Philanthropy and Beyond: Creating Shared Value to Promote Well-Being for Individuals in Their Communities.

Health care organizations can magnify the impact of their community service and other philanthropic activities by implementing programs that create shared value. By definition, shared value is created when an initiative generates benefit for the sponsoring organization while also generating societal and community benefit. Because the programs generate benefit for the sponsoring organizations, the magnitude of any particular initiative is limited only by the market for the benefit and not the resources that are available for philanthropy.In this article we use three initiatives in sectors other than health care to illustrate the concept of shared value. We also present examples of five types of shared value programs that are sponsored by health care organizations: telehealth, worksite health promotion, school-based health centers, green and healthy housing, and clean and green health services. On the basis of the innovativeness of health care organizations that have already implemented programs that create shared value, we conclude that the opportunities for all health care organizations to create positive impact for individuals and communities through similar programs is large, and the limits have yet to be defined.

Population health improvement: a community health business model that engages partners in all sectors.

Because population health improvement requires action on multiple determinants--including medical care, health behaviors, and the social and physical environments--no single entity can be held accountable for achieving improved outcomes. Medical organizations, government, schools, businesses, and community organizations all need to make substantial changes in how they approach health and how they allocate resources. To this end, we suggest the development of multisectoral community health business partnership models. Such collaborative efforts are needed by sectors and actors not accustomed to working together. Healthcare executives can play important leadership roles in fostering or supporting such partnerships in local and national arenas where they have influence. In this article, we develop the following components of this argument: defining a community health business model; defining population health and the Triple Aim concept; reaching beyond core mission to help create the model; discussing the shift for care delivery beyond healthcare organizations to other community sectors; examining who should lead in developing the community business model; discussing where the resources for a community business model might come from; identifying that better evidence is needed to inform where to make cost-effective investments; and proposing some next steps. The approach we have outlined is a departure from much current policy and management practice. But new models are needed as a road map to drive action--not just thinking--to address the enormous challenge of improving population health. While we applaud continuing calls to improve health and reduce disparities, progress will require more robust incentives, strategies, and action than have been in practice to date. Our hope is that ideas presented here will help to catalyze a collective, multisectoral response to this critical social and economic challenge.

HealthPartners adopts community business model to deepen focus on nonclinical factors of health outcomes.

Clinical care contributes only 20 percent to overall health outcomes, according to a population health model developed at the University of Wisconsin. Factors contributing to the remainder include lifestyle behaviors, the physical environment, and social and economic forces--all generally considered outside the realm of care. In 2010 Minnesota-based HealthPartners decided to target nonclinical community health factors as a formal part of its strategic business plan to improve public health in the Twin Cities area. The strategy included creating partnerships with businesses and institutions that are generally unaccustomed to working together or considering how their actions could help improve community health. This article describes efforts to promote healthy eating in schools, reduce the stigma of mental illness, improve end-of-life decision making, and strengthen an inner-city neighborhood. Although still in their early stages, the partnerships can serve as encouragement for organizations inside and outside health care that are considering undertaking similar efforts in their markets.

Achieving accountability for health and health care.

There is no well-established mechanism at the local level to discuss or manage the balance of investments in health care and the other social determinants of health. We propose the development of voluntary regional organizations and/or use of current organizations to work with stakeholders of the health system to 1) review local data on health, experience and quality of care, and costs of care (Triple Aim); 2) create shared goals, actions and investments to meet the Triple Aim; and 3) involve citizens in local delivery system reform and stewardship of financial resources. These accountable health communities (AHCos) would contribute to co-creating a sustainable health system.

The simple health system rules that create value.

In 1991, Plsek sought to improve the quality of health care by challenging the readers of Crossing the Quality Chasm to find the few simple rules that might guide the local development of the 21st century health system. We have analyzed our health system's activities in the context of systems science as it seeks to create value (improve population health and patient experience, and reduce costs) for its stakeholders. We have concluded that 5 rules are simultaneously necessary and sufficient for success: 1) The stakeholders agree on a set of mutual, measurable goals for the health system; 2) the extent to which the goals are being achieved is reported to the public; 3) resources are available to achieve the goals; 4) stakeholder incentives, imperatives, and sanctions are aligned with the agreed-on health system goals; and 5) leaders among all stakeholders endorse and promote the agreed-on health system goals.

Measuring health care access and quality to improve health in populations.

