The Stew BLOG

Report Refresh: Population Health, Community Integrators, and Innovations in Financing

Bobby Milstein, Director, System Strategy | 08/19/2015

Last year, Jim Hester and Paul Stange wrote a provocative, but brief essay for the IOM Roundtable on Population Health Improvement entitled, A Sustainable Financial Model for Community Health Systems.

Most of the themes and proposals in that short commentary have been retained or expanded in this new CDC policy brief.

The section on “A Sustainable Payment Model for Community Integrators” begins with this unambiguous statement.

“The elusive ‘holy grail’ for the population health movement has been a payment model that breaks the cycle of dependence on limited-term grants and provides sustainable support for both infrastructure and interventions.  Two critical requirements that support sustainable population health improvement are reinvestment of a portion of the savings from interventions back into the community and better alignment of diverse funding sources with interventions in the balanced portfolio.” (p.6)

The report also defines several potential financing vehicles in the following three categories:

  • Payment models for care delivery that reward value-based outcomes instead of volume;
  • Multisector funds that blend resources into a common pool, such as through some Medicaid Section waivers; and
  • Innovative financing vehicles that access new and existing pools of public and private capital.

Looking ahead, the authors identify several looming challenges, including some that alter the very definition of success in this work.

“The business case for population health is complex and requires investments from multiple sectors that accrue over long periods of time.  This requires a shift in focus, as population health programs have traditionally been evaluated on the basis of risk factor reduction–that is, whether an intervention changed behavior–rather than on their combined health and financial impact.”  (p.10)

Here is the full citation:

Hester JA, Stange PV, Seeff LC, Davis JB, Craft CA. Toward Sustainable Improvements in Population Health: Overview of Community Integration Structures and Emerging Innovations in Financing. Atlanta, GA: CDC; 2015. CDC Health Policy Series, No. 2.  Available from

What do you find most valuable about this expanded essay?  Are there particular ideas that may help to advance your own work?

Download Towards Sustainable Improvements in Population Health_Hester

Bobby Milstein is a director at ReThink Health.