinguished itself as one of only a h... more its neighboring counties, most in rural Western Kentucky, distinguished itself as one of only a handful of U.S. regions to improve on a majority of measures tracked by the Commonwealth Fund’s Scorecard on Local Health System Performance, 2016 Edition. The most striking gains were tied to the state’s Medicaid expansion, which added nearly 500,000 low-income adults to the program. Local leaders who were concerned about lack of access to care relied on the expansion to recruit federally qualified health centers to the region, while hospitals and other providers enhanced access through schoolbased clinics, which offer urgent and behavioral health services.

Digital technologies that serve as a communication bridge between providers and consumers have th... more Digital technologies that serve as a communication bridge between providers and consumers have the potential to disrupt the U.S. health care system by enabling consumers to get care and support when and where they need it, while also making their needs and preferences known. This report describes early efforts to use digital technologies-ranging from remote monitoring devices and teleconferencing devices for virtual office visits to data mining tools-to redesign care models around the common needs of discrete patient populations. The approaches described, including those designed to increase patient engagement and close communication gaps, focus on the needs of patients with complex and costly medical and behavioral health conditions as these efforts may present the greatest opportunity for simultaneously improving care and reducing costs. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts. Commonwealth Fund pub. 1776.

The Milbank Quarterly, 2006

Motivated by pressure and a wish to improve, health care organizations are implementing programs ... more Motivated by pressure and a wish to improve, health care organizations are implementing programs to improve patient safety. This article describes six natural experiments in health care safety that show where the safety field is heading and opportunities for and barriers to improvement. All these programs identified organizational culture change as critical to making patients safer, differing chiefly in their methods of creating a patient safety culture. Their goal is a safety culture that promotes continuing innovation and improvement, transcending whatever particular safety methodology is used. Policymakers could help stimulate a culture of safety by linking regulatory goals to safety culture expectations, sponsoring voluntary learning collaborations, rewarding safety improvements, better using publicly reported data, encouraging consumer involvement, and supporting research and education.

ABSTRACT: The Mayo Clinic is the world's oldest and largest integrated multispe cialty group... more ABSTRACT: The Mayo Clinic is the world's oldest and largest integrated multispe cialty group medical practice, combining clinical practice, education, and research at the regional, national, and international levels for the benefit of individuals with routine as well as ...

ABSTRACT: HealthPartners is the nation's largest nonprofit, consumer-governed health care or... more ABSTRACT: HealthPartners is the nation's largest nonprofit, consumer-governed health care organization, providing health and dental care and coverage to more than 1 million individuals in Minnesota and surrounding states. Key factors driving HealthPartners' ...

To learn more about new publications when they become available, visit the Fund's Web site and re... more To learn more about new publications when they become available, visit the Fund's Web site and register to receive Fund e-mail alerts.

A recent data analysis about how states fared between 2013 and 2016 under the Affordable Care Act... more A recent data analysis about how states fared between 2013 and 2016 under the Affordable Care Act examines progress in coverage and access.

Four case studies document the progress achieved in the past five years by health care organizati... more Four case studies document the progress achieved in the past five years by health care organizations that were early leaders in patient safety improvement. Their experience reflects an expansion of interventions from individual hospital units to whole facilities and delivery systems, including new settings such as home health care. Approaches include developing practical methods for training, coaching, and motivating staff to engage in patient safety work; designing effective tools and systems to minimize error and maximize learning; and leading change by setting ambitious goals, measuring and holding units accountable for performance, and sharing stories to convey values. Results include advancements in safety practices, reductions in serious events of patient harm, improved organizational safety climate and morale, and declines in malpractice claims. Keeping the commitment to patient safety has required sustained focus on making safety a core organizational value, a willingness to...

