What’s the Way to Wellville?
The Way to Wellville is a five-community, ten-year challenge to produce visible improvements in health and economic vitality. The challenge is sponsored by HICCup (Health Initiative Coordinating Council), a nonprofit founded by angel investor Esther Dyson to encourage new models and markets for the cultivation of health.
The Wellville 5 communities will receive support from HICCup and a network of partners over the next ten years in the areas of data and measurement, evidence-based health solutions – including healthy food systems – and innovative financing strategies. Rigorous evaluation will measure the impact of specific health initiatives, reinforced by a coordinated, community-wide approach, while generating new insights, investment and market opportunities for producing health.
HICCup and its partners will support the Wellville communities in much the same way that a startup accelerator supports a promising business idea and leadership team. In this case, the community is the startup – and the community’s product is health. Just like a business startup, the community sets its course, develops its plans, negotiates with suppliers, measures its impact, and changes course as appropriate. Along the way, we’ll help the Wellville 5 make course corrections where appropriate and connect them with health and policy experts, solution providers, funders and investors – all with an interest in testing and financing innovative health strategies.
HICCup is also creating a larger network of communities called Greater Wellville. The effort will allow the 40-plus communities that applied to the Way to Wellville challenge to participate in peer learning and to engage the HICCup partner network in local opportunities.
What are Wellville 5?
After a nationwide search that drew 42 applications from 26 states, HICCup selected and announced on August 14, 2014 the five communities that will participate in the Way to Wellville challenge.
Here are the Wellville Five and a summary of focus areas in each community:
- Clatsop County, Oregon (population 37,301), led by Columbia Pacific Coordinated Care Organization and partners, will focus on a pay-for-success model for high-quality preschool, chemical dependency, mental health (including a focus on adverse childhood experiences), access to primary care medical homes, employment, obesity and food access, prenatal education and care, and so-called time banking, which lets community members exchange services based on available time, skills and needs.
- Greater Muskegon, Michigan (population 79,275), led by Public Health – Muskegon County, will address tobacco use, adult obesity, post-secondary education, and social/emotional support (with a focus on adverse childhood experiences), by leveraging strong partnerships with the Rotary Club and others already collaborating in Muskegon’s “1 in 21” campaign to become the state’s healthiest county by 2021.
- Lake County, California (population 63,983), led by North Coast Opportunities and partners, will integrate preventive and clinical health services to address obesity and other chronic physical health issues, substance abuse, and mental and emotional health, while creating new measures to support long-term sustainability and financing. Critical to the success of these efforts is a working relationship between the county’s two health systems, a relationship that began to take shape in 2016.
- North Hartford, CT (population 23,000), led by Community Solutions, a data-driven social impact organization. Guiding the work in North Hartford is the “Community Triple Aim”: improved population health (life expectancy and related health metrics); improved wellbeing (quality of life metrics); and improved value of public and private investment (impact/dollar). In addition to Community Solutions and Wellville, St. Francis Hospital/Trinity Health, the City of Hartford, Cigna and others are engaged in collaborative efforts to meet the objectives of the Community Triple Aim.
- Spartanburg, South Carolina (population 37,238), led by the Mary Black Foundation and partners, will focus on access to care, wellness programming for small businesses, obesity, early childhood (0-5) services, and community pride – often referred to as social capital – which is linked to health indicators and the capacity of communities to engage support for initiatives that improve those indicators.
What are the five metrics?
HICCup has proposed five overarching measures to determine success in the Wellville communities. The measures cover traditional “health care,” along with a broader view of health itself – and the reciprocal relationship between health and the community. While our preliminary set of measures is below, we continue to evaluate them with an eye to ensuring that they measure what is actually occurring as a result of working taking place in the Wellville 5.
Below are the five proposed measurement areas and examples of each:
- Health impact – e.g., self-reported health/sense of wellbeing, or more traditional/condition- specific measures like transitions to diabetes, mental or dental health
- Financial impact – e.g., health care costs, payer trends, broader measures of health value
- Social/environmental context – e.g., early childhood education, civic engagement/volunteering, crime rate
- Sustainability – e.g., collective-impact governing body, health financing system, funding diversification
- Local priorities – e.g., a “wild card” specific to each community, such as teenage pregnancy, healthy sleep, community pride
What are the evaluation goals?
At the end of ten-years, five communities will demonstrate the impact of multiple reinforcing health initiatives. While each community has its own focus, as described earlier, all of them will work to improve child nutrition, the overall food environment, local social conditions, and the local provision of preventive and chronic disease care. The idea is not just to make a measurable difference in five places, but to demonstrate how a comprehensive approach to health can work and be replicated in many other communities around the country.
The evaluation will support multiple goals:
- Measure the outcomes/impact of each community’s health-creation efforts, and the value of those outcomes to engage greater support and sustainability going forward;
- Learn along the way about the process and context of each community’s health-creation efforts so that teams can make ongoing/real-time improvements to their approach;
- Document and share what works, what doesn’t and what is learned so that other communities can replicate successful approaches.
HICCup has not yet selected an evaluator for the ten-year challenge, in part because we are still determining, with our Wellville communities, the best approach to evaluation and what it will require.
What happened after the communities were selected?
To kick off the ten-year health challenge, Wellville community leaders will attended HICCup’s Next Step to Wellville conference, September 16 to 18, 2014 in Tampa, Florida. Next Step introduced community leaders to one another and to innovators in health data, solutions, and financing to explore opportunities for partnerships.
In 2015 and 2016, similar events were held in, respectively, Lake County, CA and Spartanburg, SC. These events gave the communities an opportunity to learn from experts in fields relevant to the work they’re undertaking, familiarize themselves with new and emerging technologies and solutions, and to build learning relationships with one another. In 2017, Clatsop County, OR will host our annual event.
