At the United Hospital Fund, those imperatives resonate through our work every day, as we confront changing and complex health care needs and the increasing costs that accompany them. There’s more urgency than ever to grapple effectively with those challenges. But there’s also—as I see from the vantage point of nearly two decades at the Fund—more opportunity. This annual report provides a glimpse of how we are approaching both.

Anticipating, engaging with, and effectively responding to health care’s most pressing issues has been at the heart of the Fund’s work for 132 years. Whether bringing hospitals together to address common problems or creating effective approaches to the health challenges of emerging social issues, the Fund has been an agile and important force for improving our health care  system.

Over the past decade, our work has evolved with the rapidly changing health care and political environment, with three priorities predominating:

Those are all clearly evident in this past year’s accomplishments, as this annual report highlights.

Underlying each of these priorities is the urgent goal of containing costs, not through spending cuts alone but by redesigning the way services are organized and by developing essential payment incentives and public policies. The contentious national debate—over philosophy, economics, and health policy—continues. But whatever policies emerge, there must be coherence to them, and a balance between interventions to reduce cost growth and efforts to increase the ability of people to get high-quality care.

That is why, at the Fund, we’re invested in understanding how all the parts of our system work, or don’t—so we can help decision-makers in the public sector, and leaders in the business and health care communities, understand what the choices and new possibilities are. That is particularly evident in our work informing the development of New York’s health benefits exchange, through which individuals and small businesses will be able to access more affordable insurance. And it’s evident in the work of our Medicaid Institute to make New York’s $50 billion Medicaid program more cost-effective while better serving beneficiaries.

Now, we are adding yet another dimension to discussions about efficiency and cost. With rising costs principally driven by patients with severe chronic illness, often complicated by behavioral health issues, we are in the forefront of efforts to better coordinate care, and to put resources to work especially for those high-risk patients most likely to need intense services, before that need and its associated costs arise.

Expanding on that coordinated approach, we continue our initiatives to make family caregivers the integral part of the health care team that they, their ill family members, and health care providers need them to be—an issue that we helped bring to national attention. Along with giving family caregivers the training and support they need, we are working with health care professionals in hospitals, nursing homes, rehab centers, and home care agencies to dramatically expand their vision of families’ roles—and make chronic care safer and more effective in the process.

Similarly, we have pioneered connections between neighborhood health care and community services, to help seniors manage their chronic illnesses while remaining in their own homes. Our “Health Indicators” make it possible for communities to assess their seniors’ health status and to

plan targeted, evidence-based strategies for meeting their needs. And our Web-based “NORC Blueprint” is a nationally recognized resource on creating innovative, community-based programs to do just that.

Our focus on safe and effective care, acute as well as chronic, continues to shape and disseminate advances in hospital performance, helping make New York a leader in the quality movement. The multi-hospital collaborations that we have cosponsored and supported with funding and technical expertise have yielded significant improvements in infection rates, anticipating and warding off medical crises, and perinatal care. And we are taking those advances to the next

level by training a new generation of quality improvement leaders.

All these efforts reflect the broad-based recognition that fundamental change in the way health care is organized is the key to a smarter, more cost-effective health care system, and that the way we pay for care must be consistent with the goals of such a system. We also recognize that the growth of information technology that has kick-started the quality improvement movement underlies and enables all these efforts.

It will be difficult, moving from a system built around individual interactions between physician and patient to one that uses resources more efficiently, reduces cost growth, and, ultimately, offers better-coordinated, higher-quality care. But I am struck by the tremendous grass-roots energy—among providers, payers, and patients themselves—that is making real change for the better, every day.

As the Fund has done throughout our rich history, we continue to lead, support, and bring together those working to ensure New York health care’s excellence—identifying

innovations as they arise, helping disseminate them more broadly, and asking the essential tough questions about them.

It’s a time of daunting challenges, and dazzling promise, and we at the Fund are in the forefront of the momentum that’s building toward a more rational health care future. Your interest and support in our efforts and accomplishments are an important part of that, and we count on you to join us on the journey.