Building on earlier initiatives, Cincinnati Children’s Hospital Medical Center launched an Asthma... more Building on earlier initiatives, Cincinnati Children’s Hospital Medical Center launched an Asthma Improvement Collaborative in 2008 to enhance the quality and coordination of asthma care for low-income, Medicaid-insured children in Hamilton County, Ohio. A multidisciplinary team made improvements across the continuum of care and strengthened linkages with managed care and community-based organizations to help patients and families overcome barriers to asthma control. A lengthening time between hospital encounters among those who received intensive care coordination services suggests a positive effect of this approach for participants. Hospital data showed promising improvement in a combined rate of readmissions or emergency department revisits for asthma at Cincinnati Children’s, although an analysis of Medicaid data found the initiative had not yet achieved its objectives at the county level. Findings from this initiative should be of interest to others seeking to achieve ambitious...

most of the surrounding San Joaquin and Calaveras Counties, stands out along with Akron, Ohio, fo... more most of the surrounding San Joaquin and Calaveras Counties, stands out along with Akron, Ohio, for having improved on more performance measures (19 of 33) than any other region on the Commonwealth Fund’s Scorecard on Local Health System Performance, 2016 Edition. California’s Medicaid expansion enabled local providers to increase capacity, which may explain the improvements on some measures of care quality and reductions in potentially avoidable hospitalizations, emergency department visits, and readmissions. Leaders have also expanded access by locating clinics in schools and a neighborhood community center. The region’s improvement efforts appear to be facilitated by supportive state policy and the market dominance of a locally governed Medicaid managed care plan. To make further progress, community leaders are developing coalitions and seeking funds to address the social determinants of poor health, including poverty, violence, and poor nutrition. CASE STUDY JULY 2017

This report presents 10 case studies of health care organizations, clinical teams, and learning c... more This report presents 10 case studies of health care organizations, clinical teams, and learning collaborations that have designed innovations in five areas that hold great promise for improving patient safety nationally: promoting an organizational culture of safety, improving teamwork and communication, enhancing rapid response to prevent heart attacks and other crises in the hospital, preventing health care–associated infections in the intensive care unit, and preventing adverse drug events throughout the hospital. Participating organizations ranged from large integrated delivery systems to small community hospitals. The cases describe the actions taken, results achieved, and lessons learned by these patient safety leaders, with suggestions for those seeking to replicate their successes. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or...

Issue brief, 2016

Issue: Achieving a high-performing health system will require improving outcomes and reducing cos... more Issue: Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients--those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs--those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks--to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009--2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient-provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewe...

Geisinger Health System is a physician-led, not-for-profit, integrated delivery system serving an... more Geisinger Health System is a physician-led, not-for-profit, integrated delivery system serving an area with approximately 2.6 million people in northeastern and central Pennsylvania with innovative products and services designed to drive higher performance. Geisinger's leaders believe that the organization can simultaneously improve quality, sat- isfaction, and efficiency only by redesigning and reengineering the delivery of care. This philosophy is epitomized by ProvenCare, a portfolio of products (many of which are package-priced) for which care processes have been redesigned to reliably administer a coordinated bundle of evidence-based best practices. Use of the ProvenCare model has improved clinical outcomes while decreasing resource utilization. Fundamental to Geisinger's success are its vision of becoming a national model for care delivery, the lead- ership to achieve that vision reinforced with a performance-based compensation system strategically aligned with specifi...

Case studies of three organizations participating in the Institute for Healthcare Improvement’s T... more Case studies of three organizations participating in the Institute for Healthcare Improvement’s Triple Aim initiative shed light on how they are partnering with providers and organizing care to improve the health of a population and patients’ experience of care while lowering—or at least reducing the rate of increase in—the per capita cost of care. The organizations—CareOregon, a nonprofit managed health care plan serving lowincome Medicaid enrollees; Genesys Health System, a nonprofit integrated delivery system in Flint, Mich.; and QuadMed, a Wisconsin-based subsidiary of printer Quad/Graphics that develops and manages worksite health clinics and wellness programs—were selected to illustrate diverse approaches. Lessons from these organizations can guide others who wish to undertake or promote transformation in health care delivery.

