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Financing Pop pulatio He on ealth Im vement mprov n Worksh Summary hop Joe Al lper and Al Baciu, Rapporte lina , eurs IO Roundt OM table on Po opulation H Health Imp provement PR REPUBLIC CATION CO OPY: UNCOR RRECTED PROOFS

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by Contract/Grant No. 245367 between the National Academy of Sciences and the Kresge Foundation. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. Library of Congress Cataloging-in-Publication Data or International Standard Book Number 0-309-0XXXX-X Library of Congress Catalog Card Number 97-XXXXX Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu/. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Cover credit: “Invest in Me” image used with permission of Joeff Davis, photographer. Suggested citation: IOM (Institute of Medicine). 2014. Financing population health improvement: Workshop summary. Washington, DC: The National Academies Press. PREPUBLICATION COPY: UNCORRECTED PROOFS

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PREPUBLICATION COPY: UNCOR R C O RRECTED PROOFS

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The Nation Academy of Sciences is a private, nonpr nal o rofit, self-perpet tuating society of distinguished scholars enga d aged in scientific an engineering research, dedica nd ated to the furthherance of scien and technology and to the use for the g nce eir general welfare. Up the authority of the charter granted to it by the Congress in 1863, the Acad pon y g n demy has a man ndate that requir it to res advise the federal governme on scientific and technical matters. Dr. Ralp J. Cicerone is president of the National Acad f ent m ph s e demy of Sciences. The Nation Academy of Engineering was established in 1964, under t charter of th National Acad nal f w i the he demy of Science as a es, parallel orga anization of outs standing enginee It is autonom ers. mous in its admi inistration and in the selection o its members, s n of sharing with the National Academ of Sciences the responsibilit for advising the federal gov my t ty vernment. The National Acade emy of Engineering also sponsors engineering programs aimed at meeting natio g a onal needs, enc courages educat tion and researc and ch, recognizes the superior achi t ievements of eng gineers. Dr. C. D. Mote is presid D dent of the Natioonal Academy of Engineering. f The Institu of Medicine was established in 1970 by th National Aca ute e he ademy of Scien nces to secure th services of e he eminent members of appropriate pro f ofessions in the examination of policy matters p e p pertaining to the health of the pu ublic. The Institu acts ute esponsibility giv to the Nation Academy of Sciences by its congressional charter to be an adviser to the federal under the re ven nal f s n government and, upon its own initiative, to identify issu of medical c t ues care, research, and education. Dr. Victor J. D Dzau is president of the Institute of Medicine. f The National Research Co ouncil was organnized by the Nattional Academy of Sciences in 1 1916 to associate the broad com e mmunity of science and technology with the Aca y ademy’s purpose of furthering knowledge an advising the federal gover es g nd e rnment. Functioning in accordance with general po g olicies determine by the Acade ed emy, the Counc has become t principal op cil the perating agency of both the Nation Academy of Sciences and the National Ac b nal f cademy of Eng gineering in pro oviding services to the government the public, and the scientific and engineering communities. T Council is ad t, d a The dministered join by both Aca ntly ademies and the Inst titute of Medicin Dr. Ralph J. Cicerone and Dr. C. D. Mote are chair and vi chair, respec ne. D ice ctively, of the N National Research Coouncil. www.natio onal-academie es.org PR REPUBLIC CATION CO OPY: UNCOR RRECTED PROOFS

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PLANNING COMMITTEE ON RESOURCES FOR POPULATION HEALTH IMPROVEMENT1 TERRY ALLAN, Co-Chair, President, National Association of County and City Health Officials; Health Commissioner, Cuyahoga County Public Health GEORGE ISHAM, Co-Chair, Senior Advisor, HealthPartners; Senior Fellow, HealthPartners Institute for Education and Research DEBBIE I. CHANG, Vice President, Policy and Prevention, Nemours MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County JIM HESTER, Consultant, Former Director, Health Care Reform Commissioner for the Vermont State Legislature PEGGY HONORÉ, Director, Public Health System, Finance and Quality Programs, Department of Health and Human Services JEFFREY LEVI, Executive Director, Trust for America’s Health GLEN P. MAYS, F. Douglas Scutchfield Endowed Professor of Health Services and Systems University of Kentucky JOSÉ MONTERO, Director, New Hampshire Division of Public Health Services ANDREW WEBBER, Chief Executive Officer, Maine Health Management Coalition Institute of Medicine Staff ALINA BACIU, Senior Program Officer COLIN FINK, Senior Program Assistant AMY GELLER, Senior Program Officer LYLA HERNANDEZ, Senior Program Officer ANDREW LEMERISE, Research Associate CAROL MASON SPICER, Associate Program Officer (until March 2014) DARLA THOMPSON, Associate Program Officer (from May 2014) ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice Consultants JOE ALPER, Consulting Writer 1 IOM planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS v

