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National Academy of Medicine; The Learning Health System Series; Hunt A, Anise A, Chua PS, et al., editors. Valuing America’s Health: Aligning Financing to Reward Better Health and Well-Being. Washington (DC): National Academies Press (US); 2024 Feb 12.
Valuing America’s Health: Aligning Financing to Reward Better Health and Well-Being.
Show detailsThe following tables provide an overview of the Steering Group’s judgment of the impact and feasibility of the stakeholder-specific priority actions outlined in Chapter 4.1
PATIENTS, FAMILIES, AND COMMUNITIES
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Harness the political process and advocate for financial reforms and more equitable and inclusive health policies. | Transformative | 4.4 | 2.6 |
| Engage in advocacy skills training to enhance the power of the whole person, whole population health movement by expanding stakeholder networks. | Intermediate and Incremental | 2.8 | 3.6 |
| Develop and participate in community-based, multi-stakeholder coalitions to guide the design, implementation, and evaluation of programs to support whole person and whole population health and well-being. | Intermediate and Incremental | 3.2 | 3.4 |
| Ensure that a diverse array of community members is involved in the governance of local, state, and/or regional health coalitions to improve equity, inclusion, and representation as it pertains to race, ethnicity, age, and disability status, among other personal characteristics. | Intermediate and Incremental | 3.0 | 3.2 |
| Educate stakeholders on the need to advocate for policies that prioritize whole health, including the indirect impacts of other policy decisions on health. | Intermediate and Incremental | 2.8 | 3.6 |
State and Local Governments
Legislative and Executive Branches
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Pursue and use 1115 waivers to cover innovative care and payment models that address social determinants of health. | Transformative | 3.6 | 4.0 |
| Require managed care organizations to focus on prevention and social determinants of health through Medicaid managed care contracts. | Transformative | 3.4 | 4.0 |
| Use accountable care organization models to assign providers responsibility for the costs and quality of a defined community’s health. | Transformative | 3.4 | 3.0 |
| Align policies across state health insurance programs like Medicaid, Children’s Health Insurance Program, and state employee insurance, as well as between state insurance programs and state social service entities to better support health outcomes. | Transformative | 3.4 | 2.8 |
| Require that all nonprofit hospitals engage in multi-stakeholder collaborations to establish and finance locally controlled pools of funds with a neutral community entity as a fiscal agent similar to the Massachusetts Prevention & Wellness Trust Fund program. | Transformative | 4.6 | 3.2 |
| Design and require the use of HIAs to assess the impact of policy proposals and business activities on health, particularly in sectors where health impacts may not be currently considered. | Transformative | 3.4 | 3.4 |
| Develop, or require the development of, cross-sector, data-sharing capabilities to facilitate cross-platform collaboration between public health, insurance, social services, and care delivery information systems. | Transformative | 3.4 | 2.6 |
| Require nonprofit health systems to apply community benefit dollars toward impact investments that improve social, economic, and environmental conditions in disadvantaged communities while also producing economic returns for investors. | Intermediate and Incremental | 3.3 | 3.8 |
Community Benefit Oversight
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Set performance goals to improve health outcomes and transform nonprofit hospitals’ approaches to consumer engagement and care. | Transformative | 3.8 | 3.0 |
| Amplify baseline federal requirements to promote meaningful engagement of cross-sector and/or community-governed collaborations as key components in CHNAs and CHAs. | Intermediate and Incremental | 2.6 | 3.2 |
| Require the standardization and integration of CHNAs conducted by hospitals within the same health system to yield robust data on unmet health and health-related social needs within a designated service area. | Intermediate and Incremental | 2.4 | 3.8 |
| Leverage state authority to make appointments to the boards of public hospitals that ensure meaningful community representation. | Intermediate and Incremental | 2.0 | 3.8 |