OSF HealthCare, an integrated health care delivery system serving parts of Illinois and Michigan,... more OSF HealthCare, an integrated health care delivery system serving parts of Illinois and Michigan, was an early leader in promoting a collaborative approach to patient safety improvement. OSF has enhanced these efforts during the past five years by continuing to build awareness of safety risks through systemwide error reporting and local risk assessment, by identifying clinicians who can serve as models for their peers, and by engaging staff in intraorganizational learning and competition to spur improvement. It also has raised performance expectations by educating hospitaland system-level board members about patient safety issues and quality improvement techniques. Exemplary facility-level results include: an 80 percent reduction over six years in the rate of ventilator-associated pneumonia among intensive care patients; an increase from 39 percent to 100 percent in compliance with a standardized medication administration process; and a nine-percentage-point increase over one year i...

This Chartbook was developed with the hope of filling that gap by creating an authoritative but u... more This Chartbook was developed with the hope of filling that gap by creating an authoritative but usable resource to translate what is most important about quality into a format that interested constituencies can easily understand for their decision-making and to provide a platform for public discussion. Our goal is not to create another academic report on quality but rather a tool to educate the public and policymakers on the state of health care quality in the U.S. We have systematically selected a representative range of quality data presented through graphs and narrative to "tell the story" of the problems and successes, and, most importantly, the opportunities to improve health care for the benefit of Americans.

Commonwealth Fund Issue Briefs

JAMA, 2014

In the United States, where a person lives determines the kind of health care available and the l... more In the United States, where a person lives determines the kind of health care available and the length and quality of life a person is likely to enjoy. The 2014 edition of The Commonwealth Fund's Scorecard on State Health System Performance 1 documents persistently wide geographic disparities, with some states consistently performing better than others on the scorecard's 42 indicators of health care access, quality, efficiency, and outcomes (eFigure 1 in Supplement shows the 50 states and the District of Columbia ranked by quartile on a composite score aggregated from the 42 indicators of health system performance, using the most recently available data typically representing the year 2011 or 2012, or both). The scorecard reveals that performance either declined or failed to improve during the 5 years up to 2012 in the majority of states on two-thirds of the 34 indicators with trend data (eFigure 2 in Supplement shows the number of states and the District of Columbia in which performance improved, stayed the same, or worsened over a 4-to 5-year time span for each of the 34 trending indicators). The findings are sobering in their portrayal of a geographic divide among state health systems. No state is making widespread progress toward the achievable outcomes that all individuals should expect considering the substantial and increasing resources devoted to health care in the United States. Notably, however, among the handful of indicators for which improvements (eg, immunizations for children, safer prescribing of medications for the elderly, patient-centered care in the hospital, avoidable hospital admissions and readmissions, and cancer-related deaths) occurred in a majority of states, there was often concerted, coordinated attention to improvement at federal, state, and local levels. These successes suggest an opportunity for physicians to join with others to exert leadership in both medical practice and the policy arena so that such gains become the norm in coming years. With new resources and tools provided by national reforms, this opportunity extends across all states. Although lagging states exhibit the greatest need for improvement, even leading states (eg, Minnesota, Massachusetts, New Hampshire, Vermont, and Hawaii) have opportunity to improve.

Denver Health, a comprehensive and integrated medical system that is Colorado's largest healt... more Denver Health, a comprehensive and integrated medical system that is Colorado's largest health care safety-net provider, has a national reputation as a high-performance organization. Members of The Commonwealth Fund Commission on a High Performance Health System observed Denver Health during a site visit in March 2006, to assess its operation and determine whether it might serve as a model for other public and private health care systems around the country. The Commission concluded that Denver Health is indeed a "learning laboratory." It has succeeded at providing coordinated care to the community, promoting a culture of continuous quality improvement, adopting new technology and incorporating it into everyday practice, taking risks and making mid-course corrections, and providing leadership and support— and accepting accountability—both at the top and throughout the organization. Moreover, it has accomplished these objectives and others in straightforward ways that co...

