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1 Introduction2 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. The roundtableâs 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 WisconsinâMadison, asserted that âpopulation health improvement will not be achieved until appropriate financial incentives are designed for this outcomeâ (Kindig, 1997, p. 174), and Magnan noted that this statement remains true more than two decades later. âWe are moving in the right direction,â Magnan said, âbut with the recent report of declining U.S. life expectancy, there is much more to be done.â 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, 2014a,b, 2015; NASEM, 2018a,b). 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 well-being for all. Participants were welcomed by Marc Gourevitch on behalf of NYU Langone Health. 2 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. 1 PREPUBLICATION COPY: UNCORRECTED PROOFS
REORIENTING INVESTMENT PRIORITIES TOWARD HEALTH AND WELL-BEING 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 âuntil we bring the value for health and well-being into our markets, we are not going to see the full potential for health and well-being to flourish.â In other words, âto get better results, we must invest differently.â 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 âgood news and bad newsâ along the macroeconomic path to realizing the countryâs 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 âuntil we really bring the value for health and well-being into our markets, weâre not going to see the full potential for health and well-being to flourish.â 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 Milstein, Magnan, Cathy Baase (Michigan Health Improvement Alliance), James Knickman (NYU), Lisa Richter (Avivar Capital), Mylynn Tufte (North Dakota Department of Health), and Caroline Whistler (Third Sector Capital). (The planning committeeâs Statement of Task is provided in Box 1-1.) As outlined by Milstein, the workshop objectives were to: â¢ 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; â¢ 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 â¢ Identify leadership and partnership opportunities that could help to further the shift toward new investments that produce equitable health and well-being. 2 PREPUBLICATION COPY: UNCORRECTED PROOFS
INTRODUCTION BOX 1-1 Planning Committee Statement of Task An ad hoc committee will plan and convene a 1-day public workshop that will explore some of the factors that can spur change in economic priorities in two spotlight industries: health care and financial services. Both industries are in the midst of a quest to reorient decision making regarding when, where, and with whom to invest resources that affect all lives and livelihoods, and thus shape the conditions for health and well-being. The workshop will feature invited presentations and discussion that will explore (1) the history and current state of the shift to new investment priorities (e.g., environmental sustainability, worker well-being); (2) what industry leaders are doing to make progress and avoid pitfalls; (3) tools and platforms that are useful to these efforts; and (4) lessons and insights that stakeholders can use to help reinforce the shift toward healthier investments. The committee will plan and organize the workshop, select and invite speakers and discussants, and moderate discussions. A proceedings and a proceedings in brief of the presentations and discussion at the workshop will be prepared by a designated rapporteur in accordance with institutional guidelines. 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 investing and community development domains. However, some resources and readings were provided on the workshop web page and by email to registered attendees (see Appendix D), along with a commissioned graphic (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 organizationâs priorities, relationships, and investments in a changing landscape. The workshop concluded with a small group activity that drew from the dayâs discussions to consider priorities for value and investment, followed by final observations and reflections from Josh Sharfstein (see Chapter 7). Points of interest were shared on Twitter throughout the day by participants using the hashtag âpophealthrt.â3 3 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 February 8, 2019). 3 PREPUBLICATION COPY: UNCORRECTED PROOFS