Investing in Health: Building Healthy Communities Federal Reserve - - PowerPoint PPT Presentation

Investing in Health: Let Communities Show the Way

Building Healthy Communities Federal Reserve Bank of Cleveland October 23, 2014 Rick Brush HICCup.co

What’s the return on $2.9 trillion?

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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.

What matters to health

What’s the return on $2.9 trillion?

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Health Context & Behaviors (90%) Health Care (10%) Health Care (97%) (3%) Prevention

• 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).

What matters to health Where we spend

What’s the return on $2.9 trillion?

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Health Context & Behaviors (90%) Health Care (10%) Health Care (97%) (3%) Prevention é Late Stage Interventions ê Infant Mortality ê Life Expectancy at Birth ê Diabetes ê Obesity ê Heart Disease ê COPD ê Disability

• 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). United States compared to 16 "peer" countries, National Research Council, “US Health in International Perspective: Shorter Lives, Poorer Health” (Washington, DC: National Academies Press, 2013).

What matters to health Where we spend What we get (outcomes: é better, ê worse)

What matters to health?

5 Living and ! Working ! Conditions! ! General Socioeconomic, Cultural and Environmental Conditions! ! Social and Community Networks! !

work environment

!

safety

!

social cohesion physical health

!

participation

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medical home

!

education

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policies

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market dynamics

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employment and economic

• pportunity

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water, sanitation, air quality

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neighborhood design and built environment

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housing

!

mental health

!

transportation

!

food systems

!

Lifestyle Factors! Health Care! Genetics! Community Conditions!

Health-impact investing

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Health- impact investing

identify

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invest

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improve

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return

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Health Impact BondSM

An opportunity?

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October 19, 2014

http://www.theatlantic.com/health/ar chive/2014/10/getting-private- investors-to-fund-public-health- projects/381628/

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16,000 children (potential) éhealth, êER 30%, êIP 50% $1K-$5K (estimated net savings PPPY) Home-based education & environmental remediation

$0 $4.0 $8.0 $12.0 $16.0 2012 2013 2014 2015 2016

Post-intervention P r e

• i

n t e r v e n t i

• n

Savings 2014 2015 2016 2017 2018

grant funding for 200 children investors for scale up RCT using insurance claims data Validated by third-party actuary

identify

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invest

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improve

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return

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Health Impact BondSM Health- impact investing

Health-impact investing: Childhood asthma in Fresno CA

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Health-impact investing at a community level

42 communities applied

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Lake County Clatsop County Greater Muskegon Spartanburg Niagara Falls Perris Marion Bangor Winona New Ulm Jackson Marshall Lawrence Boothbay Billings Scranton Lynchburg Lancaster Kissimmee Charlotte Starkville High Point Burlington Garden City/ Finney County Union County Klamath Falls Athens County Wilkes County Yamhill County Sanilac County Kershaw County Clinton County Cheshire County La Crosse County Columbus/Bartholomew County Wenatchee Valley Susquehanna Valley Takoma Park-Silver Spring Oxford County Tuscarawas County Greenville

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Legend

Wellville Five Greater Wellville U.S. County

42 communities applied à 4 in Ohio

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Lake County Clatsop County Greater Muskegon Spartanburg Niagara Falls Perris Marion Bangor Winona New Ulm Jackson Marshall Lawrence Boothbay Billings Scranton Lynchburg Lancaster Kissimmee Charlotte Starkville High Point Burlington Garden City/ Finney County Union County Klamath Falls Athens County Wilkes County Yamhill County Sanilac County Kershaw County Clinton County Cheshire County La Crosse County Columbus/Bartholomew County Wenatchee Valley Susquehanna Valley Takoma Park-Silver Spring Oxford County Tuscarawas County Greenville

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Legend

Wellville Five Greater Wellville U.S. County

• Athens County
• Marion
• Tuscarawas County
• Union County

Lake County Clatsop County Greater Muskegon Spartanburg Niagara Falls Perris Marion Bangor Winona New Ulm Jackson Marshall Lawrence Boothbay Billings Scranton Lynchburg Lancaster Kissimmee Charlotte Starkville High Point Burlington Garden City/ Finney County Union County Klamath Falls Athens County Wilkes County Yamhill County Sanilac County Kershaw County Clinton County Cheshire County La Crosse County Columbus/Bartholomew County Wenatchee Valley Susquehanna Valley Takoma Park-Silver Spring Oxford County Tuscarawas County Greenville

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Legend

Wellville Five Greater Wellville U.S. County

Wellville Five + Greater Wellville network

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• Greater

Muskegon

Muskegon Norton Shores Roosevelt Park North Muskegon Muskegon Heights Lake Michigan

• Lake

County

Clearlake Lakeport Kelseyville Upper Lake Nice Lucerne Lower Lake Cobb Mountain Middletown Clear Lake

• Niagara Falls

• Spartanburg

• Clatsop

County

Warrenton Astoria Seaside Cannon Beach Gearhart

Clatsop County, Oregon Lake County, California Greater Muskegon, Michigan Niagara Falls, New York Spartanburg, South Carolina

Lake County Clatsop County Greater Muskegon Spartanburg Niagara Falls Perris Marion Bangor Winona New Ulm Jackson Marshall Lawrence Boothbay Billings Scranton Lynchburg Lancaster Kissimmee Charlotte Starkville High Point Burlington Garden City/ Finney County Union County Klamath Falls Athens County Wilkes County Yamhill County Sanilac County Kershaw County Clinton County Cheshire County La Crosse County Columbus/Bartholomew County Wenatchee Valley Susquehanna Valley Takoma Park-Silver Spring Oxford County Tuscarawas County Greenville

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Legend

Wellville Five Greater Wellville U.S. County

Let communities show the way

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• Greater

Muskegon

Muskegon Norton Shores Roosevelt Park North Muskegon Muskegon Heights Lake Michigan

• Lake

County

Clearlake Lakeport Kelseyville Upper Lake Nice Lucerne Lower Lake Cobb Mountain Middletown Clear Lake

• Niagara Falls

• Spartanburg

• Clatsop

County

Warrenton Astoria Seaside Cannon Beach Gearhart

Clatsop County, Oregon Lake County, California Greater Muskegon, Michigan Niagara Falls, New York Spartanburg, South Carolina

The community is the startup – and the product is health.

Health Capital Market

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community-led (re)investment “capital stacks” financing portfolio of investable solutions + +

social/cultural

community conditions

new health system self-management

Health Capital Market

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new insurance/reinsurance new HC payment/delivery impact investing health trust/fund philanthropy policy change public sector $/incentives debt financing community benefit new business models sponsorships/in-kind micro/crowdfunding innovation fund health credit exchange

Philanthropy/publi c funding Investment capital Health system paid for health

Get involved

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rick@hiccup.co HICCup.co @WayToWellville @HICCup_co collectivehealth.net @collectivehlth