| Use certificate of need decisions to address inequities and disparities relating to access to primary care, geographic location, race, ethnicity, disability status, etc. | Intermediate and Incremental | 3.0 | 3.2 |
Insurance Oversight
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Adopt and expand laws and regulations pertaining to health insurance rate review and, specifically, approval authority. | Transformative | 4.2 | 3.2 |
| Leverage state insurance department approval processes to institute usual source of care requirements for fully insured health plans. | Intermediate and Incremental | 3.0 | 3.3 |
Appropriations
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Place unspent government funds from pandemic-era legislation such as the American Rescue Plan Act into community-governed pools and allow service beneficiaries and navigators to govern their use toward upstream determinants of health and social services. | Transformative | 3.6 | 2.8 |
| Earmark funds for structured training at the local level to strengthen political and health literacy, as well as civic engagement and community governance skills. | Intermediate and Incremental | 2.8 | 3.4 |
Public Health Agencies and Departments
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Lead the development of community-wide goals and collective impact strategies to improve health and equity, involving multiple government agencies, nonprofit partners, and the private sector. Support the full engagement of community residents in the process. | Transformative | 4.0 | 2.4 |
| Partner with health care organizations incentivized to better health outcomes to codevelop and lead community programs that advance prevention. Support the full engagement of community residents and local organizations in the process. | Transformative | 4.0 | 3.8 |
| Lead coordination of CHAs and CHNAs, so that they provide opportunities for meaningful engagement of community residents, address key determinants of health, and advance prevention across the community, shifting collective emphasis away from individual conditions (such as diabetes and heart disease) to community infrastructure that better supports health. | Intermediate and Incremental | 3.2 | 3.4 |
| Create protocols for systematically assessing the capacity of community health and social service providers to determine how the community as a whole can address service gaps in an efficient, collective, and sustainable way. | Intermediate and Incremental | 2.4 | 3.6 |
| Utilize public health authority as appropriate to allow community-supported strategies to have the greatest impact. | Intermediate and Incremental | 2.5 | 2.3 |
Federal Government
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Expand ACA requirements governing “essential benefits” for plans sold in the individual and small group markets. | Transformative | 4.2 | 2.8 |
| Review ERISA and large group insurance requirements to add integrative care and home and community services and supports as essential benefits. | Transformative | 3.6 | 2.6 |
| Revise the medical loss ratios used in the ACA to become “health loss ratios” that support health rather than health care. | Transformative | 4.4 | 3.0 |
| Design and require the use of health impact assessments to assess the impact of policy proposals and business activities on health, particularly in sectors where health impacts may not be currently considered. | Transformative | 3.8 | 2.8 |
| Supplement federal health care reform efforts to create a federal benefits package that incentivizes an expanded or reconsidered set of “essential benefits.” | Transformative | 4.0 | 2.8 |
| Require that all nonprofit hospitals engage in multi-stakeholder collaborations to establish and finance locally controlled pools of funds with a neutral community entity as a fiscal agent. | Transformative | 3.8 | 2.4 |
| Require nonprofit health systems to apply community benefit dollars toward impact investments that improve social, economic, and environmental conditions in disadvantaged communities. | Transformative | 3.4 | 3.4 |
| Create a parsimonious set of quality measures that provide meaningful information on person-centered health and well-being outcomes. | Transformative | 3.6 | 4.4 |
| Require a 2% to 5% withholding from current federal grants to state programs to create a flexible federally funded pool for which localities or states could apply to implement community-governed whole person health improvement strategies. | Transformative | 3.6 | 3.2 |
| CMS should stop paying for interventions or services not proven to improve health outcomes and increase scrutiny of new and existing therapeutics, adjusting their reimbursement policies accordingly. | Transformative | 3.4 | 3.2 |
