Frontiers Project, Brief Summary

Moving Beyond Reform and Rebound

When it comes to health in America, we can’t afford to ignore the fact that we spend too much and get too little in return.  Even worse, our current strategy for health care reform is likely to fall short of improving the nation’s health over time.  Instead, we must focus more on staying healthy in the first place, delivering high-value care when needed, and investing differently to assure that there is a healthy health system in every region across the country.

This project, sponsored by the Robert Wood Johnson Foundation and the Rippel Foundation, looks for innovators who are working toward system-wide solutions with sustainable financing and shared stewardship.  Knowing that health and health care are shaped largely by a mix of local and larger forces, we are learning with leaders in diverse contexts who are moving their health systems in new, more sustainable directions.

All across the U.S., teams of innovators are looking beyond limited, lopsided, and disconnected initiatives in pursuit of more lasting health and economic results.  They are determined to escape the typical cycle of reform and rebound that comes from relying on narrowly focused, short-term investments.

What makes their approach different is a wide-angle view on their entire regional health system.  They are committed to eliminating waste, paying for value, and strategically reinvesting gains. At the same time, they look to combine health services for individuals with investments in the factors that safeguard health for everyone (for example, social support, economic development, educational opportunity, environmental protection, and healthier choices in homes, workplaces, schools, and other settings).

These leaders recognize that a more seamless system, anchored in a deeply seeded culture of health, also opens opportunities to better align resources and establish financing structures that are stable and self-reliant.  System-wide solutions like these are increasingly within reach in regions across the country and they suggest promising new frontiers for the future.  Even now, there are scores of regional reforms under way.  But it is not clear how they will be guided and financed, or what will happen to the money that is saved as healthcare spending eventually declines.

To spot and spread the most effective innovations, the Frontiers in Sustainable Financing and Health System Stewardship project will explore critical questions, such as:

  • What conditions best support a balanced and sustainable health investment strategy?
  • How could diverse stakeholders set priorities and align their often competing interests?
  • Who ought to make critical decisions about health investment, and who should benefit?
  • What measures help to chart progress and track return-on-investment?

Together with scholars at The Dartmouth Institute and Washington University, we are engaging a widening circle of colleagues to answer these and many more questions.  We are searching for the most compelling opportunities for system-wide impact, while also identifying the obstacles that must be overcome, and the resources that are needed to succeed.  We will spotlight the most serious strategies that are grounded in negotiated priorities and fueled by coordinated investments that are both strong enough and sustained long enough to overcome the forces that so often erode short-term gains.

Over the next year and a half, we will visit sites where exciting innovations are under way, interview champions in the field, convene interactive learning labs, map organizational networks, and collect examples of noteworthy endeavors in the U.S. and beyond.  Our goal is to harness lessons learned both in and outside the health sector, pinpoint pitfalls, share hard-won insights, and track novel strategies that may be used to spark and sustain system-wide impact.  We will also look ahead to propose hypotheses for further action and help to shape where the next frontiers are likely to arise.

If you have stories to share, we want to build on your experience.  Together, we can navigate this rapidly changing landscape and identify the most compelling directions for future investment.  We also want to understand the perspectives of diverse stakeholders, including area residents, organizational allies, and principled investors who want to leverage their resources to achieve lasting health and economic returns.

To move forward faster, we are hosting this web-based learning network where all of us may share ideas and benefit from each other’s thinking about these critical frontiers.  By learning together, we can eliminate excuses, sharpen our skills, and overcome many obstacles that cause us to feel stuck.

Connect with the Frontiers in Sustainable Financing and Health System Stewardship project directly at or visit us online at  (under construction for launch in early 2014).


ReThink Health is a collaborative initiative of the Rippel Foundation, which is dedicated to seeding innovations by thinking and acting differently in pursuit of healthier health systems in regions across the country.