THE LEARNING HEALTH SYSTEM SERIES

VALUING AMERICA’S HEALTH

Aligning Financing to Reward Better Health and Well-Being

WASHINGTON, DC
NAM.EDU

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

NATIONAL ACADEMY OF MEDICINE 500 Fifth Street, NW Washington, DC 20001

This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a contribution worthy of public attention but does not constitute endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual contributors and do not represent formal consensus positions of the authors’ organizations; the NAM; or the National Academies of Sciences, Engineering, and Medicine.

This initiative was convened with support from the George Family Foundation, Nemours, Samueli Foundation, Well Being Trust, and Whole Health Institute. Any opinions, findings, or conclusions expressed in this publication do not necessarily reflect the views of any organization or agency that assisted in the development of this project.

International Standard Book Number-13: 978-0-309-70620-9
International Standard Book Number-10: 0-309-70620-3
Digital Object Identifier: https://doi.org/10.17226/27141
Library of Congress Control Number: 2023948064

Copyright 2024 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation: National Academy of Medicine. 2024. Valuing America’s Health: Aligning Financing to Reward Better Health and Well-Being. Hm. Pham, M. Chesney, D. Chisolm, D. Erickson, C. Koller, P. Long, L. G. Moore, L. M. Nichols, A. Offodile, C. Powell, J. Sharfstein, D. Shurney, S. Szanton, J. Lee, J. L. Flaubert, M. Cocchiola, P. S. Chua, A. Anise, and A. Hunt, editors. NAM Special Publication. Washington, DC: The National Academies Press.

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ABOUT THE NATIONAL ACADEMY OF MEDICINE

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Learn more about the National Academy of Medicine at NAM.edu.

VALUING AMERICA’S HEALTH: ALIGNING FINANCING TO REWARD BETTER HEALTH AND WELL-BEING

Steering Group Members

HOANGMAI PHAM (Chair), Institute for Exceptional Care

MARGARET CHESNEY, University of California, San Francisco

DEENA CHISOLM, Nationwide Children’s Hospital

DAVID ERICKSON, Federal Reserve Bank of New York

CHRISTOPHER KOLLER, Milbank Memorial Fund

PETER LONG, Blue Shield of California

L. GORDON MOORE, Goodside Health

LEN M. NICHOLS, The Urban Institute

ANAEZE OFFODILE, MD Anderson Cancer Center

CHERYL POWELL, Ad Hoc LLC

JOSHUA SHARFSTEIN, Johns Hopkins University

DEXTER SHURNEY, Adventist Health

SARAH SZANTON, Johns Hopkins University

NAM Staff

Development of this publication was facilitated by contributions of the following NAM staff, under the guidance of J. Michael McGinnis, Leonard D. Schaeffer Executive Officer and Executive Director of the NAM Leadership Consortium:

JENNIFER LEE, Visiting Scholar (until April 2022)

JENNIFER LALITHA FLAUBERT, Program Officer

MICHAEL COCCHIOLA, Associate Program Officer (until July 2022)

PEAK SEN CHUA, Consultant

AMANDA HUNT, Senior Program Officer (from August 2022)

AYODOLA ANISE, Deputy Director, NAM Leadership Consortium (until February 2023)

SHARYL NASS, Director of the Board on Health Care Services

JENNA L. OGILVIE, Deputy Director of Communications (until April 2023)

MADELEINE DEYE, Editorial Projects Coordinator

TOCHI OGBU-MBADIUGHA, Senior Program Assistant (until June 2022)

DISCLOSURE OF CONFLICTS OF INTEREST

L. GORDON MOORE discloses former employment by 3M Information Systems.

JOSHUA SHARFSTEIN discloses personal fees from Sachs Policy Group, a health care and health care payment consulting company.

NAM LEADERSHIP CONSORTIUM

Collaboration for a Learning Health System

MARK B. MCCLELLAN (Chair), Duke University

AMY ABERNETHY, Verily

SHANTANU AGRAWAL, Anthem Inc.

JEFFREY BALSER, Vanderbilt University Medical Center

GEORGES BENJAMIN, American Public Health Association

RACHELE BERRIA, AstraZeneca

DAVID BLUMENTHAL, The Commonwealth Fund

NAKELA COOK, PCORI

KAREN DESALVO, Google

JUDITH FAULKNER, Epic Systems

DAVID FEINBERG, Cerner

JULIE L. GERBERDING, Merck & Co., Inc.

SANDRA HERNANDEZ, California Health Care Foundation

DIANE HOLDER, UPMC Health Plan

MICHELE HOOD, American Hospital Association

FREDERICK ISASI, Families USA

ADAM LENKOWSKY, Bristol Myers Squibb

PETER LONG, Blue Shield of California

JAMES L. MADARA, American Medical Association

LAURA MAURI, Medtronic

SUZANNE MIYAMOTO, American Academy of Nursing

VALERIE MONTGOMERY RICE, Morehouse School of Medicine

MARY D. NAYLOR, University of Pennsylvania

HAROLD PAZ, Stony Brook University

JONATHAN B. PERLIN, The Joint Commission

RICHARD PLATT, Harvard Medical School

DWAYNE PROCTOR, Missouri Foundation for Health

KYU RHEE, CVS Health, Aetna

LEWIS G. SANDY, UnitedHealth Group

LEONARD D. SCHAEFFER, University of Southern California

BRUCE SIEGEL, America’s Essential Hospitals

DAVID SKORTON, Association of American Medical Colleges

JENNIFER TAUBERT, Johnson & Johnson

REED V. TUCKSON, Tuckson Health

DEBRA B. WHITMAN, AARP

NAM Leadership Consortium Staff

LAURA ADAMS, Senior Counsel

AYODOLA ANISE, Deputy Director (until February 2023)

SARAH GREENE, Senior Counsel

AMANDA HUNT, Senior Program Officer

SUNITA KRISHNAN, Program Officer (since December 2022)

J. MICHAEL MCGINNIS, Executive Director

ANNIE MURFF, Senior Program Assistant

STEPHANIE STAN, Research Associate (since June 2023)

ASIA WILLIAMS, Program Officer

ACKNOWLEDGMENTS

The Steering Group would like to thank members of the Health Financing Writing Group, who helped develop and provide independent feedback on the Special Publication’s care financing and economics content featured in sections 4 and 5. The members of the group are as follows.

