What is ReThink Health?

At ReThink Health, a Rippel initiative, we work with national and regional stewards to discover what it takes to design and execute transformative change and produce better health and well-being for all.

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Who are Stewards?

Stewards are people or organizations who take responsibility for working with others to create conditions that all people need to thrive, beginning with those who are struggling and suffering. Stewards may be affiliated with organizations or may act on their own agency, such as a resident. Stewards have (or are interested in developing) an equity orientation in regard to purpose, power, and wealth.

They understand

Purpose must be larger than oneself and one’s organization.
Power must be built and distributed with others, not consolidated.
Wealth must be invested, not withheld, to create long-term value as well as address short-term urgent needs.

As a Rippel initiative, we are interested in working with a particular kind of steward—those who are positioned to influence how regional decisions are made, and how resources are spent—to equitably shift the system in ways that better produce health and well-being.

How do stewards shift the system that produces health and well-being?

Rippel’s best hypothesis is that as stewards mature in their ability to facilitate cross-sector collaboration and alignment, they are able to create a new ecosystem for health and well-being in their regions; an ecosystem known for producing equitable outcomes. This hypothesis is backed by both empirical and anecdotal evidence. Like Rippel, you might be wondering: how do stewards mature? Working together with stewards to discover “how” is the reason for Rippel’s ReThink Health initiative and its multiple projects.

One of the major contributions of the ReThink Health Frontiers and Ventures projects was to develop A Pathway for Transforming Health and Well-Being Through Regional Stewardship. This Pathway clarifies Rippel’s hypothesis about the essential practices stewards should commit to and develop as part of their quest. It also describes what stewards can expect to experience when they work together in these ways, across five phases of development.

As our team works with stewards, we all get more and more knowledgeable about what the Pathway ought to include. With the passing of time we have refined our hypothesis, making it stronger and better for stewards who want to use it as a framework for transforming the regions they serve. Refinement will continue as we take on each new initiative and project.

Dive into the Pathway and learn about

The essential practices stewards should commit to and develop as part of their quest to create equitable opportunities for everyone to reach their full potential for health and well-being
What stewards can expect to experience when they work together in these ways, across five phases of development

What happens when stewards work with Rippel’s ReThink Health team?

ReThink Health’s team works together with stewards as learning partners. As stewards mature, they conquer challenge after challenge, and then encounter new ones. Rippel works hard with stewards who are at the forefront of discovering what it takes to overcome these challenges, including:

Regional cross-sector groups who are the furthest along on the Pathway. These groups often include regional philanthropists, policymakers, corporate, nonprofit, and resident leaders. For example, we worked with multisector partnerships in six regions on Ventures. We also worked with THRIVE, a coalition in central Michigan working to transform health and the economy in their region.
Individual or cross-sector groups convening in state or nationwide networks to influence regional work. For example, we’ve partnered with the California Accountable Communities for Health Initiative (CACHI) to help networked leaders of regional multisector partnerships advance in their resident engagement and sustainable financing activities. We also work with the National Academies of Sciences, Engineering, and Medicine (NASEM) to shape the nation’s agenda for population health.
Stewards who recognize the regional influence their organization has, and seek to have greater impact. These stewards often have major national influence on regional work, or who are anchor institutions with a vested interest in the region’s prosperity and are unlikely to leave the region. For example, we work with major hospital systems in a variety of regions on our Hospital Systems in Transition project, and that project is funded by the Robert Wood Johnson Foundation as part of their interest in learning how regional stewards can best transform health and well-being.

What is a region?

Regional stewards determine their geographic area of focus for their transformation effort, and there isn’t a standard way to do so. Stewards may draw a “regional area” boundary by neighborhood, zip code, county, city, hospital service area, hospital referral region, or other self-defined configurations.

We work with our steward partners to carefully consider the six conditions of systems change, and ask: what conditions are holding the problem in place and how can stewards shift them to produce better health and well-being for all? Then, we prototype, make sense of, and refine strategies that best help stewards move along the Pathway and nudge their systems forward. We share the most promising strategies widely, so many more stewards can benefit.

Shifting the Conditions That Hold the Problem in Place

Stewardship is an already-established practice

In 2000, the World Health Organization broadly defined stewardship as “the careful and responsible management of the well-being of the population”, and in the most general terms as “the very essence of good government.” [citation]Kapoor N, Kumar D, Nivedita Thakur N. Core attributes of stewardship; foundation of sound health system. Int J Health Policy Manag 2014; 3: 5–6. doi: 10.15171/ijhpm.2014.52https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075105/

01/01/2019

The World Health Organization has collected resources related to stewardship, with an emphasis on the health care sector.

Vital Conditions for
Health and Well-Being

What are the vital conditions?

