Reports ReThink Health’s research and publications explore topics that help advance our shared understanding of our complex health system and support strategies for regional reform. With a vision of a health system that simultaneously achieves better health, high quality care, sustainable costs, greater equity, and thriving communities, the following ReThink Health articles provide insight into the important thinking, analysis, and lessons that will help us all achieve these goals. Health Affairs Commentary: A Balanced Investment Portfolio for Health is Within Reach April 3, 2018 David Kindig (professor of population health sciences, University of Wisconsin School of Medicine and Public Health) and Bobby Milstein (director of system strategy, ReThink Health) published a Commentary in the April 2018 issue of Health Affairs titled: “A Balanced Investment Portfolio For Equitable Health And Well-Being Is An Imperative, And Within Reach.” In it, they show that health care spending in the U.S. is highly inefficient and has not resulted in equitable health and well-being, in large part because the overall health investment portfolio is out of balance. In Health Affairs: Many Multisector Partnerships Not Yet Mature January 9, 2018 Health Affairs has published the results of our months-long research endeavor to further understand and define the national landscape of multisector partnerships for health. The article, “Multisector Partnerships Need Further Development to Fulfill Aspirations for Transforming Health and Well-Being”, was authored by the ReThink Health Ventures team and appears in the journal’s January 2018 special issue on the Culture of Health. The Ventures team found that even the partnerships with a reputation for being in mature stages of development were not as well poised to lead health transformation as their reputations implied. 2016 Pulse Check Report By: Jane Erickson, Bobby Milstein, Lisa Schafer, Katy Evans Pritchard, Carly Levitz, Creagh Miller, and Allen Cheadle March 2017 Multi-sector partnerships play an increasingly significant role in the movement to improve health, equity, and economic prosperity. These partnerships recognize that many of our most pressing challenges defy sector boundaries, and cannot be effectively addressed by any one institution alone. Progress Along the Pathway to Health System Transformation: A Pulse Check on Multi-Sector Partnerships is the only survey of its kind to ask leaders across the U.S. what their partnerships do, how they finance their work, and how their groups have been developing over time. Simulating Four Possible Policy Reversals and How They Might Affect the Nation’s Health By: Jack Homer December 2016 This paper uses the ReThink Health Dynamics Model to simulate the impact on health of possible policy reversals under a Trump Administration in four key areas: health insurance, economy, environment, and crime. How Do Institutional Financing Structures for Meeting Social Needs Get Their Start? By: Katherine Wright, Kim Farris-Berg, and Stacy Becker September 2016 How might investment in population health become systematic? This overview of how financing structures came to be in affordable housing and in community development offers some insights into possible steps for advancing the financing of population health. Combined Regional Investments Could Substantially Enhance Health System Performance And Be Financially Affordable. Health Affairs By: Jack Homer, Bobby Milstein, Gary Hirsch, and Elliott Fisher August 2016 This analysis shows that combined regional investments in both population- and clinical-level initiatives, coupled with affordable long-term financial strategies, have the potential to dramatically reduce costs, improve health, increase health equity, and boost economic productivity over the next 25 years. It also speaks to a deeper question: Is health transformation truly possible? The answer: Yes…if we are willing to be serious stewards of our common health system. At issue is not a scarcity of dollars, but a lack of power directed toward a sound, system-wide strategy. NASPAA Student Simulation Competition: Reforming the U.S. Health Care System Within a Simulated Environment. Journal of Policy Affairs Education By: Laurel McFarland, Emily Reineke, Bobby Milstein, Rebecca Niles, Gary Hirsch, Ernest Cawvey, Jack Homer, Anand Desai, David Andersen, Rod MacDonald, and Richard Irving Summer 2016 In 2014, NASPAA (Network of Schools of Public Policy, Affairs, and Administration) partnered with The Rippel Foundation to hold the first NASPAA Student Simulation Competition, built on the ReThink Health simulation platform. The competition took place at five sites and involved 181 graduate students from 93 institutions. Students used the simulator in small teams to craft long-term policy solutions to problems facing the U.S. health care system. This article describes how the competition came to be, identifies key stakeholders, describes the environment that made the competition a reality, explains the simulation model, details the planning and logistics for each competition site, lists the materials that turned the simulation into a learning experience, and speculates about implications of this competition and the role for simulation-based exercises in public management and public policy education. Leadership in Volunteer Multi Stakeholder Groups Tackling Complex Problems Leadership Lessons from Compelling Contexts By: Kate B. Hilton and Ruth Wageman 2016 This chapter explores distributed leadership in volunteer multi stakeholder groups tackling complex problems, focusing on community organizing practices to bridge the gap between health and health care in Columbia, South