I recently attended a training that began with an interesting task: draw nine dots in a three-by-three formation and then connect those dots with four straight lines. The kicker? No taking your pen off the paper once you start. It seemed impossible, but my neighbor quickly solved it. He extended the lines beyond the edge of the imaginary box, which suddenly made the task easy to complete. The exercise served as a perfect reminder of how we have been conditioned since early childhood to color inside the lines and think inside the box. This conditioning manifests in other ways as well, including in the health care sector.
Keeping people healthy is generally considered the responsibility of the health care sector, with the focus on getting patients insured and getting them health care at the right time and in the right care setting. While this is critical, it is a small part of what makes people healthy. This focus makes it difficult for health care systems to see beyond the four walls of their institution—the box we’ve been conditioned to see health care as. What it means to keep people healthy, and the role of the health care sector in achieving that, is slowly changing, though; we’ve begun to see the merits in investing money, time, and energy outside of the proverbial box.
At CCMU, we have been paying close attention to some of these shifts in how we care for people’s health:
- Community benefits – For a nonprofit hospital to qualify as tax-exempt, it has to provide community benefit. Pre-Affordable Care Act and Medicaid expansion, this played out mainly in the provision of uncompensated care; but now, with greater rates of coverage, hospitals are increasingly exploring how to work with communities to address upstream social determinants of health.
- Health (or social) impact bonds – Capital is raised from private investors for interventions focused on prevention. If the intervention succeeds, health care cost savings are captured, with some of the savings going back into the pockets of investors as profit, and additional savings seeding new prevention-oriented activities. Early this year, Denver launched a social impact bond program (PDF) to address homelessness.
- Accountable Care Organizations – Groups of health care providers, hospitals, and increasingly, community-based organizations convene to care for a population of patients. If certain quality and spending targets are met, Medicare savings result. This model has been adapted for Health First Colorado, Colorado’s Medicaid program, in what’s referred to as the Accountable Care Collaborative.
- Wellness trusts – A pool of funding raised for community prevention and wellness efforts targets specific populations. One way of garnering needed funds is through levying a small tax on insurers and hospitals. Massachusetts recently passed legislation (PDF) to create a $60-million dollar Prevention and Wellness Trust.
Initiatives are popping up all around the country, with the hope that community-based investment can make populations healthier and save costs in the system. Some of these efforts are already starting to show gains, with others demonstrating potential. Just as I plan to challenge myself to think outside the dots, CCMU will do the same, by supporting efforts that encourage the kind of outside-the-box creativity that fosters opportunities for a healthier Colorado.
