Lessons from the ReThink Health Dynamics Model

virtually every aspect about the system that shapes health in America can be improved but if it is not possible to pursue every opportunity at once at full strength then where should we begin are some strategies or certain combinations more powerful than others and most importantly how can we think together about the options and trade-offs one thing is certain our system for health is far too big and complicated to think through all the issues and potential pitfalls without help we need a credible way to play out different scenarios and consider different decisions the rethink health dynamics model was designed for precisely this situation thousands of leaders have used it to guide health improvement efforts across the country and educators in more than a dozen universities have incorporated this tool into their curricula it can even use local data to better represent a particular region what our users learning about what it takes to unlock greater health and economic potential let's review five of the most practical and pivotal lessons welcome to any town USA this is a simplified but realistic portrait of the health system in a mid-sized American city it was created using national data that have been scaled to represent a growing population that is around 300,000 instead of 300 million but in general any town is a lot like every town with real predicaments and troubling trends that make whole scale health reform a pressing priority in 2014 the residents in this region spent about 2.4 billion dollars on medical care for individuals that's just one year in one region and the future costs will climb higher as the population grows larger older sicker and more economically divided what if we invested just 1% in a temporary fund to seed innovations that would be 24 million dollars per year say for five years what can we accomplish with that as a beginning let's start with an effort to deliver better care at lower cost this can include making primary care more efficient following guidelines for routine visits helping people manage their own chronic conditions coordinating care to avoid waste and establishing medical homes to reduce unneeded visits to expensive specialists or emergency rooms as these innovations play out over time patterns of care began to shift dramatically for example there is much less reliance on expensive specialists and a greater emphasis on primary care but those early improvements do not last the full pattern shows quick impact followed by a sharp rebound this signals an underlying problem the collapse of program funding after our initial five-year investment ends the benefits of these reforms begin to erode our first lesson therefore is if we want larger and longer lasting effects then more dependable financing is required there are three ways to proceed raise more external money scaled back the initiatives or reinvest some of the gains to make the effort more self-reliant what if half of the gains from lower health care costs were reinvested to sustain the effort that is similar to new agreements currently offered by most insurers this arrangement channels nearly five times as much money into the endeavor which is enough to sustain program funding for all 25 years the rebound in the pattern of care is largely gone our second lesson is with more stable financing focused efforts to deliver better care can have clear benefits to people's health with lower rates of disease premature death and other outcomes but the results plateau and do not grow as strong as we might hope what more could we do most health professionals are paid on a fee-for-service basis the more they do the more they get paid whether or not it improves health this rewards costly care and undercuts the potential of other reforms what if in addition to the other elements we pay based on the value of services for each person instead of sheer volume this is similar to new payment plans that are becoming the norm in some regions there are positive impacts across all major measures with even lower levels of disease and a dramatically faster decline in health care costs the third lesson is that greater improvement is possible when innovations align with basic economic incentives this combination is so effective that it also generates a growing stream of unspent funds even after covering the full program price tag these are strong results but is this the best we can do can we expand our strategy for example what have we also enabled healthier behaviors and created safer environments by adding these components we now have a more balanced strategy that not only delivers higher value care downstream but also safeguards health and reduces some of the strongest drivers of disease and injury upstream how strong could this combination be how long might it take and could it really be affordable naturally it takes time for behavioral and environmental changes to play out across there many consequences but the investment pays off with results that grow increasingly better in virtually every way including better health and lower costs which are now significantly stronger program spending is a lot higher however health care costs are significantly lower so our fourth lesson is that as long as there is a commitment to reinvest some of the gains a balanced scenario featuring healthier behaviors and safer environments is not only affordable but generates even more resources that could be channeled elsewhere this is clearly a powerful strategy but what can be done to advance wider priorities like health equity and economic prosperity what if we also expand socio-economic opportunities for families for example through things like job training housing support and living wage policies the effects on health and cost are just as strong but with more than thirty percent of the population living at or near poverty and many more on the precipice of falling into disadvantage the fifth lesson is that policies to expand economic opportunity are essential to achieve real strides toward greater health equity and workforce productivity the program costs of such an expansive strategy are much higher yet may still be affordable with prudent sequencing in this example we delayed the investment in family pathways for a few years until the main cost-saving components were well established and there are enough gains from lower healthcare costs to sustain the whole endeavor with even more unspent funds accumulating over time this scenario avoids many pitfalls and steers the region in a healthier more equitable and more productive direction it also delivers strong economic value for every dollar spent this strategy could avoid more than two and a half dollars in healthcare costs and boost workforce productivity by another three dollars with such great potential we can't afford to let our troubled health system continue on the same path these scenarios show just some of the many ways we could steer our system in a new direction different regions will pursue their own course but there are some common patterns to consider clearly partial solutions and short-term shoestring investments will not be enough to unlock our true health and economic potential when equipped with practical tools like the rethink health dynamics model well-positioned leaders are developing the foresight and strength to move beyond business as usual if we want better results we're going to have to invest differently so it matters how money flows and who makes those decisions luckily more and more influential leaders are learning to wield wealth differently to invest for greater value and strategically reinvest to get the real results we all deserve these changes are achievable and affordable in fact with so many lives and so much money at stake how long can we afford not to make smarter investments a healthier future is within reach but we can't pursue a different path if we can't see it to learn more visit us at rethink health org and join us on Twitter

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