Financing Regional Health Transformation

A Primer for Changemakers (2015)

Smarter investments backed by sustainable financing can drive profound health reform in regions across the country (Learn why we focus on regions). This Financing Primer helps regional leaders think through key questions around the investment and financing of long-term, health reform ventures. It focuses on what sustainable financing is, why it is important, the critical elements of a financing plan, and what others around the country have been doing to frame and finance their work.

The Primer answers eight key questions:


Why undertake such a daunting challenge?


What is possible if we change where we invest rather than just how much?


What investment scenarios lead to markedly better outcomes?

Strategic Context:

What does it take to do business differently—together?

Practice Profiles:

What are multi-sector partnerships doing to finance their health reform ventures?


What options are emerging to finance long-term, health reform ventures?

Movements & Initiatives:

How is a new generation of movements & initiatives advancing investment & financing?

Why Focus on Regions?

There are at least three reasons to focus on regions: data, dynamics, and ownership.

  • Data: Both population health and health care delivery are strongly shaped by regional conditions, leading to stark differences in health status and many other data points, even across neighboring areas (see: County Health Rankings, the Dartmouth Atlas of Healthcare, and the Commonwealth Fund Local Health Scorecard).

  • Dynamics: It is essential to account for trends that may vary considerably across regions, such as demographics, aging, and inequity; economic recession and recovery; health status, risks, and disease progression; health insurance coverage; quality, utilization, and cost of care; demand-supply for health care resources; provider payment; program financing; and more. This is one reason why we designed the ReThink Health Dynamics Model to represent a regional health system.

  • Ownership: People often feel a stronger connection to health issues when they arise closer to home. Because U.S. health policy is so complicated and contentious, it is easier to see how the health system works at a regional level–and to embrace one’s own role as a potential change agent within it.

Is there a standard definition of a region? No. It is always a matter of judgment to decide what the right geographical scope ought to be for a particular health reform venture. Reform-minded groups may organize in neighborhoods, zip codes, counties, cities, hospital service areas, hospital referral regions, or other self-defined configurations. For more information on regional health reform efforts, see the Pulse Check on multi-sector partnerships for health.