Vital conditions are properties of places and institutions that all people need for health and well-being. They include a thriving natural world, basic needs for health and safety, humane housing, meaningful work and wealth, lifelong learning, reliable transportation, and, central to all of these, belonging and civic muscle.

Investments in these conditions are necessary to create an equitable, thriving future for ourselves and for generations to come.

Vital Conditions for Health and Well-Being

Belonging and Civic Muscle is at the
center because it is both a vital condition
and a practical capacity that is necessary
for equitable success in every other
kind of work.

THRIVING NATURAL WORLD

Sustainable resources, contact with nature, freedom from hazards

Clean air, water, soil; healthy ecosystems able to sustainably provide necessary resources; accessible natural spaces; freedom from the extreme heat, flooding, wind, radiation, earthquakes, pathogens

BASIC NEEDS FOR HEALTH + SAFETY

Basic requirements for health and safety

Nutritious food, safe drinking water; fresh air; sufficient sleep; routine physical activity; safe, satisfying sexuality and reproduction; freedom from trauma, violence, addiction and crime; routine care for physical and behavioral health

HUMANE HOUSING

Humane, consistent housing

Adequate space per person; safe structures; affordable costs; diverse neighborhoods (without gentrification, segregation, concentrated poverty); close to work, school, food, recreation, and nature

MEANINGFUL WORK + WEALTH

Rewarding work, careers, and standards of living

Job training/retraining; good-paying and fulfilling jobs; family and community wealth; savings and limited debt

LIFELONG LEARNING

Continuous learning, education, and literacy

Continuous development of cognitive, social, emotional abilities; early childhood experiences; elementary, high school, and higher education; career and adult education

RELIABLE TRANSPORTATION

Reliable, safe, and accessible transportation

Close to work, school, food, leisure; safe transport; active transport; efficient energy use; few environmental hazards

BELONGING + CIVIC MUSCLE

Sense of belonging and power to shape a common world

Social support; civic association; freedom from stigma, discrimination, oppression; support for civil rights, human rights; civic agency; collective efficacy; vibrant arts, culture, and spiritual life; equitable access to information; many opportunities for civic engagement (voting, volunteering, public work)

Who uses this framework?

Rippel’s ReThink Health initiative first introduced the vital conditions framework through our Ventures project in 2017, with support from the Robert Wood Johnson Foundation. We have since refined it with input from thousands of contributors. A growing cadre of organizations now explicitly focus on establishing the vital conditions, including changemakers in all walks of life as well as scores of agencies across the federal government.

With few exceptions, users say that the vital conditions framework is clear, concise, and built for concerted action.

“Never before have so many federal agencies and legions of leaders across the US been able to organize around the same set of vital conditions in a common quest to thrive together.”

—Milstein, et al., Health Affairs Forefront

Federal Plan Uses the Vital Conditions Framework

In November 2022, the federal government released its interagency plan for Equitable Long-Term Recovery and Resilience. With commitments from more than 44 federal agencies, this landmark plan outlines a whole-of-government approach to unlock America’s full potential for all people and places to thrive together. It orients federal action around vital conditions that are essential for all people and places to thrive. “Adopting this framework is a major step in reflecting the reality of people’s lives, as well as the interdependence of government agency missions to make real and lasting improvements in population health,” said Rippel President and CEO Becky Payne, former Lead, Federal Interagency Workgroup for Equitable Long-Term Recovery and Resilience at the U.S. Department of Health and Human Services. Read her full statement.

What is a Well-Being Portfolio?

The importance of vital conditions becomes even easier to see when combined alongside urgent services in a full well-being portfolio. In times of crisis, urgent services are lifesaving and life-altering. Anyone experiencing adversity may need urgent services (such as acute care for illness or injury, or addiction treatment) to regain their health and well-being. But urgent services cannot produce the experience of thriving. The path to thriving goes through vital conditions. They shape the choices, opportunities, and challenges that we encounter throughout our lives, from birth to death and across generations.

When vital conditions are disrupted or denied, people struggle and suffer, driving demand for urgent services, which in turn diverts even more resources from vital conditions. The best way to escape this downward spiral is through a balanced portfolio of investments in both vital conditions and urgent services.

When stewards from all walks of life are able to negotiate investment priorities across the well-being portfolio, the experience reliably opens space for honest exchange about the legacies we want to pass on to future generations and what it takes for everyone to thrive together—no exceptions.

Where can I find other resources about the vital conditions?

Read definitions of the vital conditions and urgent services

Discover why organizing around vital conditions moves the social determinants agenda into wider action

Explore additional resources and connect with fellow stewards through

Team

The Rippel Foundation, home of ReThink Health, is made up a team of dynamic individuals who share a passion for partnering with stewards as they design and execute the strategies they need to guide transformative change and produce better health and well-being for all. We think big, strive for excellence, take risks, and push boundaries.

