Aligning Investments to Improve Population Health

In early 2020, key stakeholders from across sectors in New Hampshire came together to establish a statewide partnership with a focus on improving community health and well-being. The New Hampshire Hospital Association, the Center for Impact Finance, and the Public Health Institute created a partnership, supported by an advisory board comprised of hospital leaders, community leaders, state agency representatives, insurers, financial institutions, and more.1 Our initiative gives particular focus to addressing inequities in housing quality, food access, affordable child care, early childhood education, transportation, and other basic goods and services that have significant impacts upon the health and quality of life for adults and children. The challenges presented by the COVID pandemic have brought these inequities into sharp focus.

In addition to the challenges associated with COVID, the health care sector is moving from fee-for-service to risk-based payment, which creates incentives to keep people healthy and out of inpatient acute care settings. In this context, it becomes increasingly important to work across sectors to prevent and/or proactively treat diabetes, asthma, and cardiovascular diseases, among others. With these challenges in mind, the health care sector has come together with the public health, social services, community development, and business sectors in a spirit of shared ownership to strategically address the social determinants of health. Our Aligned Investments initiative focuses in three main areas:

• Establish an evidence base for resource allocation decisions, focusing on collection of qualitative information and quantitative analysis of demographic and health care utilization data and use of GIS technology at the census tract level to assess health problems in specific geographies and to monitor the impact of efforts to address them.
• Develop and deploy a common fund for co-investment at scale in communities where health inequities are concentrated to produce meaningful results.
• Build a common platform for policy advocacy to align actions on the ground with policies at the local and state level to reinforce, scale, and sustain positive results.

Creating a common investment fund to invest in specific sub-geographies and developing a shared policy advocacy agenda offers immense potential to leverage existing assets and produce measurable improvements across the state of New Hampshire. We have prioritized an approach that supports optimal transparency, aligns and leverages assets across sectors, is cost-effective, and works within the existing ecosystem.