| Create a funding pool modeled off the CMMI State Innovation Model that would incentivize less-resourced states or regions to adopt population-based global budgets, specifically focusing on improving children’s health, as communities, health care payers, and providers often need financial support to transition to innovative payment models that support whole person care (e.g., all-payer global budgets). | Intermediate and Incremental | 2.8 | 3.4 |
| Increase funding and support for programs that address health-related social factors. | Intermediate and Incremental | 3.0 | 2.6 |
| Create a commission to deliver recommendations to Congress on how to restructure existing health and social service programs to bring greater value to consumers and taxpayers. | Intermediate and Incremental | 2.0 | 4.4 |
| Strengthen and optimize CHNAs to center on community-governed interventions and funding in order to enhance collective financing mechanisms listed in the previous section. | Intermediate and Incremental | 3.2 | 3.8 |
| Pioneer the development and implementation of payment models based on priorities of CBOs and designed with their partnership. | Intermediate and Incremental | 3.2 | 3.2 |
Care Delivery Organizations and Health Systems
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Transform the landscape of economic incentives to support whole person health by transitioning 75% of the health system reimbursement framework to population-based payments. | Transformative | 4.6 | 2.2 |
| Pursue multilevel approaches to working collaboratively with community stakeholders, such as fair compensation for community health workers, credibly and meaningfully integrating community voices into health system strategy and decision-making, and building meaningful alliances with a broad ecosystem of community organizations. | Transformative | 3.8 | 2.6 |
| Invest in information technology infrastructure that can catalyze gains in community health, such as robust information exchange and data-sharing processes between care delivery organizations and CBOs, as well as “digital front doors” (i.e., health kiosks) in the community. | Transformative | 3.4 | 3.4 |
| Screen patients for social determinants of health and health-related social needs and provide closed-loop referrals to social service entities and CBOs that can meet those needs. | Transformative | 4.2 | 4.5 |
| Set goals for an increased amount of community benefit dollars and grants spent on evidence-based services and strategies that strengthen whole person, whole population health and well-being. | Intermediate and Incremental | 3.2 | 3.6 |
| Align the compensation structure of senior executives to health system performance on a set of community defined health metrics. | Intermediate and Incremental | 3.2 | 2.2 |
| Establish a community liaison infrastructure within the health system to align activities and create shared expectations with CBOs. | Intermediate and Incremental | 2.8 | 3.4 |
Payers
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Establish processes to routinely identify the social needs of the health plan members and direct investments toward resources to address those needs. | Transformative | 4.3 | 4.4 |
| Create a population health business model where private payers such as commercial health insurance plans, insurance plan providers, health systems, and, if possible, CMS pay CBOs to create value and improve health and well-being by facilitating healthy opportunities. | Transformative | 4.4 | 3.4 |
| Evaluate and expand on the scope of “essential benefits” required under the ACA to include guaranteed coverage for services that produce whole health and well-being. | Transformative | 3.8 | 3.2 |
| Reimburse care delivery organizations, social service entities, and community-based organizations for closed-loop referrals targeting member social determinants of health and health-related social needs. | Transformative | 3.4 | 3.2 |
| Hold health systems accountable to anchor organization practices that will promote whole person, whole population health through payer-provider contracts. | Transformative | 3.8 | 2.0 |
| Pioneer the development and implementation of payment models based on priorities of CBOs and designed with their partnership. | Intermediate and Incremental | 3.2 | 3.2 |
| Build alliances with key community partners (e.g., law enforcement, emergency response, criminal justice, schools, and social services providers) that encourage cooperation within the local ecosystem to support outcomes aligned with the Quintuple Aim. | Intermediate and Incremental | 3.2 | 4.0 |
| Reduce practice consolidation by implementing payment policies inclusive of small, independent health care practices. | Intermediate and Incremental | 2.8 | 4.0 |
