In the final discussion, moderated by David Kindig of the University of Wisconsin, roundtable members and attendees reflected broadly on engaging business in population health improvement. The following topics were highlighted by roundtable members and participants as important takeaway messages from the presentations they heard.
George Flores of The California Endowment observed that in the discussion of the key features of the blue zones, none of the people who were interviewed identified health care services, superior doctors or hospitals, or the services of health departments as among the reasons they were living so long. Flores emphasized that health is not a service; it is an intrinsic value. People in the blue zones place a high value on a lifestyle and a culture that supports health. Referring to Dan Buettner’s assertion that health is a part of living with purpose, a participant noted that some businesses offer opportunities for employee volunteerism, which is one way to increase purpose. Catherine Baase of The Dow Chemical Company agreed that health does not come from any entity, but rather from the shared environment that supports people in achieving health. There has been an evolution in worksite health and in creating health for the employee population. In many cases the culture and environment created leads to high employee participation rates in health activities with few or no financial incentives. The challenge is to figure out how to do that at the community level.
Throughout the workshop, invited panelists shared examples of how businesses had engaged successfully in communities and in population health. In the final discussion, participants discussed lessons and specific elements that could help facilitate these types of engagement efforts in other geographic areas.
Champions, Conveners, and Integrators
Alisa May, executive director of Priority Spokane, said that two factors that were key to the success of Priority Spokane were having specific data about the community and having a champion who could reach out to other influential players and start a neutral, trusted group (i.e., Priority Spokane) to bring these data and issues forward. Having a trusted organization that businesses can look to and rely on is essential. Who fills that role in each community will be different. If there is not an existing organization to fill that role, she recommended developing one, acknowledging that this can take a number of years. Kindig and James Knickman of the New York State Health Foundation also highlighted the need for a trusted organizer, community health trust, or other integrating organizations, as had been discussed by George Isham of HealthPartners and John Whittington of the Institute for Healthcare Improvement (see Chapter 6). This will take different forms in different places, Kindig agreed.
Knickman added that although many employers are doing good things, most are not ready to take a leadership role in population health that is transformative. He suggested that it may be the employees who can energize their employers to support their communities.
Relationship Building and Trust
May further emphasized trust as an essential component of bringing diverse stakeholders together. She said that she has observed people from different nonprofit organizations or the educational sector making disparaging comments about the business sector as being highly profit driven. However, the purpose of a business is to make a profit. Trust has to work both ways, she said, and progress cannot be made in the face of negative attitudes about businesses and why they are in business. In addition, it cannot be left entirely to businesses to reach out to other members of the community and do the work of building trust and relationships. The community must reach out to businesses as well. Those relationships might begin at the Rotary club or at community meetings, for example. May recommended making a point of sitting next to business members at the
table and starting those casual conversations that can eventually lead to a brief presentation, with one key piece of data that can take the relationship to the next level. Peggy Honoré of the U.S. Department of Health and Human Services agreed that the public health and health care communities need to reach out to the business community. She told a story about a time when there was an influx of casino gaming in a particular state and while education, transportation, the police department, and other sectors of the community approached the new businesses for collaborations, the health sector did not.
Kindig pointed out that the roundtable’s December 2013 workshop, Supporting a Movement for Health and Health Equity, emphasized the role of relationships (IOM, 2014b). He added that although the Institute of Medicine workshops are not framed as relationship-building sessions, they do connect people who have not been previously connected.
Reaching Out to Key Corporate Personnel
Participants discussed further the points made in the previous panel about identifying and reaching out to the key corporate personnel. Jacqueline Martinez Garcel of the New York State Health Foundation said that to get health systems to think outside their walls, their boards and the chief executive officers must embrace change. Things start to change when the leadership of health systems starts to see population health as part of their mission and their vision.
