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What top five interventions would you support to achieve the triple aim of better care, better health, lower cost?

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Presentation on theme: "What top five interventions would you support to achieve the triple aim of better care, better health, lower cost?"— Presentation transcript:

1 What top five interventions would you support to achieve the triple aim of better care, better health, lower cost?

2 Presented to: Grantmakers in Health March 7, 2014ARCHI Leveraging the Community Benefit Requirements of the Affordable Care Act for Collective Impact: The Atlanta Regional Collaborative for Health Improvement (ARCHI)

3 Changes in Public Coverage Changes in Private Coverage Improving Health Care Quality Improving Health

4 Atlanta Regional Collaborative for Health Improvement The CHNA Opportunity in the ACA Community health needs assessments (CHNA) are now required every three years of not-for-profit health entities in order to maintain their tax-free status CHNA and implementation strategy required for each facility

5 Atlanta Regional Collaborative for Health Improvement The CHNA Opportunity in the ACA CHNA: – A description of “community” and how it was determined – A description of process and methods, including data used and information gaps – A description of how input was gathered from those with a broad interest in the community – A prioritized list of community health needs, including how the list was prioritized

6 Atlanta Regional Collaborative for Health Improvement The CHNA Opportunity in the ACA Implementation plan: – Must describe how each health need identified in the CHNA will be met, or – Describe identified needs that will not be met by that hospital and why – Must be approved by a governing body – Collaboration is encouraged

7 Atlanta Regional Collaborative for Health Improvement Solution Funders (CDC, Kaiser, St. Joseph’s Healthcare, Grady, and the Lead Organizations) Public Health, Hospitals, FQHCs, Physicians, Behavioral and Other Providers Business, Education, County Commissioners, Faith Leaders, Insurers, Philanthropy Led by United Way, ARC, and Georgia Health Policy Center

8 Atlanta Regional Collaborative for Health Improvement ARCHI Video

9 Atlanta Regional Collaborative for Health Improvement Seeding Innovations in HealthARCHI

10 Rippel, ReThink Health, & the RTH Dynamics Model

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12 THE RIPPEL FOUNDATION Seeding Innovations in Health

13 Founded in 1953 as a charitable foundation 6 person Board of Directors Home office Morristown, NJ; satellite location in Cambridge, MA $85 million in assets; $6.4 million 2014 budget 30 full and part time staff and long term contractors… and growing Legal Mandate: Women, Elderly, Cancer, Heart Disease, Hospitals 2007 Mission: “Seed Innovations in Health” Primary program and investment: ReThink Health 75% of total Rippel budget; 95% of program budget Generated $2.5 million in grants and earned income to date After 53 years of primarily making grants… Almost no grants, not operating foundation; work through DCA Commitment to collaboration with like-minded partners 13

14 1959 – We have long known that health care facilities should be adapted to the patients rather than the opposite To avoid becoming sick may be the greatest health and medical challenge to contemporary society Sooner or later some group will find out how to build, organize and operate a hospital which will be better and more flexible than at present, and at a lower cost The greatest opportunity people have to achieve and maintain good health and well-being, at the lowest possible cost, is by their own intelligent methods of daily living habits We need to develop a health care system which will be recognized as distinct from medical care. This is a real key to solving our “medical problem.” 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.

15 Build & Sustain System-Wide Change Measures Evidence, Examples, Ideas Problem Identification

16 RETHINK HEALTH A Collaborative Initiative of the Rippel Foundation

17 1. Don Berwick | CMS, IHI 2. Elliott Fisher | The Dartmouth Institute 3. Marshall Ganz | Leading Change, Harvard 4. Celinda Lake | Lake Research 5. Laura Landy | Rippel Foundation 6. Amory Lovins | Rocky Mountain Institute 7. Jay Ogilvy | Global Business Network 8. Elinor Ostrom | Nobel Laureate in Economics 9. Peter Senge | MIT, Society for Org. Learning 10. John Sterman | MIT System Dynamics Group

18 … work with leaders to demonstrate that sustainable redesign of regional health systems is possible and can improve health, care, costs, equity, ownership, productivity, regional economies, and communities vitality. Better health, better care, lower costs and access for all Collaboration by leaders across boundaries (in and out of health) Whole system thinking Redesign to meet health and care needs National purpose, local action 18 ActionResults Thinking ReActing RETHINKING 18

