Levers of Change: Local Focus, System-Wide Gains

For a small organization, the United Hospital Fund has a very large mission: to improve health care—both the outcomes and experience of health care—for all New Yorkers. We've had notable, even outsize, successes through the years, by using our resources strategically, focusing on key levers of change.

One way we've been doing that is by analyzing policies to assess how they encourage or inhibit a good health system—and by developing options for policy change to support improved outcomes.

We've all seen the enormous payoff of such work—a net increase of more than 375,000 insured New Yorkers in just the first year of the State's insurance exchange, and a major investment in reshaping New York's Medicaid program, to name just two advances. UHF is proud to have contributed in-depth, independent, insightful analysis that provided a basis for sound health policy decisions in New York, and we will continue to do so.

For the moment, the barbed debate about how to expand health coverage has largely abated. The Affordable Care Act and other hard-won policy changes have affirmed the goals and more clearly identified the breadth of issues that must be tackled for real transformation to occur, from who's covered, at what cost, through how services are delivered, paid for, and evaluated.

Now, UHF is increasingly bringing resources and attention to the challenge of moving from theory to reality—of creating concrete improvements in the delivery of care to patients and their families.

One key way of doing that is to advance the most thoroughly studied evidence-based practices—as well as promising innovative approaches—and bring them to scale. But spreading best practices that result in a positive experience and outcomes for patients remains extremely difficult, and creates the next generation of challenges: to take what works—innovative, optimal care, delivered effectively and efficiently—and make it standard practice across our system. That becomes, in the final analysis, the test of whether the better-performing health care system we all seek will be a success.

Building on our in-depth knowledge of New York's complex health care environment is another way in which UHF participates actively in the work of improving health care.

We're a New York organization that has used our understanding of the needs and strengths of our local institutions and local populations to lead and foster improvements in the city's health care services for more than 136 years.

Yet our relationships with policymakers, health care providers, payers, the business and nonprofit communities, and patient advocates, throughout the city and beyond—and our ability to bring those stakeholders together for productive exchanges—allow us to identify, assess, and help grow the most promising models for health care improvement on a broader scale. New York is, in fact, for the first time in many years, considered less an outlier than a model for approaches and programs that can be successfully applied elsewhere as well.

Another UHF characteristic: we tackle health care challenges in multiple dimensions—from access and affordability to quality and better ways of delivering services—but understand that all are interlocking parts of a larger whole, and actively make the connections among them.

Similarly, we are acutely mindful of the complexity of need, and know that approaches that will benefit a majority of people may not necessarily address the situations of specific groups of vulnerable New Yorkers. Our goal, always, is a better health system for all New Yorkers—not only those in the current policy or media spotlight, and not only the high-need, high-cost patients we typically think of, but also children, immigrants, the elderly, and family caregivers, to name a few.

UHF is also a facilitator and catalyst. Our initiatives have significantly improved patient safety in health care facilities. Created community-based supports for chronically ill seniors. Helped hundreds of thousands of family caregivers navigate the complexities of their tasks and the health care system.

Underlying our work are three deceptively simple questions that—well articulated or merely intuited—most New Yorkers have: Can I afford care? Can I find appropriate, effective care at an appropriate, convenient time and place? Does the care I get improve my health or support my well-being?

Those questions are our constant guide. They reflect what is central to our mission and to our work, the touchstone to which we always return: the people of New York, in all our diversity and resilience. How well our analyses, convening, grants, and guidance—our use of the levers at hand to create change in the larger world—translate into more effective health care for our fellow New Yorkers remains the measure of our success.

As always, we value your interest and support, and welcome your input as we continue to work for quality health care and better health for all.