Looking at the Very, Very Big Picture: A Health Affairs Study of Multi-Sector Health Initiatives

Even as the leaders of pioneering patient care organizations nationwide begin or extend their work around the development of accountable care organizations (ACOs), bundled-payment contracts, and every kind of risk-bearing contract, with the public (Medicare and Medicaid) and private payers of healthcare, a new study published in the current issues of Health Affairs offers insights as to how long the journey ahead will be, until community-wide alliances to improve health status of residents will be common—and fully successful.

The article, “Multisector Partnerships Need Further Development To Fulfill Aspirations For Transforming Regional Health and Well-Being,” was written by Beth Siegel, Jane Erickson, Bobby Milstein, and Katy Evans Pritchard, and published in the January issue of Health Affairs.

As the researcher-authors write in the abstract to the article, “Regional multisector partnerships involving stakeholders in areas such as public health, health care, education, housing, and others are growing in number. These partnerships are pursuing increasingly comprehensive strategies to transform health and well-being in their communities. Most analyses of these groups rely on self-reports and case studies. These have led many in the field to form optimistic expectations about how well prepared the groups are to lead transformative efforts—that is, how ‘mature’ they are. Few studies have systematically combined data from multiple perspectives to assess partnership characteristics against specific developmental criteria.”

The authors go on to note that, “In 2015–16 we gathered 145 nominations of regions (places) and partnerships with reputations for being relatively mature. Using a three-step assessment procedure, informed by eighty-five interviews with close observers and ten site visits, we found that most of these groups lacked certain characteristics that seem necessary to transform regional health systems. Even the more mature groups were not as well poised for transformation as their reputations implied. Our findings can help correct misperceptions and clarify ways to best support further partnership development.”

Their analysis came out of an ongoing effort on the part of numerous individuals and groups to try to understand where the phenomenon of community-wide health improvement initiatives is going. As the researchers write, “In 2015–16 the Rippel Foundation, with support from the Robert Wood Johnson Foundation, set out to identify a group of mature multisector partnerships during the first phase of its ReThink Health Ventures project. The author team, on behalf of the Rippel Foundation, expected them to comprise leaders from health, health care, and other industries, with a track record of solving problems together and an established forum for doing so. Our expectation was that mature partnerships would have ambitious and long-term strategies. They would focus not only on how health care is delivered, but also on upstream efforts to enable healthy behaviors, expand economic opportunity, and promote other conditions that must be in balance to improve health and well-being equitably.”

Following a rather complex, detailed process, the researchers analyzed a number of regional health improvement initiatives. Among the broad areas that they looked at were “Stewardship,” “strategy,” sustainable financing,” and “market and policy conditions.” Essentially, they write, every single one of these areas is turning out to be very complex and challenging, for the leaders of community-wide health improvement partnerships and initiatives.

As the authors write, “Among those partnerships with a strong focus on improving care delivery, most acknowledge the importance of addressing nonclinical factors that influence health, such as safe and affordable housing, but have yet to expand their own strategies to do so. Few partnerships,” they state, “are engaging with others in ways that ensure more balanced portfolios within their regions. It is relatively common for groups to connect health and education, for example, through a focus on early childhood development and broader concepts of lifelong health. However, relatively few have working relationships with leaders in economic development, housing, the built environment, or regional planning—all of which are important avenues for improving health and well-being.”

What’s more, the researchers note, “[L]eaders are not taking the risks necessary to broaden strategies. We found that many partnerships earned their authority by playing neutral roles when convening and educating stakeholders, coordinating needs assessments, or tracking performance. They believe that their neutrality creates safe spaces where stakeholders with vested interests can work together, and they vigorously safeguard that neutrality.” Further, the partnerships “tend to prioritize group harmony over the difficult conversations that are required—and inevitable—when competing parties entertain strategies that will upset the status quo. Many partnership conveners are reluctant to expose competing interests, and they sometimes assume, naively, that leaders will do so themselves when gathered together.” Among those competing interests? Market competition among hospitals and health systems.

All of this should be of great interest to the leaders of patient care organizations now moving into collaborative partnerships with health plans, community health entities, and public health agencies. Inevitably, as providers expand their horizons and push into new territory, they will face new and expanded challenges.

Clearly, based on this research and analysis, provider leaders attempting to collaborate with other organizations will need to work out broad process governance and data governance issues, and will need to rethink what it means to share information, and how to do so.

And ultimately, provider leaders are going to need to start planning for all of this now. It’s a daunting prospect, of course; but it’s also a prospect that the leaders of hospitals, medical groups, and health systems, should welcome, as they expand outwards towards true community-wide health improvement work.

Not surprisingly, healthcare IT leaders will be in the thick of all of this, as they have been all along. What will be exceptionally important for CIOs, CMIOs, CNIOs, CTOs, and others, will be to think broadly and strategically about where their efforts are headed. And yes, much of this will inevitably seem rather amorphous right now; but it must be considered, even as a broad-horizon set of issues.

And, even with the challenges that these researchers have uncovered and analyzed, there is immense potential in community-wide health improvement initiatives. Are broad, heterogeneous coalitions and alliances messy and complicated? They absolutely are. But they also contain within them the seeds of great advances in the health of entire communities. So the next few years will be fascinating in this regard. And yes, once again, healthcare IT leaders will be right in the middle of all of this—so yes, now is a good time to start thinking very broadly about these horizon issues—because they will emerge—and will be additional to-do-list items for healthcare IT leaders to manage and master.

Welcome to the future of healthcare.