To reap the benefits of an all-payer claims database, states need to cultivate relationships with... more To reap the benefits of an all-payer claims database, states need to cultivate relationships with stakeholders and learn how to use data to meet their needs.

its neighboring counties, most in rural Western Kentucky, distinguished itself as one of only a h... more its neighboring counties, most in rural Western Kentucky, distinguished itself as one of only a handful of U.S. regions to improve on a majority of measures tracked by the Commonwealth Fund’s Scorecard on Local Health System Performance, 2016 Edition. The most striking gains were tied to the state’s Medicaid expansion, which added nearly 500,000 low-income adults to the program. Local leaders who were concerned about lack of access to care relied on the expansion to recruit federally qualified health centers to the region, while hospitals and other providers enhanced access through schoolbased clinics, which offer urgent and behavioral health services.

Digital technologies that serve as a communication bridge between providers and consumers have th... more Digital technologies that serve as a communication bridge between providers and consumers have the potential to disrupt the U.S. health care system by enabling consumers to get care and support when and where they need it, while also making their needs and preferences known. This report describes early efforts to use digital technologies-ranging from remote monitoring devices and teleconferencing devices for virtual office visits to data mining tools-to redesign care models around the common needs of discrete patient populations. The approaches described, including those designed to increase patient engagement and close communication gaps, focus on the needs of patients with complex and costly medical and behavioral health conditions as these efforts may present the greatest opportunity for simultaneously improving care and reducing costs. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. To learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts. Commonwealth Fund pub. 1776.

The Milbank Quarterly, 2006

Motivated by pressure and a wish to improve, health care organizations are implementing programs ... more Motivated by pressure and a wish to improve, health care organizations are implementing programs to improve patient safety. This article describes six natural experiments in health care safety that show where the safety field is heading and opportunities for and barriers to improvement. All these programs identified organizational culture change as critical to making patients safer, differing chiefly in their methods of creating a patient safety culture. Their goal is a safety culture that promotes continuing innovation and improvement, transcending whatever particular safety methodology is used. Policymakers could help stimulate a culture of safety by linking regulatory goals to safety culture expectations, sponsoring voluntary learning collaborations, rewarding safety improvements, better using publicly reported data, encouraging consumer involvement, and supporting research and education.

ABSTRACT: The Mayo Clinic is the world's oldest and largest integrated multispe cialty group... more ABSTRACT: The Mayo Clinic is the world's oldest and largest integrated multispe cialty group medical practice, combining clinical practice, education, and research at the regional, national, and international levels for the benefit of individuals with routine as well as ...

ABSTRACT: HealthPartners is the nation's largest nonprofit, consumer-governed health care or... more ABSTRACT: HealthPartners is the nation's largest nonprofit, consumer-governed health care organization, providing health and dental care and coverage to more than 1 million individuals in Minnesota and surrounding states. Key factors driving HealthPartners' ...

To learn more about new publications when they become available, visit the Fund's Web site and re... more To learn more about new publications when they become available, visit the Fund's Web site and register to receive Fund e-mail alerts.

A recent data analysis about how states fared between 2013 and 2016 under the Affordable Care Act... more A recent data analysis about how states fared between 2013 and 2016 under the Affordable Care Act examines progress in coverage and access.

Four case studies document the progress achieved in the past five years by health care organizati... more Four case studies document the progress achieved in the past five years by health care organizations that were early leaders in patient safety improvement. Their experience reflects an expansion of interventions from individual hospital units to whole facilities and delivery systems, including new settings such as home health care. Approaches include developing practical methods for training, coaching, and motivating staff to engage in patient safety work; designing effective tools and systems to minimize error and maximize learning; and leading change by setting ambitious goals, measuring and holding units accountable for performance, and sharing stories to convey values. Results include advancements in safety practices, reductions in serious events of patient harm, improved organizational safety climate and morale, and declines in malpractice claims. Keeping the commitment to patient safety has required sustained focus on making safety a core organizational value, a willingness to...

