Dynamics Model

How can stewards understand their health ecosystem and test potential ways to transform it together?

The first job of stewards is to understand their health ecosystem. The ReThink Health Dynamics Model can help.

This Model is a regional health ecosystem in a computer. It’s a realistic, yet simplified, tool that stewards anywhere can use to customize and test different strategies for transforming the system that produces health and well-being in their region.

By simulating how a health system responds to changes, it lets stewards see how different strategies might play out. For example, they’ll gain knowledge about which investments will do the most to save lives, reduce costs, improve quality, enhance equity, and boost productivity. With a diverse menu of initiatives and financing options, everyone can test their own ideas and track results across scores of measures. This helps foster alignment about which idea will achieve the results they want.

The model has been used in regions across the country to:

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    Align quickly around sound strategies

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    Explore impacts of sustainable funding

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    Shift strategies and funding in more effective directions

Dynamics Map
Easy to use to collaborate

Easy to use to collaborate

Best used in a group, the Model is meant to make it easier for people with differing viewpoints to find common ground and strategize together.
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  • 100+ Strategy Labs

  • 5,000+ Leaders

  • 20+ Universities

  • Finalist, Social Impact Exchange Business Competition



Designed by an award-winning team of MIT-trained system modelers, the Model brings together decades of evidence and is updated periodically to reflect new research and input from users.

Stories From The Field

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“ReThink Health modeling helped people discover surprisingly strong areas of consensus. It helped us sail through a step where we might otherwise have gotten stuck.”

Karen Minyard

Executive Director

Georgia Health Policy Center

Meet Our Project Team


Bobby Milstein

Director of System Strategy

Rebecca Niles

Senior Strategy Consultant

Jack Homer

Senior Modeling Consultant

ReThink Health is grateful for the contributions of
Gary Hirsch (early co-development), and Kris Wile (User Inferface design).

More Dynamics Model Resources

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  • Blogs
  • Videos
  • Publication

ReThink Health Dynamics: Understanding and Influencing Local Health System Change

This paper by Gary Hirsh, et. al (including others from ReThink Health) is a detailed overview of the ReThink Health Dynamics model, as presented in 2012 at the 30th International Conference of the System Dynamics Society. It explains the model’s elements and how stewards can use it to more efficiently identify interventions likely to be effective—and weed out those that aren’t.

External Resource

County Officials Embark on New, Collective Endeavors to ReThink Their Local Health Systems

Our joint article with the Georgia Health Policy Center, published in The Journal of County Administration, explains how county officials can benefit from using the ReThink Health Dynamics Model to support strategy design (not predict outcomes), and shares real-world stories of the insights two counties gained from the model.

External ResourceVideo

Scaling the ReThink Health Dynamics Model

Our Director of System Strategy Bobby Milstein presents our entry (one of three finalists) in the business plan competition at Social Impact Exchange 2014. He talks about how the ReThink Health Dynamics Model moves the field forward by giving stewards a birds-eye view of their system so they can make smarter investments, rallying around a vision they themselves created. He also lays out our plan to scale the model’s impact and answers questions from the audience.


ReThink Health Dynamics Model Overview

This animated video provides a clear and simple introduction to the ReThink Health Dynamics Model, explaining the basics of what it does, how it works, and how it can help stewards design strategies for transforming their regional health ecosystem.


Stories from the Field: Upper CT River Valley

In the Upper Connecticut River Valley, ReThink Health worked with diverse stewards to build a shared vision and strategy for lower health care costs and a healthier region.


Stories from the Field: Pueblo, CO

In Pueblo, Colorado, health stewards worked with ReThink Health modelers to map their health system, identify smart investments, and set up a plan for action.


How to Use the ReThink Health Dynamics Model

This video runs through the step-by-step process of using the ReThink Health Dynamics Model to explore strategic combinations of interventions to improve a region’s health ecosystem.