Poor health status, rapidly escalating health care costs, and seemingly little association between investments in health care and health outcomes have prompted a call for a "pay-for-performance" system to improve population health. We suggest that both health plans and clinical service providers measure and report the rates of 5 behaviors: 1) smoking, 2) physical activity, 3) excessive drinking, 4) nutrition, and 5) condom use by sexually active youth. Because preventive services can improve population health, we suggest that health plans and clinical service providers report delivery rates of preventive services. We also suggest that an independent organization report 8 county-level indicators of health care performance: 1) health care expenditures, 2) insurance coverage, 3) rates of unmet medical, dental, and prescription drug needs, 4) preventive services delivery rates, 5) childhood vaccination rates, 6) rates of preventable hospitalizations, 7) an index of affordability, and 8) disparities in access to health care associated with race and income. To support healthy behaviors, access to work site wellness and health promotion programs should be measured. To promote coordinated care, an indicator should be developed for whether a clinical service provider is a member of an accountable care organization. To encourage clinical service providers and health plans to address the social determinants of health, organizational participation in community-benefit initiatives that address the leading social determinants of health should be assessed.

Crossroads in quality.

Expanding insurance coverage is a critical step in health reform, but we argue that to be successful, reforms must also address the underlying problems of quality and cost. We identify five fundamental building blocks for a high-performance health system and urge action to create a national center for effectiveness research, develop models of accountable health care entities capable of providing integrated and coordinated care, develop payment models to reward high-value care, develop a national strategy for performance measurement, and pursue a multistakeholder approach to improving population health.

Partnering care delivery and research to optimize health.

A close partnership between care delivery and research organizations has the potential to provide essential elements needed to optimize health and health care. This clinical leadership panel, held during the 14th Annual Health Maintenance Organization Research Network (HMORN) Conference, identifies the value, opportunities and challenges of those close partnerships between three HMORN care delivery and research organizations. The objectives of this plenary session were: (1) identify the important facets of partnership that bring value to care delivery and research, (2) pinpoint the critical alignments of care delivery and research that are needed to fulfill the promised value between clinical and research organizations, and (3) recognize the challenges that clinical and research organizations need to address.

Applying the planned care model to intimate partner violence.

PURPOSE: This article presents the steps for organizing a health organization's response to intimate partner violence (IPV) according to the Planned Care Model (PCM). IPV is common and costly and results in poor physical and mental health outcomes for victims and their families. Because most care is not acute, a planned approach that crosses systems may result in more comprehensive and higher quality care. Community collaboration with IPV agencies is especially critical. The health care organization must make IPV a priority and set policies and systems to identify and manage patients, train staff, and measure, monitor, and provide feedback on outcomes. Other key PCM components include: practice design--design systems to identify and track victims, stratify risk, and coordinate care; evidence-based decision support--choose validated IPV screening questions and guidelines for identification, management, and referral and make them available in a systematic way with ongoing assessment and feedback to providers and other members of the health care team; patient self-management--self-man-agement materials should be selected and disseminated to those working with IPV victims; and data information systems--these should support a confidential patient registry and efforts to audit and provide feedback about identification and referral efforts. Process and outcome measures based on the management guidelines and protocols should be developed and monitored, and the results disseminated. CONCLUSION: Adapting PCM for the management of IPV stretches the traditional acute approach to IPV of screen-identify-refer. It expands the PCM into new realms, including embracing new partners, trying innovative ways to measure return on investment, grappling with ethical dilemmas, and designing a multifactorial evaluation across systems.

The boomers are coming: a total cost of care model of the impact of population aging on health care costs in the United States by Major Practice Category.

OBJECTIVE: To project the impact of population aging on total U.S. health care per capita costs from 2000 to 2050 and for the range of clinical areas defined by Major Practice Categories (MPCs). DATA SOURCES: Secondary data: HealthPartners health plan administrative data; U.S. Census Bureau population projections 2000-2050; and MEPS 2001 health care annual per capita costs. STUDY DESIGN: We calculate MPC-specific age and gender per capita cost rates using cross-sectional data for 2002-2003 and project U.S. changes by MPC due to aging from 2000 to 2050. DATA COLLECTION METHODS: HealthPartners data were grouped using purchased software. We developed and validated a method to include pharmacy costs for the uncovered. PRINCIPAL FINDINGS: While total U.S. per capita costs due to aging from 2000 to 2050 are projected to increase 18 percent (0.3 percent annually), the impact by MPC ranges from a 55 percent increase in kidney disorders to a 12 percent decrease in pregnancy and infertility care. Over 80 percent of the increase in total per capita cost will result from just seven of the 22 total MPCs. CONCLUSIONS: Understanding the differential impact of aging on costs at clinically specific levels is important for resource planning, to effectively address future medical needs of the aging U.S. population.