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What top five i nterventions would you support to achieve the triple aim of better care, better health, lower cost?. Leveraging the Community Benefit Requirements of the Affordable Care Act for Collective Impact: The Atlanta Regional Collaborative for Health Improvement (ARCHI ).

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What top five interventions would you support to achieve the triple aim of better care, better health, lower cost?

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Leveraging the Community Benefit Requirements of the Affordable Care Act for Collective Impact: The Atlanta Regional Collaborative for Health Improvement (ARCHI)

Presented to:

Grantmakers in Health

March 7, 2014

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Changes in Public Coverage

Changes in Private Coverage

Improving Health Care Quality

Improving Health

the chna opportunity in the aca
The CHNA Opportunity in the ACA
  • Community health needs assessments (CHNA) are now required every three years of not-for-profit health entities in order to maintain their tax-free status
  • CHNA and implementation strategy required for each facility
the chna opportunity in the aca1
The CHNA Opportunity in the ACA
  • CHNA:
    • A description of “community” and how it was determined
    • A description of process and methods, including data used and information gaps
    • A description of how input was gathered from those with a broad interest in the community
    • A prioritized list of community health needs, including how the list was prioritized
the chna opportunity in the aca2
The CHNA Opportunity in the ACA
  • Implementation plan:
    • Must describe how each health need identified in the CHNA will be met, or
    • Describe identified needs that will not be met by that hospital and why
    • Must be approved by a governing body
    • Collaboration is encouraged
solution
Solution

Led by United Way, ARC, and Georgia Health Policy Center

Funders (CDC, Kaiser, St. Joseph’s Healthcare, Grady, and the Lead Organizations)

Public Health, Hospitals, FQHCs, Physicians, Behavioral and Other Providers

Funders (CDC, Kaiser, etc.)

Business, Education, County Commissioners, Faith Leaders, Insurers, Philanthropy

County Commissioners

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How can we work together to solve complex problems in a complex world using technology that helps us see, understand & talk about the real problems and develop sustainable solutions…

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THE RIPPEL FOUNDATION

Seeding Innovations in Health

the fannie e rippel foundation
THE FANNIE E. RIPPEL FOUNDATION
  • Founded in 1953 as a charitable foundation
  • 6 person Board of Directors
  • Home office Morristown, NJ; satellite location in Cambridge, MA
  • $85 million in assets; $6.4 million 2014 budget
  • 30 full and part time staff and long term contractors… and growing
  • Legal Mandate: Women, Elderly, Cancer, Heart Disease, Hospitals
  • 2007 Mission: “Seed Innovations in Health”
  • Primary program and investment: ReThink Health
      • 75% of total Rippel budget; 95% of program budget
      • Generated $2.5 million in grants and earned income to date
  • After 53 years of primarily making grants…
      • Almost no grants, not operating foundation; work through DCA
  • Commitment to collaboration with like-minded partners
julius a rippel president 1953 1983
JULIUS A. RIPPEL, PRESIDENT, 1953 - 1983

1959 – We have long known that health care facilities should be adapted to the patients rather than the opposite.

1967 - To avoid becoming sick may be the greatest health and medical challenge to contemporary society.

1968 - Sooner or later some group will find out how to build, organize and operate a hospital which will be better and more flexible than at present, and at a lower cost.

1968 - The greatest opportunity people have to achieve and maintain good health and well-being, at the lowest possible cost, is by their own intelligent methods of daily living habits.

1969 - We need to develop a health care system which will be recognized as distinct from medical care. This is a real key to solving our “medical problem.”

1969 - We must have substantially new manners of thinking to enable mankind to bridge the gap between the things that have been and the things which will be.

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RETHINK HEALTH

A Collaborative Initiative of the Rippel Foundation

origins of rethink health
ORIGINS OF RETHINK HEALTH

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  • Don Berwick | CMS, IHI
  • Elliott Fisher | The Dartmouth Institute
  • Marshall Ganz | Leading Change, Harvard
  • Celinda Lake | Lake Research
  • Laura Landy | Rippel Foundation
  • Amory Lovins| Rocky Mountain Institute
  • Jay Ogilvy | Global Business Network
  • Elinor Ostrom | Nobel Laureate in Economics
  • Peter Senge | MIT, Society for Org. Learning
  • John Sterman | MIT System Dynamics Group

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10

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challenge principles
CHALLENGE & PRINCIPLES

Action

Results

ReActing

Thinking

… work with leaders to demonstrate that sustainable redesign of regional health systems is possible and can improve health, care, costs, equity, ownership, productivity, regional economies, and communities vitality.

Better health, better care, lower costs and access for all

Collaboration by leaders across boundaries (in and out of health)

Whole system thinking

Redesign to meet health and care needs

National purpose, local action

RETHINKING

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work with leaders coalitions to
 WORK WITH LEADERS & COALITIONS TO…

Bring system stakeholders together in a way that builds trust, shared vision, and collaborative action. 

Build purposeful and effective stewardship teams that can sustain efforts and achieve measurable results over time. 

Assure that health resources are being spent to achieve the greatest impact. 

Align community priorities with health system priorities.

Finance and sustain efforts long enough to see real results and avoid rebound experiences. 

