Investing in Health: Building Healthy Communities Federal Reserve Bank of Cleveland Let Communities October 23, 2014 Show the Way Rick Brush HICCup.co
What’s the return on $2.9 trillion? What matters to health Health Context & Behaviors (90%) Health Care (10%) S. A. Schroeder “We Can Do Better – Improving the Health of the American People,” New England Journal of Medicine , 357 (2007): 1221-28. 2
What’s the return on $2.9 trillion? What matters Where we to health spend Prevention (3%) Health Context & Behaviors (90%) Health Care (97%) Health Care (10%) S. A. Schroeder “We Can Do Better – Improving the Health of the American People,” New England Journal of Medicine , 357 (2007): 1221-28. Centers for Medicare and Medicaid Services, “National Health Expenditures” Table 1, (Washington, DC: CMS, Office of the Actuary, National Health Statistics Group, 2012). 3
What’s the return on $2.9 trillion? What matters Where we What we get (outcomes: é better, ê worse) to health spend é Late Stage Interventions Prevention (3%) Health Context & ê Infant Mortality Behaviors ê Life Expectancy at Birth (90%) ê Diabetes ê Obesity ê Heart Disease Health Care ê COPD (97%) ê Disability Health Care (10%) United States compared to 16 "peer" countries, National S. A. Schroeder “We Can Do Better – Improving the Research Council, “US Health in International Health of the American People,” New England Perspective: Shorter Lives, Poorer Health” (Washington, Journal of Medicine , 357 (2007): 1221-28. DC: National Academies Press, 2013). Centers for Medicare and Medicaid Services, “National Health Expenditures” Table 1, (Washington, DC: CMS, Office of the Actuary, National Health Statistics Group, 2012). 4
What matters to health? safety ! General Socioeconomic, Cultural and transportation Environmental Conditions ! social cohesion ! ! food systems Social and Community education ! Networks ! policies ! ! ! Community Conditions ! participation market dynamics ! ! work environment Living and ! physical health ! Lifestyle Factors ! Working ! employment and ! Conditions ! economic ! opportunity ! Health Care ! housing ! Genetics ! medical home water, sanitation, air quality ! ! mental health neighborhood design ! and built environment ! 5
Health-impact investing identify invest 1 2 Health Health- Impact impact investing Bond SM return improve 4 3 6
An opportunity? October 19, 2014 http://www.theatlantic.com/health/ar chive/2014/10/getting-private- investors-to-fund-public-health- projects/381628/ 7
Health-impact investing: Childhood asthma in Fresno CA 16,000 children (potential) grant funding for 200 children é health, ê ER 30%, ê IP 50% $1K-$5K (estimated net savings PPPY) investors for scale up identify invest 1 2 Health- Health Impact impact investing Bond SM $16.0 n o t i return improve n e r v e 4 n t 3 i e - r P $12.0 Savings $8.0 Post-intervention $4.0 $0 2014 2015 2016 2017 2018 2012 2013 2014 2015 2016 RCT using insurance claims data Home-based education & environmental remediation Validated by third-party actuary 8
Health-impact investing at a community level 9
42 communities applied Wenatchee Valley Clatsop County Oxford Bangor Yamhill County County Clinton County Boothbay Billings Burlington Cheshire Klamath Falls Lawrence Marshall Sanilac Greater County Winona County Niagara Muskegon New Ulm Falls Charlotte Scranton La Crosse Lake County County Lancaster Tuscarawas Marion County Susquehanna Valley Union County Athens Takoma Park-Silver Spring Columbus/Bartholomew County County Garden City/ Lynchburg Finney County Wilkes County High Point Spartanburg Jackson Perris Kershaw County Greenville Starkville 4 Kissimmee Legend Wellville Five Greater Wellville U.S. County 10
