The Stew BLOG

Accelerating System Transformation by Disrupting the Status Quo

Laura Landy, President & CEO | 12/22/2016

However the nation’s policies evolve in the months ahead, one thing is clear—how policy makers meet our health and health care challenges remains among the core questions we face as a country. Going back to the time of former President Teddy Roosevelt, lawmakers have tried to address the health of the U.S. population. And while various policy solutions have been tried over the past 100 years, we still don’t have it right.

To get to the solution, we have to start by being honest with ourselves: we know that America’s health system is failing us, and we know why. Too often, we don’t properly value population health, the cost of care continues to rise, policy decisions happen in silos, financing decisions are short-sighted, and we continue to neglect opportunities to improve health where we live, work, and play. The list goes on and on.

To break from this endless cycle, we’re going to need to try something new.

Investing To Accelerate Transformation

In 1950s and 1960s, Julius A. Rippel, the first president of the Fannie E. Rippel Foundation, advocated a role for foundations as “pioneers in neglected or untried areas of need.” He firmly believed, “We must have substantially new manners of thinking to enable mankind to bridge the gap between the things that have been and the things which will be.” Foundation leaders, such as myself, are in a unique position. How we think about and use our resources can make a real difference. These times call for truly catalytic philanthropy—investments that accelerate change, not foster business as usual.

The Rippel and the Robert Wood Johnson Foundations (RWJF) are investing in one promising opportunity, a new project from ReThink Health that will help identify what it takes to truly transform health. ReThink Health Ventures offers a critical opportunity to delve into the real challenges facing our health system and to test real-world solutions with some of the most innovative multi-sector partnerships in the country.

Over the next two years, six uniquely positioned regional partnerships will work with ReThink Health to explore what it takes to steer a complex health ecosystem in a new direction and see demonstrable results. Through a tailored curriculum and collaboration with peers and experts, Ventures partnerships will synthesize evidence, explore plausible scenarios, and gain a greater understanding of how they can develop a team and resources needed to transform a health system.

They will focus on building robust long-term strategies; broad-based leadership and transparent governance through true stewardship; and sustainable financing mechanisms. Together, the Ventures cohort will create a learning community to help guide and inform the work and assess progress. Along the way, each Ventures community will arrive at critical stepping stones—for example, identifying a region’s values in pursuit of its vision and goals. As leaders reach a clear-eyed assessment of their current situation and identify the cost of doing nothing at all, progress will seem more attainable.

Six Regions Poised For Change

We knew when we began this project that the unique blend of groups comprising the cohort would be critical. In lieu of a traditional call for application process, we decided to seek nominees by reaching out broadly to thought leaders around the country who have a deep understanding of regional collaboration efforts. We asked nominators to share the names of communities that had the ambition, appetite, and ability to fundamentally reimagine and redesign health in their region. We started with a pool of more than 100 and eventually identified six: Sonoma County, California; Trenton, New Jersey; the Finger Lakes region of New York State; Central Oregon; King County, Washington; and Bernalillo County, New Mexico

What defines the ideal Ventures participant? We were looking for those regions best positioned to move to the next phase of change and who were ready to do the hard and sometimes uncomfortable work that is required. Over close to a decade on the ground in nearly 85 regions of the country, and after conducting research on hundreds more, ReThink Health has learned that the key ingredients to successful long-lasting regional change are simultaneous efforts to implement sound strategy, broad-based stewardship, and sustainable financing from the beginning. To build on those learnings, we identified key characteristics within each of these core areas and the wider payment, policy, and community environment in which the partnerships operated.

The partnerships participating in Ventures are strong systems thinkers working at the city, county, or multi-county level. They recognize the need to make system-wide changes in order to generate more inclusive health value—demonstrated by the improved health of populations, better care, lower costs, greater equity, and increased economic productivity—and they are already working to address the many interdependent sectors that affect health in a community. They are committed to a comprehensive approach—an agenda that includes “downstream” work such as access to care or care coordination, and “upstream” work that promotes healthy behaviors and the broader social determinants of health.

All of these groups have been working to improve health for many years. The players at the table, in each Ventures community, have a history of overcoming challenges together with recognizable achievements, and they have adapted together as the work has evolved. In particular, we sought leaders who are committed to sustaining the work over the long term and who value an inclusive approach to their work, including engagement and buy-in among local residents in each of the communities.

As may be obvious, this is a new definition of leadership—one that is becoming increasingly important in our complex and diverse world. It is up to us, together—and not only up to “them”—to find the solutions that fit for where we live, work, and play. The Ventures participants are dissatisfied with the status quo, not only around health outcomes, but also around issues of social equity and economic transformation, and they are ready to embark on a new path. Ventures is designed to help them make improvements on these fronts. We invite you to follow along with us on our blog as we embark on this journey and capture and share lessons from this innovative effort.


This article was originally posted on the Health Affairs Blog, December 8, 2016. ©2016 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.