From the Wild West to the “final frontier” of space, the metaphor of the frontier has always served as a touchstone for American optimism. ReThink Health, an initiative of the Rippel Foundation, shares that optimism. Through our work with changemakers at the regional level, we seek to understand the frontiers of health policy and practice, boldly pursuing our vision: a United States in which all the sectors that affect health are led, designed, and financed in ways that foster healthy people and thriving communities.
Eighteen months ago, with support from the Robert Wood Johnson Foundation, ReThink Health embarked on a journey to Advance the Frontiers in Sustainable Financing and Health System Stewardship. Aimed at exploring and mapping what is happening in the field of regional health transformation, and identifying how we and others can help accelerate those efforts, this project allowed us to test and confirm ReThink Health’s learnings to date, build on them, and share those discoveries broadly.
What we found was both validating and instructive. While changemakers often have a clear vision of what transformed health looks like, they need help figuring out how to navigate the pathway that will take them there. The project reinforced the idea that the greatest challenges to transforming health at the regional level are around long-term, sustainable financing, and broad-based stewardship—which is a term that refers to leaders stepping beyond their organizational boundaries, working together, and sharing responsibility to advance health transformation.
Through our inaugural Pulse Check, we gathered information about multisector partnerships working to reimagine and transform regional health systems around the country—an effort we will continue annually. We complemented this with in-depth research as well as convenings of leaders of health partnerships.
Consistently, we found that even the most advanced regional leadership groups encounter potentially paralyzing hurdles when attempting to move beyond coordinated initiatives toward whole-scale redesign of the health ecosystem and greater interdependence among institutions in their regions.
One of these sticking points is the necessary mindset shift of changemakers—from organizational leader to system steward. Most of the regions profiled in the Pulse Check include leaders from many different sectors—not only health care and public health, but also nonprofits, social services, business, transportation, and education. To a lesser extent, leaders from the housing, health insurance, philanthropy, and media sectors are also involved. And while these leaders often align around specific priorities and strategies, they have a hard time sustaining and building a larger vision. They are often stymied by the inevitable pitfalls that line the pathway to a more interdependent and effective health ecosystem.
We have translated these insights into a new online, multimedia resource that will better help leaders entrenched in this challenging process. Stewarding Regional Health Transformation: A Guide for Changemakers is designed to help individual leaders and multisector collaborations to successfully navigate this pathway and determine the best ways to work together. The tools, case studies, and self-assessments will spur the big-picture thinking needed for leaders to step outside of their own frames of reference, assess where they are on their journey, and determine how they can enable and accelerate regional change.
Another related challenge that groups face is how to build and finance a long-term sustained effort that can remain in place long enough to achieve success. Nearly three-quarters of those who responded to the Pulse Check named financing as their most persistent challenge, with the vast majority relying on just a few short-term mechanisms, such as contracts with and grants from government agencies and foundations, and community benefit funding from hospitals.
This lack of sustainable resources accounts for the common “reform and rebound” pattern we have seen play out across the country. Often, a specific reform initiative begins with financing in place, but the funding ends, and the group finds itself back where it started. This is not only discouraging to those active in reform efforts, but it is at odds with the transformative change that we know is necessary.
There are a growing number of mechanisms to finance health reform efforts. In fact, the Pulse Check identified thirty-three different approaches being used today. But the promise of modern innovations such as social impact bonds and welfare trusts does not necessarily mean they are appropriate to the task at hand. Financing can be daunting for the multiple regional stakeholders and sponsoring organizations who come together to advance a health reform agenda.
Ideally, leaders need to develop the fiscal fluency to understand the full array of financing opportunities and build on them. But these skills aren’t learned in school or on the job. We have compiled a number of resources and curated an online multimedia portal that will introduce leaders to the imperative of financing. Financing Regional Health Transformation: A Primer for Changemakers helps orient those working to transform health toward an understanding of the importance of financing and which financing options are available. The primer offers a multimedia experience through podcast interviews with experts in the field (including Suzanne Delbanco, Miriam Laugesen, and Bobby Milstein); topical videos; tools to test investment scenarios; recommended readings; curated reference lists; and links to organizations that are devoted to changing how we pay for health in its fullest sense.
All of our tools and resources are aimed at providing change agents with the information, insights, and actions needed to overcome entrenched beliefs and to question the status quo. I hope you will share these materials with the most activated changemakers you know, inspiring them to reimagine and transform health. The Pulse Check, stewardship guide, and financing primer are all available at www.rethinkhealth.org.
Related reading:
“The Rippel Foundation And The RWJF Push Frontiers For Financing And Sustaining Improvements In Health,” by Laura Landy, president and CEO of the Rippel Foundation and founder and chair of ReThink Health, GrantWatch section of Health Affairs Blog, February 13, 2014.
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