External Resource

NASPAA Student Simulation Competition: Forio Blog

This post on the Forio’s blog details how the ReThink Health Dynamics Model was used in a day-long competition involving 45 teams from 93 schools. The Network of Schools of Public Policy, Affairs, and Administration (NASPAA) hosted this event to challenge teams of graduate students to use modeling to develop policy solutions to public health issues.


Beyond Reform and Rebound

Our Director of System Strategy Bobby Milstein presents at the Grand Rounds on the Future of Public Health at Columbia University, exploring how stewards can overcome the “reform and rebound” cycle (how complex adaptive systems tend to delay, dilute, or defeat the actions of change agents within them) to help the US close the health care outcomes gap with other developed nations.


What Do The Poor Need? Try Asking Them

The ReThink Health Model offers interventions that include “Pathways to Advantage”. These represent interventions, such as job training, that improve the economic status and productivity of residents and, in turn, their health. In this New York Times opinion piece, author David L. Kirp argues that in order to improve poor neighborhoods, the people who live there must have a hand in deciding the solutions that could help strengthen their community.


Lessons Learned from the ReThink Health Dynamics Model

This animated video uses detailed scenarios to explore five of the most practical and pivotal lessons from the ReThink Health Dynamics Model that stewards can apply to their own work.


Community Comes Together around College Football and the Triple Aim

Explore how the ReThink Health Dynamics Model was being used to guide strategy discussions to achieve the triple aim in Pueblo County, and to help bring uncommon partners together to create common solutions.


Modeling Regional Health Reform

In a presentation to a National Academies of Sciences, Engineering, and Medicine gathering, our Director of System Strategy Bobby Milstein introduces the ReThink Health Dynamics Model and shows how the model’s insights can be used to illustrate the value of upstream investments, particularly in the factors other than health care that impact health and well-being.

External Resource

It Takes More Than A Village To Improve Community Health

In this post on the The Health Care Blog, Susan Dentzer, senior policy advisor to RWJF (at the time), tells the story of how the Atlanta Regional Collaborative for Health Improvement (ARCHI) designed, with the help of the ReThink Health Dynamics model, a playbook for improving health in their region, with a focus on alleviating poverty.


NASEM PopHealth Roundtable: How Modeling Can Inform Strategies to Improve Population Health

A summary of a one-day public workshop exploring the potential uses of simulation and other types of modeling for selecting and refining potential strategies to improve health. This workshop from The National Academies of Sciences, Engineering, and Medicine features accomplished presenters from multiple sectors (including Bobby Milstein, our director of system strategy).

External Resource

Hygeia’s Constellation: Navigating Health Futures in a Dynamic and Democratic World

Before joining the ReThink Health initiative at Rippel, Bobby Milstein wrote this paper at the CDC using the metaphor of navigation-by-constellation (represented by Hygeia, the greek goddess of good health) to explore what an explicitly dynamic and democratic view of public health work might entail.


Understanding the Impacts of Incarceration on Health

This report outlines the vicious cycle of negative effects incarceration has on health—not just for the incarcerated person, but intergenerationally within their family and community—based on a workshop we hosted alongside the Minnesota Department of Health in which people with varying perspectives on criminal justice applied systems thinking to explore incarceration’s impact on health and well-being.


NASPAA Student Simulation Competition: Reforming the U.S. Health Care System Within a Simulated Environment

In 2014, the Network of Schools of Public Policy, Affairs, and Administration (NASPAA) held a competition in which graduate students used the ReThink Health Dynamics Model to craft long-term policy solutions to problems facing the U.S. health care system. Along with 10 other authors (including some from ReThink Health), Laurel McFarland, executive director of NASPAA, recounts in this paper how and why the competition came to be, and its implications.


Rethinking the Bradley Ratio

Yale’s Elizabeth Bradley studied how the ratio between state-level expenditures in social services and health care impacted health outcomes, finding that social spending was associated with better outcomes. In this blog, we share our nuanced view of her findings—both applauding her accomplishment and urging caution to not apply it too broadly.


By How Much Do Costs Need to Be Reduced to Leverage True Health Transformation?

