Financing Population Health Improvement: Workshop Summary (2015)

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Introduction and Overview¹

Despite spending far more on medical care than any other nation and despite having seen a century of unparalleled improvement in population health and longevity, the United States has fallen behind many of its global counterparts and competitors in such health outcomes as overall life expectancy and rates of preventable diseases and injuries. A fundamental but often overlooked driver of the imbalance between spending and outcomes is the nation’s inadequate investment in nonclinical strategies that promote health and prevent disease and injury population-wide, strategies that fall under the rubric of “population health.”

A previous report from the Institute of Medicine’s (IOM’s) Board on Population Health and Public Health Practice, For the Public’s Health: Investing in a Healthier Future, concluded that “funding for governmental public health is inadequate, unstable, and unsustainable” and that “the underinvestment in public health has ramifications for the nation’s overall health status, for its financially strained health care delivery system, and for its economic vitality and global competitiveness” (IOM, 2012, p. 14). Given that it is unlikely that government funding for governmental public health agencies, whether at the local, state, or federal levels, will see

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¹The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.

significant and sustained increases, there is interest in finding creative sources of funding for initiatives to improve population health, both through the work of public health agencies (the focus of the 2012 IOM report) and through the contributions of other sectors, including non-health entities.

To explore the range of resources that might be available to provide a secure funding stream for non-clinical actions to enhance health, the Roundtable on Population Health Improvement held a public workshop on February 6, 2014, that featured a number of presentations and discussions, beginning with an overview of the range of potential resources (e.g., financial, human, and community) and followed by an in-depth exploration of several dimensions related to financial resources. Examples of the topics covered included return on investment, the value of investing in population-based interventions, and possible sources of funding to improve population health.

THE ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT

The Roundtable on Population Health Improvement provides a trusted venue for leaders from the public and private sectors to meet and discuss leverage points and opportunities for achieving a more healthy population, which arise from changes in the social and political environment. The Roundtable’s vision is of a strong, healthy, and productive society that cultivates human capital and equal opportunity. Fulfilling this vision begins with the recognition that outcomes such as improved life expectancy, quality of life, and health for all are shaped by interdependent social, economic, environmental, genetic, behavioral, and health care factors and that achieving these outcomes will require robust national and community-based policies and dependable resources.

In his introductory remarks, workshop co-chair and planning committee member George Isham, senior advisor to HealthPartners and senior fellow at the HealthPartners Institute for Education and Research, said that the Roundtable intends to “catalyze urgently needed action toward a stronger, [healthier], and [more] productive society and to facilitate sustainable collaborative action by a community of science-informed leaders and public health care, business, education, early childhood development, housing, agriculture, transportation, economic development, and nonprofit and faith-based organizations.” To accomplish these goals, the Roundtable has identified six areas of activity on which it is working:

• identifying and informing the deployment of key population health metrics;

• providing insight and information on the allocation of adequate resources to achieve improved population health;
• identifying, evaluating, and informing the deployment of research to improve health;
• sharing insights and informing the development and implementation of public- and private-sector policies that can improve health;
• fostering and building relationships that will inspire stakeholder participation in the effort to improve population health; and
• reflecting on the design and implementation of effective communication strategies that inform stakeholders and decision makers about the forces that shape health.

WORKSHOP SCOPE AND OBJECTIVES

To help advance knowledge and inform thinking about resources that can be used to improve population health, this workshop was held. The workshop planning committee was given the charge in Box 1-1.²

The workshop, the fifth in an ongoing series organized by the Roundtable, was divided into a series of sessions that each included an overview talk and a panel discussion. The workshop began with an introduction on how the nation might pay for health improvement interventions occurring outside the clinical arena, followed by a session on health care system investments in population health. That session was followed by sessions on the relationship between community development and population health and between pay-for-success financing and community health, and then a concluding panel on the implications of new and emerging sources of population health funding. The central purpose of each session was to provide a better understanding of the various resources needed to support improvements in population health. Although these resources could be financial resources, resources related to the workforce and associated education or training, informational resources, or the broad category of assets that communities bring to the table such as social capital and cultural diversity, this workshop focused on financial resources and, in particular, on the varied private sector funding sources and mechanisms that can help alter the social and environmental determinants of health.

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²The planning committee’s role was limited to planning the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.

BOX 1-1
Statement of Task

ORGANIZATION OF THE SUMMARY

This publication summarizes the discussions that occurred throughout the workshop, highlighting the key lessons presented, practical strategies, and the needs and opportunities for improving future capacity to fund and implement effective interventions and to measure the outcomes of the interventions that have been implemented. Chapter 2 provides an overview of the financial resources that are available for population health improvement, and Chapter 3 considers how the health care delivery system itself can invest in effective population health interventions, including through partnership with other sectors, such as housing. Chapter 4 highlights examples where community development and health improvement interests align to the benefit of both practice communities, while Chapter 5 discusses three new pay-for-success financing schemes that are being used to fund population health interventions at scale. Chapter 6 summarizes the participants’ reflections on what they learned from the day’s proceedings.