Get to know the Rippel team below.

Programs

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Molly Belsky

Program Associate

Maggie Cooke

Senior Strategic Partnerships Associate

Anna Creegan

Project Director

Jane Erickson

Director of Learning and Impact

Joann Yoon Kang

Program Director

Bobby Milstein

Director of System Strategy

Tiona Moore

Director, Systems Change

Brooke Muya

Senior Program Associate

Komal Razvi

Associate Director, Systems Change

Verinda Sood

Program Coordinator

Katherine Wright

Associate Director, Stewardship Practice

Project Teams

To see who is involved with ReThink Health’s current project teams, click on the icons below

Amplifying Stewardship Together

Portfolio Design for Healthier Regions

Hospital Systems in Transition

Learning & Impact

Cierra Bryant

Senior Learning and Impact Associate

Jane Erickson

Director of Learning and Impact

Administration

Joey Lee

Finance Associate

Sonali Bhatnagar

Administrative Associate

Adele DiBari

Executive Associate

Kimberly Hines Hart

Corporate Counsel

Steve Kohn

IT Consultant

Audrey Wells

Director of Finance and Administration

Board of Trustees

Edward W. Ahart

Chair

Elliott S. Fisher

Trustee

Michael W. Harris

Trustee

Lydia Nadeau

Trustee

Becky Payne

President & CEO

James R. Sonneborn

Trustee

David S. Surrenda

Trustee

Strategy and Management

Jane Erickson

Director of Learning and Impact

Joann Yoon Kang

Program Director

Alan Lieber

COO and Chief Health Care Strategist

Bobby Milstein

Director of System Strategy

Becky Payne

President and CEO

Teri Wade

Director, Communications and Influence

Audrey Wells

Director of Finance and Administration

Communications

Molly Belsky

Program Associate

Bradley Girard

Director, Branding and Creative

Laila Hussain

Deputy Director, Communications

Amanda McIntosh

Communications Manager

Teri Wade

Director, Communications and Influence

ReThink Health’s History

ReThink Health is the brainchild of a group of visionary leaders from multiple sectors. It’s grounded in the earliest thinking of The Rippel Foundation’s first President, Julius A. Rippel, who as far back as 1959 raised concerns about our unsustainable health care system and the need for new ways of thinking and acting to keep people healthy and health care affordable. After decades of grantmaking, it became apparent in 2007 that to achieve Rippel’s mission, a tectonic structural shift to the system that produces health and well-being would be necessary.

To figure out how to spark that change, Rippel convened a group of extraordinary leaders—those who would become ReThink Health’s pioneering founders. The group included some of the nation’s most respected health care leaders, as well as a diverse group of experts and change agents from economics, politics, business, community organizing, and energy. Putting their heads together between 2008 and 2010, they realized everyone would need to rethink their approach to improving health and well-being—and an entirely new kind initiative would be needed to help leaders across regions and sectors to see a new way forward. That initiative is ReThink Health. They based the initiative on the guiding principles that, to make lasting change to the health ecosystem, efforts must be:

Systemic Approach challenges from a system level and design a new system that fosters health and well-being.
Transformative Incremental change is not enough. Business-as-usual is not working, so we must upend the status quo and transform the system, all the way down to how people think about health and well-being.
Stewarded Leaders must be stewards—they must take responsibility for forming working relationships with others to transform health and well-being across their region.
Multisector Stewards must form relationships across sectors. Every part of a regional system contributes to health and well-being, so they must all be at the table, whether they are health care providers or payers, or they are focused on education, business, justice, and so on.
Regional Health and well-being are largely local, so system-wide national impact will build from local action. There is no one-size-fits-all solution.
Equitable The transformed system that produces health and well-being must be equitably designed and address systemic inequities in the current system, as those inequities are a major barrier to health and well-being for all.

Based on these pillars, the pioneers founded ReThink Health with the goal of gaining greater understanding of these ideas and spreading what is being learned about what it will take to transform the system that produces health and well-being. Some of ReThink Health’s most exciting discoveries since its founding include:

Dynamics Model

This “health system in a computer” is an interactive tool that allows stewards to explore how various strategies might impact their region’s health and well-being. Thousands of people and organizations have used the model to test different combinations of investments and interventions, informing their real-life strategies.

A Pathway to Transform Health and Well-Being Through Regional Stewardship

This Pathway is ReThink Health’s best hypothesis of what it takes to become stewards and transform together.

Ventures

The Ventures project explored what could accelerate the progress of ambitious multisector partnerships working to transform health in their regions, and what often stands in the way of that progress. We worked with multisector partnerships in six regions across the country as they built practices that are essential for transforming a regional health ecosystem.

