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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Page R8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Building Sustainable Financing Structures for Population Health: Insights from Non-Health Sectors: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24760.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Building Susta ainable Fina ancing Stru g ucture es ulation Health: In for Popu n nsights from Non m n- Health Sect tors PROC CEEDINGS OF A W S WORKSHO OP Th heresa Wiz zemann, Ra apporteur Roundtabl on Popu le ulation Hea Improv alth vement Boa on Popu ard ulation He ealth and Pu ublic Heal Practice lth e Health and Medicine D H Division PREPUBL LICATION CO OPY: UNCOR RRECTED PR ROOFS

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and Aetna Foundation, The California Endowment (#10002009), Fannie E., Health Resources and Services Administration (DHHS-10002817), New York State Health Foundation (#10001272), Rippel Foundation, and Robert Wood Johnson Foundation (#10001270). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/24760 Additional copies of this publication 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. Copyright 2017 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Building sustainable financing structures for population health: Insights from non-health sectors. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24760. PREPUBLICATION COPY: UNCORRECTED PROOFS

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS

PLANNING COMMITTEE ON BUILDING SUSTAINABLE FINANCING STRUCTURES FOR POPULATION HEALTH1 PAMELA RUSSO (Chair), Senior Program Officer, Robert Wood Johnson Foundation CARTER BLAKEY, Deputy Director, Office of Disease Prevention and Health Promotion and Director, Division of Community Strategies, U.S. Department of Health and Human Services. ALEX BLANDFORD, Deputy Program Director, Behavioral Health, Justice Center, Council on State Governments DENISE FAIRCHILD, President and Chief Executive Officer, Emerald Cities Collaborative GARY GUNDERSON, Vice President for Faith and Health, Professor of Public Health Sciences, Wake Forest Baptist Medical Center, and Professor of Religion and the Health of the Public, Wake Forest University School of Divinity. JIM KNICKMAN, Derzon Clinical Professor, Robert F. Wagner Graduate School of Public Service, New York University BOBBY MILSTEIN, Director, ReThink Health CHRIS PARKER, Associate Project Director, Georgia Health Policy Center 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. v PREPUBLICATION COPY: UNCORRECTED PROOFS

ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1 GEORGE J. ISHAM (Co-Chair), Senior Advisor, HealthPartners, Inc., and Senior Fellow, HealthPartners Institute for Education and Research SANNE MAGNAN (Co-Chair), former President and Chief Executive Officer, Institute for Clinical Systems Improvement DAVID A. KINDIG (Co-Chair Emeritus), Professor Emeritus and Emeritus Vice Chancellor, University of Wisconsin School of Medicine and Public Health TERRY ALLAN, Health Commissioner, Cuyahoga County Board of Health JOHN AUERBACH, Associate Director for Policy, Centers for Disease Control and Prevention, and Acting Director, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention CATHERINE BAASE, Global Director of Health Services, The Dow Chemical Company RAYMOND J. BAXTER, Senior Vice President, Community Benefit, Research and Health Policy, Kaiser Permanente and President, Kaiser Permanente International RAPHAEL BOSTIC, Professor and Judith and John Bedrosian Chair in Governance and Public Enterprise, Sol Price School of Public Policy at the University of Southern California DEBBIE I. CHANG, Vice President, Policy and Prevention, Nemours CHARLES J. FAZIO, Senior Vice President and Medical Director, HealthPartners, Inc. GEORGE R. FLORES, Program Manager, The California Endowment ALAN GILBERT, Director, Global Government and NGO Strategy, GE Healthymagination MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County MARTHE R. GOLD, Visiting Scholar, The New York Academy of Medicine GARTH GRAHAM, President, Aetna Foundation GARY GUNDERSON, Vice President, Faith and Health Ministries, and Professor, Wake Forest School of Medicine ROBERT M. KAPLAN, Chief Science Officer, Agency for Healthcare Research and Quality JAMES KNICKMAN, Derzon Clinical Professor, Robert F. Wagner Graduate School of Public Service, NYU School of Medicine PAULA LANTZ, Professor and Associate Dean for Research and Policy Engagement, Gerald R. Ford School of Public Policy, University of Michigan MICHELLE LARKIN, Assistant Vice President, Program Portfolios, Robert Wood Johnson Foundation THOMAS A. LAVEIST, Professor and Chair, Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University JEFFREY LEVI, Professor, Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University SARAH R. LINDE, Rear Admiral, U.S. Public Health Service, Chief Public Health Officer, Health Resources and Services Administration 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. vii PREPUBLICATION COPY: UNCORRECTED PROOFS

PHYLLIS D. MEADOWS, Senior Fellow, Kresge Foundation, and Associate Dean for Practice and Clinical Professor, School of Public Health, University of Michigan BOBBY MILSTEIN, Director, ReThink Health JOSÉ T. MONTERO, Vice President of Population Health and Health Systems Integration, Cheshire Medical Center/Dartmouth Hitchcock Keene MARY PITTMAN, President and Chief Executive Officer, Public Health Institute PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation DAVID SANDMAN, President and Chief Executive Officer, New York State Health Foundation Health and Medicine Division Staff ALINA BACIU, Study Director COLIN FINK, Senior Program Assistant (until February 2017) DARLA THOMPSON, Program Officer ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice Consultant THERESA WIZEMANN, Rapporteur viii PREPUBLICATION COPY: UNCORRECTED PROOFS

CONTENTS 1 INTRODUCTION ................................................................................................................1 2 SUSTAINABLE FINANCING STRUCTURES FOR POPULATION HEALTH: HISTORICAL PATTERNS AND INSIGHTS FOR THE FUTURE ...................................7 3 CASE EXAMPLE 1: JUSTICE REINVESTMENT ..........................................................17 4 CASE EXAMPLE 2: CLEAN ENERGY FINANCING ....................................................27 5 REALIGNING RESOURCES FOR POPULATION HEALTH: SMALL GROUP CONVERSATIONS ...........................................................................................................41 6 REFLECTIONS ON THE WORKSHOP ...........................................................................53 A REFERENCES....................................................................................................................57 B WORKSHOP AGENDA ....................................................................................................59 C SUSTAINABLE FINANCING STRUCTURES FOR POPULATION HEALTH: HISTORICAL PATTERNS AND INSIGHTS FOR THE FUTURE: COMMISSIONED PAPER ................................................................................................................................63 D SPEAKER BIOGRAPHICAL SKETCHES .......................................................................79 ix PREPUBLICATION COPY: UNCORRECTED PROOFS

ACRONYMS AND ABBREVIATIONS ACO accountable care organization CARB California Air Resources Board COWS Center on Wisconsin Strategy GDP gross domestic product HUD U.S. Department of Housing and Urban Development IEA International Energy Agency NHT National Housing Trust PAYS® Pay As You Save® xi PREPUBLICATION COPY: UNCORRECTED PROOFS

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In October 2016, the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement hosted a workshop to explore sustainable financing structures that reflect a recognition of the health and non-health factors that shape the well-being of U.S. communities. The goals of the workshop were to learn from the long-term, sustainable financing strategies used in other sectors, to explore how those approaches could be applied to population health, and to consider structures that work across sectors. This publication summarizes the presentations and discussions from the workshop.

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