Kim Farris-Berg

Senior Project Director, Sustainable Financing

One of the most common problems communities face in trying to improve health is where the funding will come from. Overwhelmingly, communities are conducting small-scale initiatives funded by grants. But that’s not going to get us very far, very fast if we’re serious about improving health, reducing health disparities, and lowering healthcare costs.

What exactly is needed for the field in order to finance population health at scale and over the long term? We’ve been calling this the “Job to be Done.” What is the Job to be Done to ensure sustainable financing for population health? There may be more than one Job.

Whatever the Job or Jobs are, they ought to be built off an understanding of the problem(s) we must solve. When we can define what needs to get done for the field we’ll have a much better sense of what new approaches to financing will be successful.

One problem to tackle: Partnerships are relying too much on grants

At ReThink Health, one of the problems we must solve is increasingly obvious: How on earth can we expect multi-sector partnerships to finance health transformation by relying almost entirely on grants? Multi-sector partnerships (and their respective backbone organizations) coordinate efforts in regional reform that span health, health care, and other sectors. But as they improve over time, and their efforts broaden, their sources of financing have not.

Our 2014 Pulse Check survey provides one of the few nationwide snapshots of innovative, multi-sector partnerships and their role in reshaping the evolving health landscape. One of the most important findings from the financing questions is that the partnerships very heavily rely on short-term, often insecure, financing mechanisms such as grants, contracts, or prizes for their funding. (Perhaps not surprisingly, our 2016 survey found the same. Sign up here to receive the full report when it’s available this winter!)

Here’s a chart breaking this down from the 2014 Pulse Check report:

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Our Sustainable Financing Team has been thinking a lot about this. What does this suggest about the Job(s) to be Done?

What can we learn from other fields about sustainable financing?

Here’s one idea we’ve been kicking around:

Currently, financing the work of the multi-sector partnerships is almost solely the responsibility of backbone organizations. But should it be? Backbones have a broad scope of responsibilities on their plate, of which financing is only one.

Organizations coordinating community reforms in other fields are no longer chasing grant money as a primary means of financing. Whatever the Job to be Done was in Affordable Housing and Community Development, for example, it was answered primarily by creating centralized federal financing schemes implemented at state and local levels. Imagine communities trying to provide affordable housing without the Low Income Housing Tax Credit or Section 8 certificates; community development without CDFI institutions, the Community Reinvestment Act, or Community Development Block Grant Funds; or K-12 education without state constitutional requirements to provide children with an education?

When you stop and think about it, the public invests in all sorts of things because we see intrinsic value in those investments. In our next financing blog you’ll learn how affordable housing and community development stakeholders (people, nonprofit and private organizations, public entities, and more) worked together over time seek a structured framework for financing. Named or unnamed, this was “the Job.” If we approached population health similarly, we could have viable financing structures and multi-sector partnerships would be more able to concentrate on all the other things that must be accomplished to improve health.

Contribute your ideas about the “Job to be Done”

We’d like to learn from you: What “Jobs” do you think must be accomplished in order to finance population health at scale and over the long term? Why?

Comment below and/or contact the author: kfarrisberg@rethinkhealth.org

The personal views and opinions expressed in this blog are those of the original authors only, and do not necessarily represent those of The Rippel Foundation and ReThink Health.

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