Systems Mapping

ReThink Health worked with multisector partnerships in Minnesota and Michigan to create maps of their regions’ health ecosystems, as part of their collaborative exploration of effective ways to intervene.

Beyond the Grant: A Sustainable Financing Workbook

This workbook, divided into easy-to-digest modules, uses colorful examples, engaging exercises, and plain, everyday language to help stewards do what it takes to expand their financing horizons beyond the grant to more sustainable options.

Community Activation for Health System Transformation

Community Activation for Health System Transformation was a 5-year project focused on developing a set of skills stewards can use to train themselves and others to build coalitions, distribute stewardship mindsets across those coalitions, and build stewardship capacities among themselves and others. We forged and tested a curriculum for teaching these skills that had a major impact on a national workforce in the health care sector.

Resident Engagement

We developed a toolkit with exercises, meeting guides, videos, and more to help stewards plan resident engagement efforts. Among other things, the toolkit can help stewards accurately assess their resident engagement efforts, get on the same page about their goals, and figure out how to close the gap between the two. As part of this, we laid out a typology of the three outcomes (resident awareness and participation, feedback and input from residents, and active resident leadership) that stewards engaging in regional resident engagement practices seek to pursue, and the common practices they use to achieve those outcomes. Transforming a region’s system for health requires a balance between practices across all three outcomes.

Tax Credits for Financing Population Health

With the National Academy of Medicine, we published a widely-read paper and designed a national meeting exploring how stewards might use tax credits as a means to fund population health efforts.  The paper includes two detailed prototypes we developed to show how such a tax credit could work.

Pulse Check

Rippel’s ReThink Health initiative is proud to publish the 2021 Pulse Check on Shared Stewardship for Thriving Together Across America, the first and only nationwide survey to examine the state of stewardship values, priorities, and practices. Findings reveal the extent to which individuals and organizations in pivotal positions are thinking and acting like stewards of an equitable, thriving future.

And this work continues as ReThink Health takes the lessons from these discoveries into three new projects:

Amplifying Stewardship Together

What does it take to be a steward in today’s world?

Portfolio Design for Healthier Regions

What does it take for stewards to reallocate resources to improve their regional health ecosystem?

Hospital Systems in Transition

How will hospitals best claim an emerging role as regional stewards of health and well-being?

ReThink Health’s Pioneers

See some key accomplishments that led to each pioneer’s role in founding ReThink Health. These tremendously talented people continued to make marks in their respective fields, but the list below only features highlights from before they founded the initiative.

Donald Berwick

Health care quality improvement

Former head of the Centers for Medicare & Medicaid Services and the Institute for Healthcare Improvement. One of the country’s foremost advocates for advancing quality improvement and value-driven health care.
Elliott Fisher

Health policy and research

At the time, was director of The Dartmouth Institute for Health Policy & Clinical Practice. His research has shown how variations in health care spending have little to do with health status or price or outcomes, but rather on greater use of services.
Marshall Ganz

Community organizing

Harvard professor and community organizing luminary. Helped organize the United Farm Workers and supported development of President Obama’s winning campaign strategy.
Laura Landy

Philanthropy and entrepreneurship

Rippel president and CEO. An entrepreneur and foundation leader whose work has focused on bridging sound market and business practices with social goals to create sustainable solutions to our nation’s most challenging problems.
Amory Lovins

Energy research

A renowned scientist and founder of the Rocky Mountain Institute, whose critical thinking about alternative approaches to energy policy has driven world leaders and the public to think differently about climate change and sustainable energy.
James (Jay) Ogilvy

Business (strategic planning)

A cofounder of Global Business Network, who helped pioneer scenario planning, which has become an integral part of strategic thinking in business and government and has revolutionized both public and private planning.
Elinor Ostrom

Economics

A Nobel Laureate in Economic Sciences, whose research has been at the forefront of promoting policies for fostering democratic governance and sustainable stewardship of common resources shared among populations. Elinor passed away in 2012.
Peter Senge

Organizational design and systems thinking

A pioneer and influential leader in economic and organizational design, systems thinking, and leadership development, who founded the Society for Organizational Learning. His book The Fifth Discipline has been hailed as one of the most important management books ever by publications like Harvard Business Review and Financial Times.
John Sterman

Environment and system dynamics

An MIT professor and a leader in system dynamics, who has focused on addressing climate change and helping corporations see opportunities and consequences of their investments.
David Surrenda

Organizational psychology

A psychologist and founder of the Graduate School of Holistic Studies at John F. Kennedy University. David developed The Leadership Edge which helps leaders advance creative-change strategies and sustainable solutions for their organizations.

Work at Rippel

Discover how working with The Rippel Foundation, home of ReThink Health, will help you realize your full potential while helping national and regional stewards guide transformative change and produce better health and well-being for all.

At this time Rippel is hiring:

Director of Strategic Partnerships