Some insights (published in Health Affairs) from using the ReThink Health Dynamics Model to explore how much stewards would need to reduce costs in order to finance long-term strategies for health and well-being.


Combined Regional Investments Could Substantially Enhance Health System Performance And Be Financially Affordable

In this article we published in Health Affairs, Jack Homer, Bobby Milstein, Gary Hirsch, and Elliott Fisher use the ReThink Health Dynamics Model to demonstrate how four affordable interventions—combining investments in both clinic and population health with reduced incentives for costly care and a reinvestment strategy—could be layered together in a prototypical mid-sized city to greatly enhance health and economic opportunity.


ReThink Health Dynamics Model Short Summary

This shareable 2-page infographic briefly summarizes the ReThink Health Dynamics Model and why stewards would want to use it.


Higher-Value Care Necessary but Insufficient for Health Transformation

Learn about our report (published in Health Affairs) that explores higher-value care using the ReThink Health Dynamics Model. It lays out seven key features of effective high-value care, and explains that, while alone it is expensive and tends to sputter out, it can thrive in combination with a few other changes, such as payment reform.


Reference Guide to Local Calibrations of the ReThink Health Dynamics Model

This list of relevant sources and studies can help stewards calibrate the ReThink Health Dynamics Model to their own regions.


Beware Unintended Consequences: What the ReThink Health Dynamics Model Tells Us about the Impact of President Trump’s Policies

Regardless of personal politics, it’s useful to understand the real-world impact of policy changes. We detail the likely cost of the president’s policies using the ReThink Health Dynamics Model.


Mastering Transitions in Health Care and Population Health: Becoming an ACO

It can be challenging to make changes when people’s health is on the line. Here is a look at some of what it takes for stewards working in health-related services to switch from a pay-for-service business model to a value-based one.


Stories from the Field: Atlanta, GA

ReThink Health worked with the Atlanta Regional Collaborative for Health Improvement to customize the ReThink Health Dynamics Model. This helped them increase understanding about their health system, prioritize different policies and program strategies, and get energized around a common set of goals.


New Online Features Make the ReThink Health Dynamics Model Even Easier to Use

Visit Anytown, USA for a delicious potluck dinner—served alongside computer simulations of the potential impacts of your health transformation efforts! We highlight online features added to the ReThink Health Dynamics Model in May 2018 to make it more user-friendly and robust.


Cultivating Health and the Economy, Side by Side (Case Study 1 of 3)

This origin story of THRIVE (an initiative for transforming both the health and economy of Michigan’s Great Lakes Bay region) details how we helped them map their health ecosystem and plan their “Whole System Approach to Change”—which emphasizes learning and planning before acting, to avoid hasty “fixes that fail.”


Reference Guide for the ReThink Health Dynamics Simulation Model

Want to learn all about the science behind the ReThink Health Dynamics model? Dig into this extensive collection of technical facts, figures, and diagrams.


Prototyping to Solve Complex System Challenges in Health and Health Care

Prototyping (purposefully testing out options with a learning mindset) is a great way for stewards to get a sense of how effective their portfolio of interventions might be. In this guest blog, Stacey Chang and Beto Lopez of the Design Institute for Health expand on the idea of prototyping and present a real-world example of its success.


Going Big: Addressing Big Challenges in Health and the Economy (Case Study 2 of 3)

This case study shares lessons learned and helpful strategies from THRIVE (an initiative for transforming both the health and economy of Michigan’s Great Lakes Bay region) based on their work to design big, bold plans to transform their health ecosystem using the ReThink Health Dynamics Model.


Stepping Out: Launching the First Stage of Interventions to Transform a Regional System for Health and Well-being (Case Study 3 of 3)

This case study shares lessons learned from the story of how THRIVE (an initiative for transforming both the health and economy of Michigan’s Great Lakes Bay region) developed, fine-tuned, and began to launch an interdependent portfolio of interventions based on a strategy we helped them develop and test using our Dynamics Model.


Frequently Asked Questions about the Dynamics Model

Answers to the most common questions asked about the ReThink Health Dynamics Model.