1

Introduction¹

Since 2013, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine has been providing a trusted venue for leaders from the public and private sectors to meet and discuss leverage points and opportunities for achieving better population health in the evolving political and social environments, said Sanne Magnan of HealthPartners Institute and the University of Minnesota. The roundtable’s vision is of a strong, healthful, and productive society that cultivates human capital and equal opportunity. This vision rests on the recognition that outcomes such as improved life expectancy, quality of life, and health for all are shaped by interdependent social, economic, environmental, genetic, behavioral, and health care factors. Achieving this vision will require national and community-based policies and dependable resources, Magnan continued.

In 1997, David Kindig of the University of Wisconsin–Madison asserted that “population health improvement will not be achieved until appropriate financial incentives are designed for this outcome” (Kindig, 1997, p. 174), and Magnan noted that this statement remains true more

___________________

¹ This workshop was organized by an independent planning committee whose role was limited to identification of topics and speakers. This proceedings was prepared by the rapporteur as a factual summary of the presentations and discussions that took place at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, the Health and Medicine Division, or the roundtable, and they should not be construed as reflecting any group consensus.

than two decades later. “We are moving in the right direction,” Magnan said, “but with the recent report of declining U.S. life expectancy, there is much more to be done.”

The roundtable has considered the topic of resources broadly and from a range of perspectives, and Magnan referred participants to the proceedings of several recent roundtable workshops as examples (see IOM, 2014, 2015a,b; NASEM, 2018, 2019). To further the discussion, on December 3, 2018, the roundtable convened a workshop, hosted by New York University (NYU) Langone Health in New York City, to explore how evolving concepts of value in health care and business investments are leading to a shift in resources toward investments in health and wellbeing for all. Participants were welcomed by Marc Gourevitch on behalf of NYU Langone Health.

Bobby Milstein of ReThink Health also noted the decades-long history of work on various aspects of the flow of resources for population health. Resources matter, he said, but “to get better results, we must invest differently.” New concepts of value and investment have the potential to shift entire sectors of the U.S. economy, Milstein continued. Magnan and Milstein referred participants to an infographic commissioned for the workshop that provides an overview of the ways in which the health care and business investment sectors are moving toward a well-being economy (see Appendix E).

There is both “good news and bad news” along the macroeconomic path to realizing the country’s potential for health, well-being, and prosperity, Milstein said. On the negative side, there has been a long history of macroeconomic and market movements (i.e., and their negative effects on workers, communities, and the environment) that have brought us to the realization, stated Milstein, that “until we really bring the value for health and well-being into our markets, we’re not going to see the full potential for health and well-being to flourish.” On the positive side, investing in health and well-being is now a recognized and visible priority. He mentioned several examples, including emphasis in the forthcoming Healthy People 2030 and the priorities established by the current Surgeon General as well as documents from the Federal Reserve and other financial organizations, on investing for outcomes and value for the long term. There is a movement toward value and an opportunity for leadership, he said. Milstein emphasized leadership opportunities as the focus of the workshop discussions and called on participants to consider what leadership role they could take to drive the necessary investments that will lead to equitable health and well-being.

WORKSHOP OBJECTIVES

The agenda for this workshop was developed by an independent planning committee that included Magnan, Milstein, Cathy Baase (Michigan Health Improvement Alliance and The Dow Chemical Company), James Knickman (NYU), Lisa Richter (Avivar Capital), Mylynn Tufte (North Dakota Department of Health), and Caroline Whistler (Third Sector Capital Partners). (The planning committee’s Statement of Task is provided in Box 1-1.) As outlined by Milstein, the workshop objectives were to:

• Reflect on the history and current state of the shift to new values and investment priorities (e.g., living wages or environmental sustainability) within two spotlight sectors: health care and business investments;
• Explore what selected organizational leaders are doing to establish new concepts of value and new investment priorities (including tools and platforms useful to these efforts); and
• Identify leadership and partnership opportunities that could help to further the shift toward new investments that produce equitable health and well-being.

The workshop, a 1-day event, could not include a detailed history of the investment landscape in the business and health sectors, or orient audience members unfamiliar with those fields to the impact invest-

ing and community development domains. However, some readings and resources were provided on the workshop web page and by email to registered attendees (see Appendix D), along with a commissioned infographic (see Appendix E), to orient workshop attendees and the broader audience to the topic and to help them enhance their understanding of the subject matter.

ORGANIZATION OF THE WORKSHOP AND PROCEEDINGS

The workshop opened with a keynote address from U.S. Surgeon General Jerome Adams (see Chapter 2). The first two panel sessions of the workshop focused on whole-sector overviews of the evolving values and priorities in health care (see Chapter 3) and in business investments (see Chapter 4). The next two panel sessions provided profiles of selected leaders in the health care (see Chapter 5) and business investment (see Chapter 6) sectors, with attention to how leaders of those institutions reposition their organization’s priorities, relationships, and investments in a changing landscape. The workshop concluded with a small group activity that drew from the day’s discussions to consider priorities for value and investment, followed by final observations and reflections from Joshua Sharfstein (see Chapter 7). Points of interest were shared on Twitter throughout the day by participants using #pophealthrt.²

___________________

² The Twitter discussion that took place on December 3, 2018, in association with the workshop can be viewed at https://twitter.com/hashtag/Pophealthrt (accessed June 23, 2021).