Dear friends,

In a Zoom room last month, I joined healthcare and policy leaders from around California to shape a powerful new approach to hold health care accountable for community health.

Thirteen of us make up the Advisory Council to the Population Health Investment (PopHI) initiative, a facet of Covered California’s Quality Transformation Initiative. It works like this: Covered California, the state’s health insurance exchange, requires participating health plans to meet certain quality measures for specific, clinically important conditions for their populations. When plans fail to reach those targets, they must make payments to a Quality Transformation Fund. In principle, those payments should decrease over time as plans improve their quality — which is the real goal. In the meantime, our job as advisors is to help determine how to invest that money to improve health for Covered California beneficiaries.

This is the first such effort I’ve heard of by a health insurance marketplace, and it packs a powerful idea about the intentionality of investments. It also holds enormous cultural potential for the healthcare community, as it stakes out a new paradigm for holding ourselves accountable to the value that was promised to people. Too often, the institutional practice is to relinquish our responsibility for quality because structural barriers make it too difficult to achieve for our patient population. Instead, we can (and should) invest in their health further upstream. That way, over time, our patients’ lives will meaningfully improve — along with measures of quality.

At HealthBegins, we coach our clients and partners to apply this same concept to reshape their investment portfolios. These organizations range from health systems thinking strategically about Community Benefit payments (required investments in community health to offset nonprofit hospitals’ income) to managed care plans thinking about community impact councils. These payments often end up being made reactively. Our innovation is to help clients transform that patchwork of payouts and programs into a strategic investment portfolio, designed cohesively to improve specific health outcomes for specific populations. Our Compass for Health Equity Transformation helps them do that. It’s novel and exciting to see this principle now applied at the state level.

The PopHI concept is powerful. It gets us closer to eliminating the wrong-pocket problem, making quality mandatory and insisting that healthcare investments measurably and effectively serve the needs of the community. It also requires us to reckon with the reality that piecemeal investments are not only inefficient, they are ultimately unable to meet the scale of the underlying structural issues that keep our communities in poor health.

I’m so grateful for and energized by the opportunity to address this meaningfully at scale. If this concept also energizes you, I welcome your thoughts on what meaningful re-investment would look like for you, and in your communities—and what your wildest dreams would be to put healthcare dollars in service of your health.

Best,

Sadena Thevarajah