In 2016, HICCup rounded out its team with the addition of a fifth navigator, allowing it to adopt a structure aligning one navigator with each of the Wellville 5 communities. This has deepened and broadened the relationship between not just the navigators and their respective communities but among the communities themselves. Better than two years into the work the have begun to confront the complex challenges of tackling complex problems. In part the Wellville navigators serve as coaches who are on hand to keep the goal in view and to facilitate the important learning that happens as the work is engaged.
How can others get involved?
HICCup is engaging prospective partners, sponsors, funders, investors and experts to work with the five Wellville communities to:
- Design and deliver a comprehensive approach to health;
- Gain access to community populations, data and test markets for new solutions;
- Measure impact through a formal five-year evaluation process; and
- Leverage a national network of organizations, combined resources, visibility and reach.
Organizations with shared goals and an interest in making a measurable impact in five communities positioned for success are encouraged to contact Rick Brush at firstname.lastname@example.org.
What support will be available to Wellville 5 communities?
The five selected Wellville communities will receive support from HICCup and its partners in five areas:
- Challenge: the projects each community undertakes will be evaluated using clearly defined metrics to be developed in consultation with the communities and a team of experts. This will help each community see clearly the results of their efforts. “The Challenge” will also generate heightened visibility and publicity for participating communities and partners.
- Navigators: one per community, who work with local leadership teams to engage broader support, partners and vendors to develop, integrate and finance efforts to cultivate health.
- HealthMart: a network of experts, collaborators and solution providers to help Wellville communities understand and shape behavior, environment and culture, while creating new business models and markets for the cultivation of health.
- HealthCapital: support efforts to structure innovative financing and investment models, including introductions to diverse funding sources – from philanthropies to for-profit investors.
- Learning/Sharing: a multi-media forum for connecting communities that are learning new ways to cultivate health, and are eager to try innovative financing that will lend sustainability to their efforts.
How will The Way to Wellville make an impact?
Despite massive spending, America’s health is getting worse. That’s because most of our nation’s $2.9 trillion annual health care tab pays for increasingly costly treatment of illness, rather than investing to cultivate better health.
Over the next ten years, five communities will work to improve the things health depends on. With support from diverse stakeholders, citizens, partners and investors, the Wellville 5 will demonstrate the impact of multiple reinforcing health initiatives. For example: health delivery and financing innovations…healthier school lunches and descent housing…better sidewalks and bike-sharing…early childhood education and economic development…social networks and workplace wellness…collaborations with national food vendors to create test markets and incentives for healthy eating…population health analytics and quantified-self tools.
Our goal on The Way to Wellville is clear, but the path is not. We are inviting communities and partners to experiment with us, not to implement some clearly defined step-by-step program that the experts have prepared. We hope to learn together, creating and refining models, metrics, tactics. One size definitely does not fit all…and a willingness to reshape and re-orient initiatives will be key to success.
Why is Way to Wellville structured as a challenge?
The Way to Wellville will provide a platform for accelerated innovation and breakthroughs through broader engagement, visibility, collaboration and support. Our intention is to create “a healthy challenge that creates the healthiest communities.” In the spirit of the Latin word competere: to strive together, we are creating both competition – to reward communities that achieve “personal bests” – and collaboration, where communities and partners interact, learn, and create greater progress together than if they were to go it alone.
What are some of the barriers to success?
The Way to Wellville communities will help unravel a wicked problem with many complex layers and seemingly intractable forces keeping the status quo in place. Existing health care business models pose serious challenges. Paying for health care when we’re sick accounts for nearly 18 percent of GDP – vs. about 10 percent of our disposable income for the food that often contributes to our illnesses. Our culture, neighborhoods and pocketbooks too often favor the unhealthy choices. And even the best-intentioned community health coalitions break down over turf and scarce funding. While the Affordable Care Act places more emphasis on access to medical care and clinical prevention, the biggest opportunities remain mostly unaddressed: a coordinated approach that shifts social, environmental and economic systems toward health.
There are some bright spots emerging. Communities are increasingly taking a “collective impact” approach, coordinating across sectors and stakeholders to fundamentally shift the conditions that matter most to health. There’s growing recognition of the nonmedical factors driving high rates of illness, creating promising new business opportunities. Health systems and payers are experimenting with value-based initiatives and pay-for-success financing. And so-called “social impact investing” drew $9 billion from investor groups in 2013.
Can better data, investing for impact, and critical density of well-coordinated, mutually reinforcing initiatives point the way to a healthier health system? The Way to Wellville communities will provide five “innovation labs” to develop, test and refine solutions over the next five years.
What were the criteria for community selection?
We were looking for five communities with populations under 100,000 each, from different parts of the country and with different issues and population types. In other words, we did not select each community in a vacuum; we selected a diverse group that we hope will make for an interesting, illuminating, challenging ten years, relevant to almost everyone across the U.S. and the world.
More than anything, we were looking for communities that are likely to succeed. Our selection criteria detail the components we believe are essential to success:
- Population of 100,000 or less, strong social cohesion, and self-contained geography;
- Collective impact approach and multi-stakeholder support;
- Entrepreneurial leadership and culture;
- Comprehensive health improvement plan, measures and track record of success;
- Innovative health financing systems; and
- Shared commitment to the ten-year journey ahead!
How is HICCup funded?
HICCup is a nonprofit supported since mid-2013 through charitable contributions from Esther Dyson, in-kind resources, and extensive field research and development among a growing group of guiding organizations, partners and communities. HICCup is fiscally sponsored by New Venture Fund (www.newventurefund.org).