I was recently on a call with a large national US Health funder who asked us the question, “Where is the field of collective impact in healthcare headed?” This question gave me pause, and while I don’t have a crystal ball to project the future, I do have a sense that there is huge opportunity for collective impact in the healthcare space and that opportunity is only growing.
The Affordable Care Act, is going to drastically change healthcare in America as it is rolled out over the next five years, like it or not. There are many questions around what the impact will look like, for patients, for doctors, for insurers, etc., and the truth is, no one really knows for certain. However, there are a few things that seem pretty certain. First, upfront spending in the sector broadly is going to increase; people are going to be buying more insurance coverage because they will be required by the government to do so. Also, the government is going to be providing more support for those who cannot afford insurance, so in addition to individuals, the government will also be putting more money into the system. With more money in the system all around, there will undoubtedly be greater scrutiny into the system as people ask how that money is spent. This isn’t an accident; the new healthcare system has been set up to encourage individuals and payers (i.e., insurance companies, Medicare, Medicaid etc.) to think more about their healthcare spending and the value they are getting for the money that is being spent.
When significant resources are being spent in new places, people will be watching and asking questions and not just about their own health but about the healthcare system broadly. People will start to ask questions not just about how to treat their diabetes, but deeper questions, “Why are so many Americans overweight and obese and how do we end it?” People will ask questions not just about how to control asthma attacks, but, “Why do so many of our children suffer from debilitating bouts of Asthma and what does it take to decrease asthma prevalence?” These types of questions move beyond just symptoms or treatments of diseases and begin to peel back the layers to the deeper determinants of health in this country. Determinants of health include things like environmental factors such as air quality and access to healthy food, and household factors such as income and parent’s education levels. Ultimately, when we look at many of the sickest patients in our country we find that many of these determinants actually drive their health status.
Determinants of health are notorious challenging to solve because they are deep systemic issues that touch upon many our society’s deepest social challenges and require many players working together to solve. Health determinants require solutions such as disease management, improvements in quality, improvements in our environment, and patient education. These types of programs require coordination between many stakeholders including hospitals / providers, non-profits, social services, payers, and local governments. Sound familiar? To me, it feels like Collective Impact offers an approach to addressing of the most confounding social determinants of health in our society. What is exciting is that healthcare reform is actually pushing us in this direction. As reform rolls out, people are going to be looking for more accountability within the system and looking for solutions that can attack some of the deeper, more systemic root causes of illness in America. Healthcare reform creates an environment that is ripe for Collective Impact. Being ahead of the healthcare reform curve means moving from symptoms, diseases, and working in isolation to thinking about health determinants, systems change, and collaboration. I’m not a gambler, but if I were, I would be placing my bets here.