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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1 GEORGE ISHAM, Co-Chair, Senior Advisor, HealthPartners, Inc.; Senior Fellow, HealthPartners Institute for Education and Research. DAVID KINDIG, Co-Chair, Professor Emeritus, University of Wisconsin School of Medicine and Public Health TERRY ALLAN, President, National Association of County and City Health Officials; Health Commissioner, Cuyahoga County Board of Health CATHERINE BAASE, Chief Health Officer, Dow Chemical Company GILLIAN BARCLAY, Vice President, Aetna Foundation RAYMOND J. BAXTER, Senior Vice President, Community Benefit, Research and Health Policy; President, Kaiser Foundation International, Kaiser Foundation Health Plan, Inc. DEBBIE I. CHANG,Vice President, Office of Policy and Prevention, Nemours LILA J. FINNEY RUTTEN, Associate Scientific Director, Population Health Science Program, Department of Health Sciences Research, Mayo Clinic GEORGE R. FLORES, Program Manager, The California Endowment MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County MARTHE R. GOLD, Professor, Sophie Davis School of Biomedical Education, City College of New York GARTH GRAHAM, President, Aetna Foundation PEGGY A. HONORÉ, Director, Public Health System, Finance and Quality Program, Office of the Assistant Secretary for Health, Department of Health and Human Services ROBERT HUGHES, President and Chief Executive Officer, Missouri Foundation for Health ROBERT M. KAPLAN, Director, Office of Behavioral and Social Sciences Research, National Institutes of Health JAMES KNICKMAN, President and Chief Executive Officer, New York State Health Foundation PAULA LANTZ, Professor and Chair, Department of Health Policy, George Washington School of Public Health and Health Services MICHELLE LARKIN, Assistant Vice President, Health Group, Robert Wood Johnson Foundation THOMAS A. LAVEIST, Professor and Director, Hopkins Center for Health Disparities Solutions, Johns Hopkins University Bloomberg School of Public Health JEFFREY LEVI, Executive Director, Trust for America’s Health SARAH R. LINDE, Rear Admiral, U.S. Public Health Service; Chief Public Health Officer, Health Resources and Services Administration SANNE MAGNAN, President and Chief Executive Officer, Institute for Clinical Systems Improvement 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS vii

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PHYLLIS W. MEADOWS, Associate Dean for Practice, Office of Public Health Practice, School of Public Health, University of Michigan; Senior Fellow, Health Program, Kresge Foundation JUDITH A. MONROE, Director, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention JOSÉ MONTERO, President, Association of State and Territorial Health Officials ; Director, New Hampshire Division of Public Health Services MARY PITTMAN, President and Chief Executive Officer, Public Health Institute PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation BRIAN SAKURADA, Senior Director, Managed Markets and Integrated Health Systems MARTIN JOSÉ SEPÚLVEDA, Fellow and Vice President, Health Research, IBM Corporation ANDREW WEBBER, Chief Executive Officer, Maine Health Management Coalition Institute of Medicine Staff ALINA BACIU, Senior Program Officer COLIN FINK, Senior Program Assistant AMY GELLER, Senior Program Officer LYLA HERNANDEZ, Senior Program Officer ANDREW LEMERISE, Research Associate CAROL MASON SPICER, Associate Program Officer (until March 2014) DARLA THOMPSON, Associate Program Officer (from May 2014) ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice PREPUBLICATION COPY: UNCORRECTED PROOFS viii

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REVIEWERS This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Institute of Medicine’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Janet Corrigan, The Dartmouth Institute for Health Policy and Clinical Practice Robert Hughes, Missouri Foundation for Health Glen Mays, University of Kentucky Paul Stange, Independent Consultant Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by George C. Benjamin. Appointed by the Institute of Medicine, they were responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the authors and the institution. PREPUBLICATION COPY: UNCORRECTED PROOFS ix

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CONTENTS ACRONYMS AND ABBREVIATIONS xiii 1 INTRODUCTION AND OVERVIEW 1 The Roundtable on Population Health Improvement, 2 Workshop Scope and Objectives, 3 Organization of the Summary, 3 2 PAYING FOR POPULATION HEALTH IMPROVEMENT: AN OVERVIEW 5 Discussion, 8 3 HEALTH CARE SYSTEM INVESTMENTS IN POPULATION HEALTH IMPROVEMENT 11 Opportunities, Challenges, and Priorities, 11 Health Care Systems as Partners in the Transformation of Community Health, 15 The Role of Affordable Housing in Population Health, 18 Discussion, 19 4 COMMUNITY DEVELOPMENT AND POPULATION HEALTH 21 History, Dimensions, and Opportunities, 22 Lesson from the Reinvestment Fund, 23 Community Development Strategies for Improving Population Health, 25 Discussion, 27 5 PAY-FOR-SUCCESS FINANCING AND POPULATION HEALTH 29 Overview, 29 Social Impact Investment and Population Health, 31 Impact Investing for Better Health and Financial Outcomes, 32 Discussion, 33 6 IMPLICATIONS OF NEW AND EMERGING SOURCES OF POPULATION HEALTH FUNDING 37 Final Reflections and Comments, 39 APPENDIXES A References 41 B Workshop Agenda 43 C Biographical Sketches of Workshop Speakers and Moderators 47 PREPUBLICATION COPY: UNCORRECTED PROOFS xi

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ACRONYMS ACA Affordable Care Act CDFI community development financial institution CMS Centers for Medicare and Medicaid Services EHR electronic health record HUD U.S. Department of Housing and Urban Development IOM Institute of Medicine IRS Internal Revenue Service OECD Organization of Economic Co-Operation and Development TRF The Reinvestment Fund PREPUBLICATION COPY: UNCORRECTED PROOFS xiii

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