Employers
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Enhance workforce well-being by establishing an expanded set of “essential benefits” in health benefit packages provided to employees that includes relevant social services. | Transformative | 4.0 | 3.8 |
| Establish linkages and partnerships with health care, local government, CBOs, and philanthropies that leverage employers’ position as community cornerstones, which includes: their ability to influence individual employees within and outside the workplace; their power as purchasers of health plans; and the impact of their businesses on the local environment. | Transformative | 3.4 | 3.6 |
| Join forces to apply employers’ collective economic power in their communities to address health-related social challenges impacting members of the community, including employees. | Transformative | 3.4 | 3.0 |
| Capitalize on sector market power to purchase health plans that provide access to closed-loop referrals that target members’ health-related social needs. | Intermediate and Incremental | 3.3 | 3.5 |
| Set minimum expectations for how health plans should contract and collaborate with CBOs. | Intermediate and Incremental | 2.6 | 2.6 |
| Incentivize employees through employer-purchased health plans to seek care from in-network practitioners with expertise in health behavior change, healthy lifestyles, and wellness (e.g., lifestyle medicine, integrative medicine). | Intermediate and Incremental | 2.8 | 2.6 |
Financial Sector Organizations
| Priority Action | Category | Impact Rating (1 to 5) 1-least impactful; 5-most impactful | Feasibility Rating (1 to 5) 1-least feasible; 5-most feasible |
|---|---|---|---|
| Create industry and professional standards (e.g., for hospitals, health plan actuaries, and chief financial officers at all health care organizations) that redefine ROI in a way that explicitly quantifies the economic value of health in the population being served. | Transformative | 4.0 | 2.4 |
| In tandem with the right regulatory incentives, partner with a diverse array of entities that benefit from health-related social services to finance them. | Transformative | 3.6 | 2.8 |
| Form an entity (similar to MedPAC) that can influence investors to redefine actuarial ROIs, allowing for longer time horizons and a more dedicated focus on collaboration and well-being. | Transformative | 3.6 | 3.0 |
| Create and finance opportunities to improve the health of communities, such as the HNEF. | Transformative | 3.8 | 3.4 |
| To promote the economic viability of investments that promote whole person health, encourage reporting of financial measures such as revenue growth and health measures such as improved patient-reported outcome measures over longer time horizons. | Transformative | 4.4 | 2.8 |
| Apply, where possible, an HIA that would assess the value of health to financial sector organizations, the impact of specific government or private sector actions on health, and the impact of health or morbidity on a local, community, business, or national level. | Transformative | 3.8 | 2.8 |
| Recognize and account for the “wrong pocket problem” in calculations investors make, as payers may not be the sole beneficiaries of the returns accrued. | Intermediate and Incremental | 3.0 | 3.0 |
REFERENCES
- Bearden T, Ratcliffe HL, Sugarman JR, Bitton A, Anaman LA, Buckle G, Cham M, Chong Woei Quan D, Ismail F, Jargalsaikhan B, Lim W, Mohammad NM, Morrison ICN, Norov B, Oh J, Riimaadai G, Sararaks S, Hirschhorn LR. Empanelment: A foundational component of primary health care. Gates Open Research. 2019;3:1654. https://doi
.org/10.12688/gatesopenres .13059.1 . [PMC free article: PMC7134391] [PubMed: 32529173] - NASEM (National Academies of Sciences, Engineering, and Medicine). Financing That Rewards Better Health and Well-Being: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press; 2021. https://doi
.org/10.17226/26332 .
Footnotes
- 1
See the publication’s Acronyms and Abbreviations section for an explanation of acronyms used throughout Appendix B. 127
- STAKEHOLDER-SPECIFIC PRIORITY ACTIONS BY IMPACT AND FEASIBILITY - Valuing Americ...STAKEHOLDER-SPECIFIC PRIORITY ACTIONS BY IMPACT AND FEASIBILITY - Valuing America’s Health
- HEALTH TRANSFORMATION THROUGH DISRUPTIVE CHANGE - Valuing America’s HealthHEALTH TRANSFORMATION THROUGH DISRUPTIVE CHANGE - Valuing America’s Health
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- Homo sapiens mitochondrial tRNA-Val, complete sequenceHomo sapiens mitochondrial tRNA-Val, complete sequencegi|1896813692|dbj|LC530724.1|Nucleotide
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