Building on earlier initiatives, Cincinnati Children’s Hospital Medical Center launched an Asthma... more Building on earlier initiatives, Cincinnati Children’s Hospital Medical Center launched an Asthma Improvement Collaborative in 2008 to enhance the quality and coordination of asthma care for low-income, Medicaid-insured children in Hamilton County, Ohio. A multidisciplinary team made improvements across the continuum of care and strengthened linkages with managed care and community-based organizations to help patients and families overcome barriers to asthma control. A lengthening time between hospital encounters among those who received intensive care coordination services suggests a positive effect of this approach for participants. Hospital data showed promising improvement in a combined rate of readmissions or emergency department revisits for asthma at Cincinnati Children’s, although an analysis of Medicaid data found the initiative had not yet achieved its objectives at the county level. Findings from this initiative should be of interest to others seeking to achieve ambitious...

most of the surrounding San Joaquin and Calaveras Counties, stands out along with Akron, Ohio, fo... more most of the surrounding San Joaquin and Calaveras Counties, stands out along with Akron, Ohio, for having improved on more performance measures (19 of 33) than any other region on the Commonwealth Fund’s Scorecard on Local Health System Performance, 2016 Edition. California’s Medicaid expansion enabled local providers to increase capacity, which may explain the improvements on some measures of care quality and reductions in potentially avoidable hospitalizations, emergency department visits, and readmissions. Leaders have also expanded access by locating clinics in schools and a neighborhood community center. The region’s improvement efforts appear to be facilitated by supportive state policy and the market dominance of a locally governed Medicaid managed care plan. To make further progress, community leaders are developing coalitions and seeking funds to address the social determinants of poor health, including poverty, violence, and poor nutrition. CASE STUDY JULY 2017

This report presents 10 case studies of health care organizations, clinical teams, and learning c... more This report presents 10 case studies of health care organizations, clinical teams, and learning collaborations that have designed innovations in five areas that hold great promise for improving patient safety nationally: promoting an organizational culture of safety, improving teamwork and communication, enhancing rapid response to prevent heart attacks and other crises in the hospital, preventing health care–associated infections in the intensive care unit, and preventing adverse drug events throughout the hospital. Participating organizations ranged from large integrated delivery systems to small community hospitals. The cases describe the actions taken, results achieved, and lessons learned by these patient safety leaders, with suggestions for those seeking to replicate their successes. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or...

Issue brief, 2016

Issue: Achieving a high-performing health system will require improving outcomes and reducing cos... more Issue: Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients--those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs--those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks--to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009--2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient-provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewe...

Geisinger Health System is a physician-led, not-for-profit, integrated delivery system serving an... more Geisinger Health System is a physician-led, not-for-profit, integrated delivery system serving an area with approximately 2.6 million people in northeastern and central Pennsylvania with innovative products and services designed to drive higher performance. Geisinger's leaders believe that the organization can simultaneously improve quality, sat- isfaction, and efficiency only by redesigning and reengineering the delivery of care. This philosophy is epitomized by ProvenCare, a portfolio of products (many of which are package-priced) for which care processes have been redesigned to reliably administer a coordinated bundle of evidence-based best practices. Use of the ProvenCare model has improved clinical outcomes while decreasing resource utilization. Fundamental to Geisinger's success are its vision of becoming a national model for care delivery, the lead- ership to achieve that vision reinforced with a performance-based compensation system strategically aligned with specifi...

Case studies of three organizations participating in the Institute for Healthcare Improvement’s T... more Case studies of three organizations participating in the Institute for Healthcare Improvement’s Triple Aim initiative shed light on how they are partnering with providers and organizing care to improve the health of a population and patients’ experience of care while lowering—or at least reducing the rate of increase in—the per capita cost of care. The organizations—CareOregon, a nonprofit managed health care plan serving lowincome Medicaid enrollees; Genesys Health System, a nonprofit integrated delivery system in Flint, Mich.; and QuadMed, a Wisconsin-based subsidiary of printer Quad/Graphics that develops and manages worksite health clinics and wellness programs—were selected to illustrate diverse approaches. Lessons from these organizations can guide others who wish to undertake or promote transformation in health care delivery.

