1. Let Communities Show the Way
Investing in Health:
Let Communities Show the Way
Building Healthy Communities
Federal Reserve Bank of Cleveland
October 23, 2014
Rick Brush
HICCup.co

2. What’s the return on $2.9 trillion?
What matters
to health
Health Context &
Behaviors
(90%)
Health Care
(10%)
S. A. Schroeder “We Can Do Better – Improving the Health of the American People,” New England Journal of Medicine, 357 (2007):

3. What’s the return on $2.9 trillion?
What matters
to health
Where we
spend
Prevention
(3%)
Health Context &
Behaviors
(90%)
Health Care
(97%)
Health Care
(10%)
S. A. Schroeder “We Can Do Better – Improving the Health of the American People,” New England Journal of Medicine, 357 (2007):
Centers for Medicare and Medicaid Services, “National Health Expenditures” Table 1, (Washington, DC: CMS, Office of the Actuary, National Health Statistics Group, 2012).

4. What’s the return on $2.9 trillion?
What matters
to health
Where we
spend
What we get
(outcomes:  better,  worse)
Health Context &
Behaviors
(90%)
Health Care
(10%)
(97%)
(3%)
Prevention
 Late Stage Interventions
Infant Mortality
Life Expectancy at Birth
Diabetes
Obesity
Heart Disease
COPD
Disability
United States compared to 16 "peer" countries, National Research Council, “US Health in International Perspective: Shorter Lives, Poorer Health” (Washington, DC: National Academies Press, 2013).
S. A. Schroeder “We Can Do Better – Improving the Health of the American People,” New England Journal of Medicine, 357 (2007):
Centers for Medicare and Medicaid Services, “National Health Expenditures” Table 1, (Washington, DC: CMS, Office of the Actuary, National Health Statistics Group, 2012).

5. really
What matters to health?

6. Health-impact investing

7. An opportunity? October 19, 2014

8. Health-impact investing: Childhood asthma in Fresno CA
16,000 children (potential)
health, ER 30%, IP 50%
$1K-$5K (estimated net savings PPPY)
grant funding for 200 children
investors for scale up
Health-
impact
investing
RCT using insurance claims data
Home-based education & environmental remediation
Validated by third-party actuary

9. Health-impact investing at a community level

10. 42 communities applied

11. 42 communities applied  4 in Ohio
Athens County
Marion
Tuscarawas County
Union County

12. Wellville Five + Greater Wellville network
Clatsop County,
Oregon
Niagara Falls,
New York
Greater
Muskegon,
Michigan
Lake County,
California
Spartanburg,
South Carolina

13. Let communities show the way
Clatsop County,
Oregon
The community is the startup – and the product is health.
Niagara Falls,
New York
Greater
Muskegon,
Michigan
Lake County,
California
Spartanburg,
South Carolina

14. Health Capital Market community-led (re)investment portfolio of
investable solutions
“capital stacks”
financing + +
social/cultural
community conditions
new health system
self-management

15. Philanthropy/public funding
Health Capital Market
Health system
paid for health
new insurance/reinsurance
new HC payment/delivery
impact investing
health trust/fund
philanthropy
policy change
public sector $/incentives
debt financing
community benefit
new business models
sponsorships/in-kind
micro/crowdfunding
innovation fund
health credit exchange
Investment
capital
Philanthropy/public funding

16. rick@hiccup.co HICCup.co @WayToWellville @HICCup_co
Get involved
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@WayToWellville
@HICCup_co
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