The Steering Group would also like to thank Maggie Super Church for her contributions in understanding the design, implementation, impact, and current developments related to the Healthy Neighborhoods Study along with the Healthy Neighborhood Equity Fund I and II. Maggie Super Church serves as an independent consultant and the former vice president for healthy and resilient communities at the Conservation Law Foundation.

REVIEWERS

This Special Publication was reviewed in draft form by the Steering Group, who were chosen for their diverse perspectives and technical expertise, in accordance with review procedures established by the National Academy of Medicine (NAM).

We wish to thank the following individuals for their contributions:

The reviewers listed above provided many constructive comments and suggestions, but they were not asked to endorse the content of the publication and did not see the final draft before it was published. Review of this publication was overseen by AYODOLA ANISE, Deputy Director, Leadership Consortium; PEAK SEN CHUA, Consultant; JENNIFER LALITHA FLAUBERT, Program Officer; AMANDA HUNT, Senior Program Officer; and J. MICHAEL MCGINNIS, Leonard D. Schaeffer Executive Officer. Responsibility for the final content of this publication rests entirely with the editors and the NAM.

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CONTENTS

Preface

Acronyms and Abbreviations

Introduction and Initiative Background

1 Valuing America’s Health

2 A Vision for Better Health and Well-Being

3 Prioritizing Whole Person and Whole Population Health and Well-Being

4 Investment Goals and Priority Actions

5 Health Transformation Through Disruptive Change

APPENDIXES

A Financing That Rewards Better Health and Well-Being Workshop Series Participant Suggestions

B Stakeholder-Specific Priority Actions by Impact and Feasibility

C Illustrative Models of Implementing Whole Person, Whole Population Health Priority Actions

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BOXES, FIGURES, AND TABLE

BOXES

1 Steering Group Members

2 Key Pillars of the Vision for Whole Person and Whole Population Health and Well-Being

3 Innovative Whole Person and Whole Population Health Service Providers

4 Housing Stability: Aligning Federal Policies with the Vision for Whole Person, Whole Population Health

5 Food Security: Aligning Federal Policies with the Vision for Whole Person, Whole Population Health

FIGURES

1 Whole person health in the context of whole population health

2 Life expectancy for OECD countries

3 U.S. Veterans Health Administration Circle of Health

4 Key components of multi-stakeholder community collaborations

5 Sample dynamics of disruptive policy | housing stability

6 Sample dynamics of disruptive policy | food security

TABLE

1 Whole Health Service Use Among Veterans with Chronic Pain, Mental Health Diagnoses, and Chronic Conditions from the First Quarter of 2017 to the Third Quarter of 2019

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PREFACE

Whole person, whole population health—the ability for people and populations to thrive and attain their full, optimized potential for health and well-being—is the ultimate goal of a healthy nation. Unfortunately, the United States faces a crisis in our collective health and well-being: declining life expectancy driven by long-standing and deepening inequities, a global pandemic, and the persistent inefficiency, ineffectiveness, and high cost of the nation’s health and health care system.

A response proportional to this crisis is required. To mobilize real-world implementation, the National Academy of Medicine (NAM) convened 13 eminent experts, with experience across care financing and payment, equity and community engagement, and private capital markets, to review a full set of opportunities, levers, and disruptive forces that could uproot dominant fee-for-service interests and effect a shift toward whole person, whole population health.

This NAM Special Publication, Valuing America’s Health: Aligning Financing to Reward Better Health and Well-Being, clearly underscores the urgency for the nation to reckon with the glaring shortfalls in the nation’s health system. It also describes why health cannot be financed, delivered, and sustained by the health and health care sector alone. Health consequences are resident in virtually every decision, policy, and action taken throughout the individuals, organizations, and sectors that constitute our nation’s society and economy. Furthermore, with the necessary leadership from government, and grassroots demand for solutions from communities, all members of society can contribute to an immediate, forceful, and momentous shifting of values, incentives, and culture that are both exogenous and endogenous to the health and health care system. Finally, the Special Publication outlines transformative actions that will help critical system stakeholders to more effectively execute responsibilities for our collective health and well-being.

The partnership between the NAM and the involved stakeholders is part of extensive and ongoing contributions to transformative health financing. Over

the past 2 years, the NAM has conducted a phased release of nine sectoral impact assessments and an associated discussion of cross-cutting policy implications. The final synthesis publication was released in August 2022. In 2021, the NAM conducted a broad appraisal of the Center for Medicare & Medicaid Innovation (CMMI) on the effectiveness of alternative payment models, gaps in data collection to support equity, and opportunities to engage beneficiaries, businesses, payers, and providers more meaningfully. The resultant publication, the CMMI Opportunity Agenda, was released in September 2022 and has already informed CMMI’s current strategic plan.

Given these contributions, it is clear that additional partnerships, cross-sectoral connections, and continuous engagement are required to realize this Special Publication’s vision of whole person, whole population health. We look forward to assisting in the achievement of that vision.

ACRONYMS AND ABBREVIATIONS

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