Support innovation, implementation, and system redesign in ways that achieve high impact goals and build critical interdependencies. 

Educate leaders to have a whole system and collaborative perspective.

Engage in action-research

Develop and share lessons, tools, approaches

since 2007
SINCE 2007…
  • Grant funding from the California HealthCare Foundation and the Robert Wood Johnson Foundation plus increasing earned income
  • Experience in more than 30 regions across the country
  • Created and used the Dynamics Model in 50 settings, 9 academic institutions, and thousands of users
  • Successful distance learning course with 180 participants
  • Building a learning network and community
  • Extensive partnerships with motivated leaders, regions and organizations
  • Strong enterprise wide evaluation process
  • Impact on regional and national levels
redirecting health futures

Historical

Data

Stewardship Teams Exploring Simulated Scenarios

in Strategy Labs

REDIRECTING HEALTH FUTURES

U.S. National Health Expenditures (1998-2020)

Where?

What?

$ in Billions

How?

Why?

Who?

Keehan SP, Cuckler GA, Sisko AM, et al. National Health Expenditure Projections: Modest Annual Growth Until Coverage Expands And Economic Growth Accelerates. Health Affairs 2012.

Heffler S, Smith S, Keehan S, Borger C, Clemens MK, Truffer C. U.S. health spending projections for 2004-2014. Health Affairs 2005:hlthaff.w5.74.

common pitfalls
COMMON PITFALLS
  • Unsustainable program financing
  • Spreading resources over too many initiatives
  • Lopsided investments downstream or upstream
  • Triggering “supply push” responses to declining utilization
  • Exacerbating capacity bottlenecks
  • Perpetuating inequity
  • Neglecting or focusing only on disadvantaged, children, or seniors
  • Pursuing narrow goals and short-term impacts
  • Concentrating only on small sub-systems
why we get caught
WHY WE GET CAUGHT….

Hard to see the bigger system and where things/we fit

Stakeholders see different problems and solutions

Stakeholders speak different languages

Don’t recognize that not all solutions are equal – good / bad

Real conversations about money, priorities, strategy, etc. are difficult

Alignment from the community to policy levels is challenging

Pressure for short term results with limited evidence for better planning

System is complex and hard to predict

unsticking
UNSTICKING…

Consider Many Pathways

Engage in Deeper Dialogue

Anticipate Consequences and Plausible Futures

rethink health dynamics model
RETHINK HEALTH DYNAMICS MODEL
  • Realistic yet simplified portrait of a local health system (N=8 to date)
  • Anchored to evidence from dozens of datasets
  • A common, testable framework and tool for open, experiential learning
  • Designed with and for diverse stakeholders
  • Not a prediction, but a way to see and feel how local health system can change

ReThink Health. Summary of the ReThink Health Dynamics model.

Available at http://rippelfoundation.org/docs/RTH-Dynamics-Model-Summary.pdf

overview
OVERVIEW

Selected Geographic Focus

Productivity & Equity

Risk

Health

Care

Cost

Aging

Capacity

  • Other Trends
  • Insurance eligibility
  • Economic conditions
  • Health care inflation
  • Primary care slots

Initiatives

Payment

Captured

Scheme

Savings

Innovation

Funds

Population tracked separately in 10 segments by age, insurance, and income

explore likely consequences of decisions
EXPLORE LIKELY CONSEQUENCES OF DECISIONS…

Savings

O

What happened?

Why?

What can we do?

Initial

R

Innovation Fund

Capture &Reinvest

Health Care

Savings

Costs

O

Funds Available

Program

for Investment

B

Investments

O

Fund

Depletion

Spending on

Programs

helps leaders and coalitions answer
HELPS LEADERS AND COALITIONS ANSWER…

Are we doing the right things now?

What should commit to do?

Do we have the right partners engaged?

How do we pay for it?

How proud would we be to succeed?

What is our plan going forward?

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philanthropy
Philanthropy
  • Convener
  • Neutral voice
  • Demonstrate patience and perseverance
  • Exhibit and encourage collaboration for collective impact
  • Invest
  • Work behind scenes
kaiser permanente
Kaiser Permanente
  • Funded research that identified need/opportunity
  • Key influencer behind the scenes
  • Shared value of collective impact
  • Continuous engagement
  • Patient capital investment
  • Aligned CHNA requirement/grant making to support ARCHI
philanthropic collaborative healthy georgia
Philanthropic Collaborative Healthy Georgia
  • 20 foundations sought to improve primary care through collaboration, data sharing and joint planning
  • Grady Health System & Four Federally Qualified Health Centers (FQHCs)
  • Collaborations on Patient Navigator Program, Accountable Care Organization application & Mobile Phone App
  • Aligned with ARCHI – Care Coordination
  • Grady allows staff privileges for FQHC physicians
united way of metro atlanta
United Way of Metro Atlanta
  • Aligned major $3.5 M Grant “Forget the Box”
  • Grantees must
    • Demonstrate at least two ARCHI priorities
    • Collaborate
    • Participate in Rethink Health learning agenda
  • Selected grantee may become ARCHI pilot
thank you

Thank You!

www.archicollaborative.org

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