Measures and Metrics
Paula Lantz, a professor at the George Washington University School of Public Health, emphasized the need for measures and metrics and for ways to use data to excite businesses and communities about “moving the dial” on population health. However, she raised a concern about the use of life expectancy as a metric because it is not accurate and can be misleading to individuals and communities. Life expectancy is a population-level statistic, and it is a synthetic measure used by demographers, she explained. She expressed concern about the idea of using population-level statistics to calculate individual life expectancies that have any predictive power, and about telling people how they might increase that life expectancy by taking certain actions. As a demographer, she said, she is concerned about how the reported increases in life expectancy of communities over a short period of time are being measured.
Many participants said they were encouraged by the examples of business engagement in population health that had been described throughout the workshop, but the sentiment was that there is much to be done to make these examples the rule rather than the exception.
Gary Rost of the Savannah Business Group cautioned that the employers and coalitions represented at the workshop are innovators and are the rare exceptions to the general pattern among businesses. A question that needs to be asked is, Who is currently providing information to the chief executive officers, chief financial officers, and benefit managers of the employers that are not engaged? He suggested that it is often brokers, consultants, actuaries, and benefit lawyers and that benefit plan design sessions for employers tend to be about avoidance (e.g., not covering certain conditions or providing certain services, or how to get people off the company health plan). Baase of The Dow Chemical Company agreed that the business case examples discussed at the workshop are not the norm. There is a real need for awareness in the business community of the capacity of businesses to affect health and of how to use the assets they have to have a beneficial impact. She added that it is hard to imagine being able to achieve public health objectives in population health without the business community, but she reminded participants that the business community is only one essential element of the solution. Isham agreed that business coalitions are far from everywhere around the country. He suggested that the Blue Zones® project (see Chapter 2) is a tremendous example of how to get things rolling in places that want to commit and that already have certain key characteristics. The question now is, How can this be expanded to everywhere else?
Addressing the Disconnect Between Health and Wellness Promotion and Health Care
José Montero of the New Hampshire Division of Public Health Services said that although there are many real life examples of businesses taking action on health, there is still a disconnect between health and wellness promotion and employee health care, especially when it comes to making direct and clear connections regarding the impact on costs and outcomes. There is a need for a comprehensive look at what we pay for and what we are getting out of it. He noted that the initial focus of the Triple Aim was clinical and was geared toward the individual,
but the concept has evolved toward looking at the overarching outcome for the population.
Sharing the Success Stories
Terry Allan of the National Association of County and City Health Officials referred to the forthcoming IBM playbook mentioned by Grace Suh of the IBM Corporation (see Chapter 4) and said that while the intent of the 9-to-14 early college high school model is to develop a pipeline of talent for IBM, the concept is also an opportunity for particularly high-need communities. There also may be playbooks available describing business efforts to address specific health problems in communities. He suggested that one role for the roundtable could be to assemble and share the stories from businesses of different sizes and how they have engaged in health.
Driving Policy Change
Allan also suggested that businesses need to be more involved in policy changes aimed at affected community health. Business has influence with legislators and elected officials and has, particularly in the health care industry, the data to support policy change.
Mentoring and Economic Development
Flores highlighted the role and capacity of business in mentoring youth so that they can become productive (thereby reducing economic and health inequities). Anybody who is employed could be a mentor to a youth who does not have an employment role model, he said. Kindig added that the business role in job creation and economic development in communities should not be overlooked.
A Continuum of Investments in Health
Phyllis Meadows of The Kresge Foundation reiterated the notion of a continuum of investments in population health, from the early investments of ensuring compliance within an institution (e.g., safety) to charitable outreach programs in health, to health as part of the strategic plan. Positive changes have occurred, she said, because many stakeholders, with good intentions, are taking action on health. However, each stakeholder is addressing pieces of health issues individually, without coming together in a strategic and effective way. This is where the next movement
has to come from, she said—to go beyond being charitable to being more strategic and, ultimately, more focused on systems change to improve population health. Andrew Webber of the Maine Health Management Coalition said that the journey will take incremental steps. The business community and other stakeholders will start to think about population health relative to the defined populations that they have authority over. That journey can lead them to consider the larger community and to engage other stakeholder groups.