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:
Align quickly around sound strategies
Explore impacts of sustainable funding
Shift strategies and funding in more effective directions
Easy to use to collaborate
100+ Strategy Labs
Finalist, Social Impact Exchange Business Competition
Stories From The Field
- Atlanta, GA
- Michigan Great Lakes Bay Region: Cultivating Health and the Economy, Side by Side (Case Study 1 of 3)
- Michigan Great Lakes Bay Region: Going Big: Addressing Big Challenges in Health and the Economy (Case Study 2 of 3)
- Michigan Great Lakes Bay Region: Stepping Out: Launching the First Stage of Interventions to Transform a Regional System for Health and Well-being (Case Study 3 of 3)
- Pueblo, CO
- Upper CT River Valley
- NASPAA Student Simulation
Meet Our Project Team
“ReThinking is the most practical thing any of us can do to change the future. It helps us see where we fit in a common system and shifts our own roles as change agents within a dynamic and democratic world.”—Bobby Milstein, Director of System Strategy
Joined Rippel: 2011
Current Roles: Bobby directs Rippel’s work on System Strategy, is a member of Rippel’s Strategy and Management Team, and is a Visiting Scientist at the MIT Sloan School of Management. Bobby is a principal contributor to the ReThink Health initiative’s projects Portfolio Design for Healthier Regions and Amplifying Stewardship Together. He also leads a suite of nationwide influence activities and coordinates ongoing development of the ReThink Health Dynamics Model, the Well-Being Portfolio Design Calculator , and other simulation tools that let leaders play out the consequences of their scenarios for change. In 2018, Bobby and four co-authors wrote the official brief that defines “health and well-being” as the central focus for the Healthy People 2030 Framework for the United States.
Career: Before joining Rippel, Bobby spent 20 years planning and evaluating system-oriented initiatives at the Centers for Disease Control and Prevention (CDC), where he was the principal architect of CDC’s framework for program evaluation. He received CDC’s Honor Award for Excellence in Innovation, the Applications Award from the System Dynamics Society, and Article of the Year awards for papers published in Health Affairs and Health Promotion Practice.
More about Bobby: Bobby once was a documentary filmmaker whose work was used by PBS to spotlight challenges of racism on college campuses. He also contributed storylines for The West Wing on how to get beyond zero-sum thinking when setting health priorities.
Education: Union Institute and University (PhD), Emory University (MPH), University of Michigan (BA)
“Using computer simulations based on systems thinking, we can see the bigger picture and think more strategically about how to make a real difference in health and well-being.”— Rebecca Niles, Senior Strategy Consultant
Joined Rippel: 2013
Current Roles: Rebecca develops and facilitates interactive workshops—also called strategy labs—to help leaders use the ReThink Health Dynamics Model, system maps, and other simulation models to identify effective system change strategies and build consensus toward their implementation.
Career: As founder and principal of Iceberg Partners, Rebecca specializes in applying systems thinking and strategy, including for Rippel’s ReThink Health initiative and other clients such as Climate Interactive and the Elizabeth Dole Foundation. Recently, Rebecca was a key contributor to the team that expanded the ReThink Health Dynamics Model to incorporate the likely effect of proposed economic expansion in Michigan—demonstrating that efforts to attract in-migration while increasing jobs for existing citizens can be a powerful part of a regional portfolio to improve population health. Rebecca began her career as a strategy consultant for Monitor Company and worked as vice president of acquisitions in affordable housing for Boston Financial. She has systems thinking and strategy experience in diverse content areas, including affordable housing, recycling, water resources, health, and manufacturing, and for clients including Vistaprint, AT&T, Ford, Amoco, Shell, USDA, and the US Forestry Service.
More about Rebecca: Rebecca loves to travel the world, recently visiting Mexico, Morocco, Brazil, Uganda, and Iceland to spend times with whale sharks, camels, street art, gorillas, and waterfalls. When stuck at home she enjoys gardening, swimming, and renovating her house.
Education: Massachusetts Institute of Technology (BS), MIT Sloan School of Management (MBA)
“From the start, Rippel has supported my efforts to do rigorous, evidence-based analysis that will make a positive, lasting impact in the real world—and provided the rare opportunity to work with decision makers across the country on new ways to improve people’s lives.”—Jack Homer, Senior Modeling Consultant
Joined Rippel: 2009
Current Roles: Jack is the lead modeler in charge of continuing development and related research and publication for Rippel’s ReThink Health Dynamics Model and Well-Being Portfolio Model.
Career: Jack is a world-recognized expert in system dynamics policy modeling, having developed original models for the Centers for Disease Control and Prevention, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the Veterans Health Administration, and many other organizations. He has run Homer Consulting since 1990, and is also a former faculty member at the University of Southern California. He has been published widely in peer-reviewed journals from the 1980s to the present, and is author of the books, Models That Matter: Selected Writings on System Dynamics 1985–2010, and More Models That Matter: System Dynamics Writings 2011-2017.
More about Jack: Jack has received awards from the International System Dynamics Society, the Applied Systems Thinking Institute, and AcademyHealth. Since childhood, Jack has enjoyed playing clarinet (in small and large ensembles) and tennis, and also writing poetry when the spirit strikes. He lives in New York’s Hudson Valley with his wife Emily and their dog Dylan, and has three adult children.
Education: Massachusetts Institute of Technology (PhD), Stanford University (MS, BS)
More Dynamics Model Resources
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.
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.
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.
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.
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).
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.