19 19 Active Stewardship Sustainable Financing Effective Strategy

20 Bring system stakeholders together in a way that builds trust, shared vision, and collaborative action. Build purposeful and effective stewardship teams that can sustain efforts and achieve measurable results over time. Assure that health resources are being spent to achieve the greatest impact. Align community priorities with health system priorities. Finance and sustain efforts long enough to see real results and avoid rebound experiences. Support innovation, implementation, and system redesign in ways that achieve high impact goals and build critical interdependencies. Educate leaders to have a whole system and collaborative perspective. Engage in action-research Develop and share lessons, tools, approaches 20

21 Grant funding from the California HealthCare Foundation and the Robert Wood Johnson Foundation plus increasing earned income Experience in more than 30 regions across the country Created and used the Dynamics Model in 50 settings, 9 academic institutions, and thousands of users Successful distance learning course with 180 participants Building a learning network and community Extensive partnerships with motivated leaders, regions and organizations Strong enterprise wide evaluation process Impact on regional and national levels 21

22 RETHINK HEALTH DYNAMICS MODEL

23 Keehan SP, Cuckler GA, Sisko AM, et al. National Health Expenditure Projections: Modest Annual Growth Until Coverage Expands And Economic Growth Accelerates. Health Affairs Heffler S, Smith S, Keehan S, Borger C, Clemens MK, Truffer C. U.S. health spending projections for Health Affairs 2005:hlthaff.w5.74. U.S. National Health Expenditures ( ) HistoricalData How? Why? Where? Who? What? $ in Billions Stewardship Teams Exploring Simulated Scenarios in Strategy Labs 23

24 Unsustainable program financing Spreading resources over too many initiatives Lopsided investments downstream or upstream Triggering “supply push” responses to declining utilization Exacerbating capacity bottlenecks Perpetuating inequity Neglecting or focusing only on disadvantaged, children, or seniors Pursuing narrow goals and short-term impacts Concentrating only on small sub-systems

25 Hard to see the bigger system and where things/we fit Stakeholders see different problems and solutions Stakeholders speak different languages Don’t recognize that not all solutions are equal – good / bad Real conversations about money, priorities, strategy, etc. are difficult Alignment from the community to policy levels is challenging Pressure for short term results with limited evidence for better planning System is complex and hard to predict 25

26 26 Consider Many Pathways Engage in Deeper Dialogue Anticipate Consequences and Plausible Futures

27 27 Realistic yet simplified portrait of a local health system (N=8 to date) Anchored to evidence from dozens of datasets A common, testable framework and tool for open, experiential learning Designed with and for diverse stakeholders Not a prediction, but a way to see and feel how local health system can change ReThink Health. Summary of the ReThink Health Dynamics model. Available at

28 Other Trends Insurance eligibility Economic conditions Health care inflation Primary care slots Aging Population tracked separately in 10 segments by age, insurance, and income Selected Geographic Focus 28 RiskHealthCareCost Capacity Initiatives Captured Savings Payment Scheme Innovation Funds Productivity & Equity

29 SYSTEM CONNECTIONS

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33 Funds Available for Investment Spending on Programs Program Investments Initial Innovation Fund Savings O B Fund Depletion Health Care Costs O O R Capture &Reinvest Savings

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37 Atlanta Regional Collaborative for Health Improvement Philanthropy can invest in aligning a community around strategies to improve healthARCHI

38 Atlanta Regional Collaborative for Health Improvement Philanthropy Convener Neutral voice Demonstrate patience and perseverance Exhibit and encourage collaboration for collective impact Invest Work behind scenes

39 Atlanta Regional Collaborative for Health Improvement Kaiser Permanente Funded research that identified need/opportunity Key influencer behind the scenes Shared value of collective impact Continuous engagement Patient capital investment Aligned CHNA requirement/grant making to support ARCHI

40 Atlanta Regional Collaborative for Health Improvement Philanthropic Collaborative Healthy Georgia 20 foundations sought to improve primary care through collaboration, data sharing and joint planning Grady Health System & Four Federally Qualified Health Centers (FQHCs) Collaborations on Patient Navigator Program, Accountable Care Organization application & Mobile Phone App Aligned with ARCHI – Care Coordination Grady allows staff privileges for FQHC physicians

41 Atlanta Regional Collaborative for Health Improvement United Way of Metro Atlanta Aligned major $3.5 M Grant “Forget the Box” Grantees must  Demonstrate at least two ARCHI priorities  Collaborate  Participate in Rethink Health learning agenda Selected grantee may become ARCHI pilot

42 Atlanta Regional Collaborative for Health Improvement Discussion: Share opportunities for investment in your community

43 Thank You!


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