OSF HealthCare, an integrated health care delivery system serving parts of Illinois and Michigan,... more OSF HealthCare, an integrated health care delivery system serving parts of Illinois and Michigan, was an early leader in promoting a collaborative approach to patient safety improvement. OSF has enhanced these efforts during the past five years by continuing to build awareness of safety risks through systemwide error reporting and local risk assessment, by identifying clinicians who can serve as models for their peers, and by engaging staff in intraorganizational learning and competition to spur improvement. It also has raised performance expectations by educating hospitaland system-level board members about patient safety issues and quality improvement techniques. Exemplary facility-level results include: an 80 percent reduction over six years in the rate of ventilator-associated pneumonia among intensive care patients; an increase from 39 percent to 100 percent in compliance with a standardized medication administration process; and a nine-percentage-point increase over one year i...

This Chartbook was developed with the hope of filling that gap by creating an authoritative but u... more This Chartbook was developed with the hope of filling that gap by creating an authoritative but usable resource to translate what is most important about quality into a format that interested constituencies can easily understand for their decision-making and to provide a platform for public discussion. Our goal is not to create another academic report on quality but rather a tool to educate the public and policymakers on the state of health care quality in the U.S. We have systematically selected a representative range of quality data presented through graphs and narrative to "tell the story" of the problems and successes, and, most importantly, the opportunities to improve health care for the benefit of Americans.

Commonwealth Fund Issue Briefs

JAMA, 2014

In the United States, where a person lives determines the kind of health care available and the l... more In the United States, where a person lives determines the kind of health care available and the length and quality of life a person is likely to enjoy. The 2014 edition of The Commonwealth Fund's Scorecard on State Health System Performance 1 documents persistently wide geographic disparities, with some states consistently performing better than others on the scorecard's 42 indicators of health care access, quality, efficiency, and outcomes (eFigure 1 in Supplement shows the 50 states and the District of Columbia ranked by quartile on a composite score aggregated from the 42 indicators of health system performance, using the most recently available data typically representing the year 2011 or 2012, or both). The scorecard reveals that performance either declined or failed to improve during the 5 years up to 2012 in the majority of states on two-thirds of the 34 indicators with trend data (eFigure 2 in Supplement shows the number of states and the District of Columbia in which performance improved, stayed the same, or worsened over a 4-to 5-year time span for each of the 34 trending indicators). The findings are sobering in their portrayal of a geographic divide among state health systems. No state is making widespread progress toward the achievable outcomes that all individuals should expect considering the substantial and increasing resources devoted to health care in the United States. Notably, however, among the handful of indicators for which improvements (eg, immunizations for children, safer prescribing of medications for the elderly, patient-centered care in the hospital, avoidable hospital admissions and readmissions, and cancer-related deaths) occurred in a majority of states, there was often concerted, coordinated attention to improvement at federal, state, and local levels. These successes suggest an opportunity for physicians to join with others to exert leadership in both medical practice and the policy arena so that such gains become the norm in coming years. With new resources and tools provided by national reforms, this opportunity extends across all states. Although lagging states exhibit the greatest need for improvement, even leading states (eg, Minnesota, Massachusetts, New Hampshire, Vermont, and Hawaii) have opportunity to improve.

Denver Health, a comprehensive and integrated medical system that is Colorado's largest healt... more Denver Health, a comprehensive and integrated medical system that is Colorado's largest health care safety-net provider, has a national reputation as a high-performance organization. Members of The Commonwealth Fund Commission on a High Performance Health System observed Denver Health during a site visit in March 2006, to assess its operation and determine whether it might serve as a model for other public and private health care systems around the country. The Commission concluded that Denver Health is indeed a "learning laboratory." It has succeeded at providing coordinated care to the community, promoting a culture of continuous quality improvement, adopting new technology and incorporating it into everyday practice, taking risks and making mid-course corrections, and providing leadership and support— and accepting accountability—both at the top and throughout the organization. Moreover, it has accomplished these objectives and others in straightforward ways that co...