Lovisa Gustafsson is a Vice President at the Commonwealth Fund, a philanthropic organization, where she leads the Controlling Health Care Costs program. The Fund is a private foundation dedicated to providing a high-caliber healthcare system, with a particular focus on the most vulnerable. The philanthropy funds research and provides grants to improve healthcare policy and practice. Ms. Gustafsson earned an MBA in Health Care Management from the Wharton School at the University of Pennsylvania and an A.B. in Sociology from Harvard College.

Lovisa Gustafsson, Vice President at the Commonwealth Fund

The Pulse: Can you begin by giving some color on the Commonwealth Fund and tell me a bit more about your career journey?

Lovisa Gustafsson: The Commonwealth Fund is a philanthropic foundation that focuses on creating a healthcare system that is equitable, affordable, and accessible for everyone.

We often describe ourselves as a mix between a think tank and a grant-making organization. We conduct in-house research and publications while also funding external grantees to explore solutions to pressing healthcare issues. Our focus areas include insurance coverage, affordability, delivery models that provide higher value, and strengthening primary care. While our mission has remained constant, our specific areas of focus shift with the evolving healthcare landscape and policy dynamics. This helps us address the most urgent and impactful issues at any given time.

I joined the Commonwealth Fund eight years ago. Before that, I worked in a variety of roles that intersected policy and business. I spent several years in healthcare consulting, focusing on regulatory and strategy issues, and worked briefly with MassHealth, Massachusetts’ Medicaid program. After business school, I joined McKesson, and through these roles, I gained experience across the private, public, and non-profit sectors. This varied background has given me a well-rounded understanding of healthcare and its key stakeholders.

I had always admired the Commonwealth Fund. As an undergraduate at Harvard studying health policy, I often encountered their research in my coursework. When a position that matched my skills and experience became available, it felt like the perfect opportunity to join an organization whose mission I had long respected.

The Pulse: The Commonwealth Fund has a long and storied history. Could you share more about its origins and evolution?

LG: The Commonwealth Fund was founded in 1918 and is one of the first foundations established by a woman. Its original mission was broadly defined as “doing something good for mankind.” Over time, it has contributed significantly to the healthcare field through transformative initiatives. For example, it funded the development of the Pap smear and its subsequent dissemination, supported the first pilot of hospice care in the U.S., and invested in building hospitals and medical schools, including HBCUs, to foster a more diverse healthcare workforce.

In its early years, the foundation took on a wide range of projects, but over the past 30 years, we’ve focused exclusively on healthcare. Today, our work falls into three broad areas: leadership development, policy research, and improving the delivery of care. Leadership development includes fellowships that bring international experts to the U.S. and programs at institutions like Harvard and Yale to support equity and minority leaders in healthcare. On the policy side, we study issues like healthcare costs, inequities, and potential solutions, while our practice work focuses on improving how care is delivered, such as advancing value-based payment models.

The Pulse: How does the Commonwealth Fund influence policy without engaging in advocacy?

LG: As a 501(c)(3) organization, we don’t advocate for specific legislation. Instead, we see our role as providing evidence that highlights critical healthcare issues, explores potential solutions, and assesses their implications. This involves both conducting our own research and funding external studies on topics like cost trends, insurance coverage, and inequities in the healthcare system.

Our goal is to help policymakers and stakeholders understand the challenges and options available. For example, if healthcare spending is unsustainable, we might highlight the potential benefits of value-based payment models. When a “policy window” opens—such as a moment when stakeholders agree there’s a problem to address—our research helps inform the debate and guide decisions. While much of our focus is federal, we also work at the state level, which often serves as a testing ground for innovative policies that can later scale nationally.

The Pulse: Are there particular areas where the U.S. could make significant strides in healthcare?

LG: Affordability is a critical issue across the board—whether for individuals, employers, or government payers like Medicare and Medicaid. Prescription drug pricing is a major concern, but affordability extends beyond medications to include broader healthcare costs. Policymakers are also interested in consolidation, private equity’s growing role in healthcare, and the value being delivered to patients versus profits.

Transparency is another area of focus, as inefficiencies in the system often obscure where money is going and why. For example, there’s growing scrutiny of intermediaries like pharmacy benefit managers (PBMs) and how their practices impact pricing and access. Policymakers from both parties are showing interest in addressing these inefficiencies, particularly when they put profits ahead of patient outcomes.

The Pulse: Do you see opportunities for meaningful change under the new administration?

LG: It’s too early to say for sure. Much depends on key appointments and the administration’s specific healthcare priorities. That said, healthcare is always a significant focus for policymakers because it represents such a large portion of federal and state budgets. Medicaid, Medicare, prescription drug pricing, and reforms targeting intermediaries like PBMs will likely remain high on the agenda.

Federal opportunities often hinge on legislative vehicles that can carry these reforms forward. However, even in the absence of federal action, states can play a crucial role in piloting innovative approaches that might later be scaled nationally.

The Pulse: This year’s conference theme is “Beyond disruption: Building lasting healthcare transformation.” How does this resonate with you?

LG: Sustainable innovation is about delivering real value. High prices aren’t necessarily a problem if they correspond to significant improvements in patient outcomes, such as addressing unmet needs or reducing hospitalizations. However, we often see cases where new products enter the market with higher prices, but no added benefit compared to existing options. These inefficiencies undermine trust in the system and discourage meaningful innovation.

At the Commonwealth Fund, we focus on reducing low-value spending and reinvesting those resources into areas that truly benefit patients. By incentivizing meaningful innovation—products and services that improve outcomes and lower overall costs—we can create a more sustainable healthcare system.

The Pulse: What advice would you give to students interested in public policy or academic roles in healthcare?

LG: You don’t need to choose between public and private sectors. Gaining experience in both can make you a more well-rounded professional and a more effective contributor to the healthcare ecosystem. Policy is a major driver in healthcare because the government is the largest payer, and private sector practices often follow public policy trends.

Some of my most successful business school peers started their careers in government, gaining invaluable insights into how the system works. This experience allowed them to transition back to private roles with a unique perspective that enhanced their impact. I encourage students to explore opportunities in public policy, even if just for an internship or a few years after graduation. It can be rewarding work, and you might find it aligns with your long-term goals.

Interviewed by Henri Mattila, December 11, 2024.