ReThink Health Evolution | Rippel Foundation

ReThink and Transforming the Current Healthcare System

Client: Rippel Foundation
Industry: Non-Profit
Video Type: Healthcare
Messaging Type: Interview-Based

About This Video Project

In this video, we explore the work of the Ripple Foundation, a non-profit organization dedicated to improving equitable health and well-being. They join forces with other stewards, or change-makers, to provide tools, resources, frameworks, and approaches that address healthcare issues. Their goal is to ReThink and transform the current healthcare system, which has been plagued by the same problems for over a century.


The Ripple Foundation is fundamentally about improving equitable health and well-being. We come together with other stewards, or folks we like to call change makers, and we bring tools and resources, frameworks and approaches that help them solve those problems. This idea of health has been inextricably bound up with health care, and the idea of being able to rethink, and dare I say, redo health, is particularly exciting to me. We know going back to 1850, we’ve been talking about the same issues over and over and over again. And the question becomes, if we know what needs to be done, why aren’t we doing it? That’s the core question. That’s the driving question for Rethink Health. It’s like, okay, this is a really big question. What are we going to do about it? What could we possibly do that’s going to make a difference? I was sitting at my desk at Dartmouth, and I get a phone call from this woman who says her name’s Laura Landy, and she says, can we have dinner together sometime? I learned from her that they had come to a point where the traditional things they were focusing on giving money to were being questioned. What happened over the next period of probably months was this recognition that maybe we ought to put together a group of people who together could start to think about what’s required to make health care better in the United States. And the fundamental idea was to reach out to people outside health care for insights about health care. He says, what you need to do is to get Don Berwick involved. His organization was known for supporting what they call the triple aim. They were focused on how did we cut per capita costs, produce better individual health care, and better what they call population health or health care for the whole community rather than just individual treatment. And what emerged out of that was the sense that this was a complex issue that really needed a transformational framework. One of those discussions led to the notion of let’s invite some additional people together. People like John Sturman, who heads the system dynamics group at MIT. It was Peter Sange, who’s the father of the learning organization. It was Jay Ogilvie, who invented scenario planning. They were coming to this as experienced change makers. People who had changed organizations, changed thinking, changed activities. Later joined by Marshall Ganz, who was a community organizer who literally organized the Grape Strike and choreographed Obama’s grassroots campaign. Lynn Ostrom, who won a Nobel Prize for talking about how you create a sustainable commons. This group expanded gradually over time, came together for two days every quarter for over two years. Everybody was doing different stuff, and they were all being catalysts with a particular skill set they had in terms of outcomes. So each of them had contributed something to the process. Atul Gawande, a physician, a guy who’s written a number of books, wrote an article for The New Yorker called The Cost Conundrum. What it showed was really the heart of what Elliott had been working on. It showed how two different cities could have fundamentally different economics for the cost of the same operation. And what it revealed was that how much money was driving the system, not the actual service. He was really saying this was a problem with kind of greed and economic opportunity for people, and it wasn’t really the medical service itself, and therefore it was all this way in which it was being done differently. Those early pioneers of Rethink Health were not just prominent figures in their own areas. They were veteran changemakers who had figured out ways of achieving large-scale system change. The question was how to go from the insights of these veteran changemakers into routine practice in the wider world, and that became the mandate of Rethink Health. We had this idea of, can you build an interactive model of a community that would actually allow people to experience what happens if you address some of the issues? The simulation model that was developed by Rethink Health is an interface where you can enter up to 20 different policies and adjust them, slide up the dial, down or up one. Do you want to enable healthy behaviors? Do you want to move to new payment models? Do you want to invest in improving childhood education for disadvantaged kids? Or do you want to prioritize environmental intervention? So the model is really pretty powerful. It predicted 20 years forward and lets you figure out, you know, how much can I reduce health care costs? What will happen to population health? And as you do those things together, you can then achieve potential outcomes, which are, you know, 15 or 20 percent reduction in health care costs, marked reductions in disadvantage. Building this system dynamics model was a huge, huge effort. You can bring a group of 50, 100 people together and have them fix their health care system using a computer model, understanding, like, I’ve got to move five levers simultaneously. I can now come up with a strategy to move three or five levers and I can get people behind that because I’ve got data to do that. So that was really, really pivotal. They were trying to think ahead about where are we headed in different scenarios and to be able to say, what are the things we can do very close to home in our own lives, in our families, in our schools, in our neighborhoods? They also talked about a commitment to connecting across boundaries. And so Rethink Health was born out of the wisdom that said, if we can concentrate on that moment of rethinking and make that our routine focus, then there’s really no limit to what could happen. How do we assess where we are as a society? And then how do we look deep beneath why are people, let’s say, for example, people who have wealth, what makes those conditions for them to have that wealth versus those who are barely making ends meet? What are the conditions that are perpetuating that? And then how do we go to the root of that problem and think really upstream to create that future trajectory for everyone to thrive? So I like to think of it as we’re in a boat. There’s different boats. Some people’s boats are patched up and well and good to go. And then there are some boats that are leaking. So what do you do? You focus on patching up the holes. But then the problem with focusing on patching up the holes is that you never get a chance to think about the boat itself, the shape of it. What is it made out of? Where am I in this stream? That’s what systems change is. Systems change is balancing the whole patching the hole in the boat, but also looking at everything else, all the other conditions that are needed for that boat to be floating and going in the direction that it needs to. One of the things that Rethink Health did through its field work with colleagues is to roll up our sleeves and articulate what we think are the vital conditions for health and well-being. Thousands of other colleagues participated in that. And in the last several years, there’s been surprising level of agreement around this set of vital conditions as the things that we should be creating. For the vast majority of people in this country, you still can gain access to health. You can still live a fairly healthy life. But there’s a large minority within the country that there are certain conditions that they face that impacts their ability to live a healthy life. Whether it’s access to healthy foods, housing, transportation, jobs, education, a sense of community, all of these factors go into driving health and well-being. And the lack of equity within our country creates these great barriers to a large number of our fellow countrymen. For everyone everywhere to thrive, there has to be some attention paid to this concept of stewardship, this concept of being responsible together for a common resource to the extent that all of us would benefit. Our responsibility is to take the long view, to recognize that the challenges that we’re facing today may take a generation to address. We didn’t get here overnight, and so having the discipline to think about who needs to be at the table. Do we have an understanding of the problem that we’re trying to solve? And how are we going to work together to achieve that long-term social change that we desire? A lot of the conversations and the focus is reaching out into the communities and finding partners that we can collaborate with and helping create stewards within the community. We at Ripple are not going to start building housing or putting up supermarkets, but we can partner with those individuals in the community in their areas of expertise and their sphere of influence to help drive this idea of improving the conditions where the people live, which will then lead to better health care outcomes. We’re at a place where people are discouraged, they’re feeling left behind, and what can each of us do to help solve the problem, and then what can we do together to try to figure out how can we all be stewards of our children’s future?

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