Carolina. Columbia faces increasing chronic disease, high rates of uninsured, unequal access to healthcare services, and rising costs. Regional leaders periodically tackled these problems together but faced challenges common to multi stakeholder groups. In 2010, leaders from Columbia partnered with the authors in a learning enterprise to find new, more sustainable ways to address these challenges. Multi-Sector Partnerships for Health: 2014 Pulse Check Findings By: Jane Erickson, Jane Branscomb, and Bobby Milstein October 2015 This report synthesizes the findings of ReThink Health’s 2014 Pulse Check which they conducted to sketch the national landscape of multi-sector, regional partnerships that are working to create healthier and more resilient communities. Using data from 133 multi-sector partnerships across the United States, they share insights into the scope, makeup, challenges, and accomplishments of these groups. ReThink Health Frontiers in Sustainable Financing and Health System Stewardship Baseline Network Assessments By: Bobbi J. Carothers, Amy A. Sorg, Douglas A. Luke, and Bobby Milstein 2015 This report summarizes early findings from three separate feasibility studies, all of which use classical methods of organizational network mapping to reveal patterns about the frontiers of health system stewardship and financing. It explores what it takes to elicit information and map the structure of organizational networks at three levels: regional structures for stewardship and financing, local links to wider enablers or role models, and national catalysts for regional health reform. Meeting Summary: ReThink Health Roundtable on Leveraging Investments September 2014 ReThink Health convened 25 leaders of regional health collaboratives for an innovative roundtable in Chicago on leveraging investments to advance their health and health care. Together these leaders meaningfully explored barriers to their stewardship activities and approaches to sustainable investment and financing. Learn more about how ReThink Health catalyzed actionable dialogue and creative problem-solving with these change-makers. County Officials Embark on New, Collective Endeavors to Rethink Their Local Health Systems Journal of County Administrators By: Bobby Milstein, Gary Hirsch, and Karen Minyard March/April 2013 In this article the authors share stories of how two different settings in the United States have worked with ReThink Health to devise strategies for transforming their local health systems. Using ReThink Health tools and processes, local leaders in Pueblo, Colorado and Atlanta, Georgia have brought together diverse stakeholders, developed system stewardship, and designed strategies for sustainable funding of health initiatives for a healthier health system in their local areas. Skillful Convening: A Powerful Tool for Health System Redesign Health Affairs By: Laura Landy April 18, 2013 This Health Affairs GrantWatch Blog describes the important role that skillful convening can play in bringing people together to support a collaborative approach to improve the performance of their local health systems. Written by Rippel President & CEO Laura Landy, the post highlights how the Rippel Foundation and ReThink Health have used this signature tool to support innovative efforts in communities across the country including Columbia, South Carolina; Pueblo, Colorado; the Upper Valley of Vermont/New Hampshire; and New Jersey. Building Great Leadership Teams for Complex Problems Chapter 4 in Developing and Enhancing High-performance Teams in Organizations, Eduardo Salas (Ed.) By: Ruth Wageman January 2013 Leadership functions increasingly are fulfilled not by a heroic individual but rather by leadership teams. While the great strengths and potential of leadership teams are compelling, it is also the case that such teams struggle with significant challenges to their effectiveness. This article draws upon everything that is known about leadership teams to identify the key challenges teams face whose core purpose is to provide leadership, collectively, to complex systems. The challenges they face are summarized as a set of tripwires. For each tripwire, a set of positive conditions are identified that can be put in place to increase the effectiveness of these teams. When Being #1 Means We Have to Think Differently: The Future of Healthcare in New Jersey By: Robert Hughes and Laura Landy Spring 2011 This white paper looks at the state of New Jersey’s health care costs and trends, identifies important themes, and generates ideas about the future. It makes clear that New Jersey’s health care costs are unsustainable, and lays out a path for action. Why Behavioral and Environmental Interventions Are Needed to Improve Health at Lower Cost Health Affairs By: Bobby Milstein, Jack Homer, Peter Briss, Deron Burton, and Terry Pechacek May 2011 Selected as the 2011 Public Health Systems Research Article of the Year by AcademyHealth, this paper evaluates the effectiveness of different health policy strategies: expanding insurance coverage, delivering better preventive and chronic care, and protecting health by enabling healthier behavior and improving environmental conditions. The researchers found that pursuing each intervention strategy in isolation could save lives and improve health system performance but would likely increase costs. However, pursuing these strategies in combination could further reduce deaths and improve health system performance while simultaneously reducing spending. The policy implications of these findings are highly relevant, as many organizations and communities across the country are seeking to create sustainable, high-quality health systems.