National Academy of Medicine
Discussion Paper

A Sustainable Financial Model for Community Health Systems

By James A. Hester, Paul V. Stange
March 06, 2014

In their discussion paper, Hester and Stange develop ideas that may be familiar to many who work to improve population health broadly conceived. The authors applaud current innovations and new models being tested to address the cost of health and quality of health care, but they find less progress in developing models for improving population health. Several authors have offered conceptual models for an “integrator” function that is needed to support coordination and payment for population health strategies. Hester and Stange build on those ideas and describe a Community Health System with a set of broad responsibilities, such as convening partners and assessing community needs. They then describe how the CHS would develop and implement a sustainable financing model to create and manage a portfolio of interventions grounded in the determinants of health, and balanced in terms of timing of results, level of evidence, and scale of return. Their conceptual financial model explains how the CHS could capture savings realized through the successful implementation of population health strategies, and reinvest the savings into future activities

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Disclaimer: The views expressed in this Perspective are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (The Academies). The Perspective is intended to help inform and stimulate discussion. It has not been subjected to the review procedures of, nor is it a report of, the NAM or the Academies. Copyright by the National Academy of Sciences. All rights reserved.