42 communities applied à 4 in Ohio Wenatchee Valley Clatsop County Oxford Bangor Yamhill County County Clinton County Boothbay Billings Burlington Cheshire Klamath Falls Lawrence Marshall Sanilac Greater County Winona County Niagara Muskegon New Ulm Falls Charlotte Scranton La Crosse Lake County County Lancaster Tuscarawas Marion County Susquehanna Valley Union County Athens Takoma Park-Silver Spring Columbus/Bartholomew County County Garden City/ Lynchburg Finney County Wilkes County High Point Spartanburg Jackson Perris Kershaw County Greenville Starkville Athens County • • Marion Tuscarawas County • 4 Kissimmee Union County • Legend Wellville Five Greater Wellville U.S. County 11
Wellville Five + Greater Wellville network Wenatchee Valley Astoria Warrenton Clatsop County Clatsop County, Gearhart Oxford Bangor Seaside Yamhill County County Clatsop Clinton County Boothbay Oregon County Billings North Muskegon Cannon Burlington Beach Niagara Falls, Cheshire Klamath Falls Lawrence Muskegon Marshall Sanilac Niagara River Lake Greater County Winona Greater County Muskegon Niagara Muskegon Niagara Falls New York New Ulm Falls Muskegon Charlotte Scranton La Crosse Muskegon, Roosevelt Heights Park Lake County County Greater Lake Lake Muskegon County Lancaster Niagara River Michigan Tuscarawas Michigan Marion �� � Norton County Susquehanna Valley Shores Union County �� Upper Lake �� Athens Takoma Park-Silver Spring �� Columbus/Bartholomew Lake County, Nice �� � County County Clear Lucerne Lakeport Lake Garden City/ Lynchburg Clearlake �� � ��� California Finney County Kelseyville Lower Lake ��� �� �� Wilkes County �� Cobb Mountain �� ��� ��� High Point �� � Middletown Spartanburg Jackson �� � �� Perris Spartanburg, ��� Kershaw County ��� 29 �� 221 �� Greenville �� �� South Carolina Spartanburg �� � Starkville 176 ��� �� � �� ��� �� �� �� �� � ��� �� 4 �� �� Kissimmee ��� Legend ��� ��� Wellville Five ��� ��� �� � Greater Wellville ��� �� ��� �� U.S. County �� �� ��� 12 ���
Let communities show the way Wenatchee Valley Astoria Warrenton Clatsop County Clatsop County, Gearhart Oxford Bangor Seaside Yamhill County County Clatsop Clinton County Boothbay Oregon County Billings North Muskegon Cannon Burlington Beach Niagara Falls, Cheshire Klamath Falls Lawrence Muskegon Marshall Sanilac Niagara River Lake Greater County Winona Greater County Muskegon Niagara Muskegon Niagara Falls New York New Ulm Falls Muskegon Charlotte Scranton La Crosse Muskegon, Roosevelt Heights Park The community is the Lake County County Greater Lake Lake Muskegon County Lancaster Niagara River Michigan Tuscarawas Michigan Marion �� � Norton County Susquehanna Valley Shores Union County �� startup – and the Upper Lake �� Athens Takoma Park-Silver Spring �� Columbus/Bartholomew Lake County, Nice �� � County County Clear Lucerne Lakeport Lake Garden City/ Lynchburg Clearlake �� � ��� California Finney County Kelseyville product is health . Lower Lake ��� �� �� Wilkes County �� Cobb Mountain �� ��� ��� High Point �� � Middletown Spartanburg Jackson �� � �� Perris Spartanburg, ��� Kershaw County ��� 29 �� 221 �� Greenville �� �� South Carolina Spartanburg �� � Starkville 176 ��� �� � �� ��� �� �� �� �� � ��� �� 4 �� �� Kissimmee ��� Legend ��� ��� Wellville Five ��� ��� �� � Greater Wellville ��� �� ��� �� U.S. County �� �� ��� 13 ���
Health Capital Market community-led portfolio of “capital stacks” + + (re)investment investable solutions financing social/cultural community conditions self-management new health system 14
Health Capital Market Health system new HC payment/delivery paid for health new insurance/reinsurance new business models impact investing innovation fund Investment health credit exchange capital health trust/fund debt financing sponsorships/in-kind community benefit Philanthropy/publi micro/crowdfunding c funding philanthropy public sector $/incentives policy change 15
Get involved rick@hiccup.co HICCup.co @WayToWellville @HICCup_co collectivehealth.net @collectivehlth 16
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