HealthBegins Upstream Strategy Map

Upstream Strategy MapTMfor Health Equity Transformation

Overwhelmed by contractual requirements for health equity and social needs? Juggling a patchwork of short-term pilots and programs? Unsure how to drive upstream impact while handling downstream needs?

To transform health equity and the social drivers of health inequity, healthcare leaders need a cohesive portfolio of investments—one that aligns clinical and community efforts across time horizons and different levels of intervention and prevention. And they need a map to navigate that journey. We've got one.

Explore the Map

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Start your portfolio planning

Click the numbers below to learn more about each step.

Review ecosystem-level investments

Upstream Strategy MapTM

Define a population

Review program & care delivery investments

Review system-level investments

Define target outcomes

Review societal-level investments

Focus on impacted places

Focus on social and structural drivers of this inequity

Put it all together & make informed choices

10

Define a pattern of inequity

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Sample Upstream Strategy MapTM

Click on interactive elements to see one health system's balanced portfolio ofinvestments to reduce racial inequities in diabetes among adults living in heavilyimpacted zip codes by addressing economic and food drivers of inequities and poor outcomes.

Levels of Intervention

Levels of prevention

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Health Equity Investment Solutions We can help develop your portfolio and align your health equity investments for impact

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With our investing solutions and expert support, we help healthcare leaders and partners:

• set strategic goals and objectives for health equity with a clear investment thesis
• organize and manage a portfolio of health equity and social needs investment strategies to acheive your goals

• assess the economic value and social impact of your existing health equity and social needs investments over different time horizons
• get actionable business insights on health equity and social needs from the latest evidence from the field

Social Needs Investment Lab

Health Equity Investment Solutions

Investment Strategy & Portfolio Development

Due Diligence & Reporting

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Investment opportunities exist across different levels of prevention

Promotion:Goal = promote healthy environments and behaviors Primary Prevention:Goal = prevent disease among susceptible people Secondary Prevention:Goal = early detection of disease and intervention Treatment:Goal = reduce the severity of disease among symptomatic patients

• Using geographic and area-level analysis of your population, which neighborhoods, census tracts, or zip codes bear a disproportionate share of this inequity?

Ask yourself...

Racial inequities disproportionately impact these zip codes: 01214 01245 01248

Example

Focus on places where your population is most impacted by this inequity

Look across all opportunities and ask yourself...

This map leads to a balanced investment portfolio for health equity. This includes strategic, coordinated programs & investments that generate value and impact across multiple levels of intervention and prevention, and over different time horizons.

Review a sample Upstream Stategy Map™

Put it all together and make informed choices

10

• What are our priorities?
• What are our roles and responsibilities?
• How can we balance our portfolio?
• How can we clarify and set expectations?

View Sample

• Promotion: Strengthen clinic or hospital financial assistance programs; promote livable wages for staff

• Primary Prevention: Increase wages internally so that no staff experience food insecurity.
• Secondary Prevention: Incorporate the diabetes prevention program into benefits plan for lower-wage employees with prediabetes

• Treatment: Reduce or eliminate medical debt burden for lower-income patients with diabetes

System-level investment examples

What investments can we make to build or transform institutional capabilitiesthat:

Ask yourself...

Review potential system-level investments to reduce health & health care inequities

• Promote healthy environments & behaviors;
• Prevent disease among susceptible people;
• Detect disease and intervene early; and
• Reduce the severity of disease among symptomatic patients.

• Promotion: Assess for and promote livable wages with vendors and partners.
• Primary Prevention: Invest in and support local food policy council.
• Secondary Prevention: Subsidize vouchers to a farmer’s market.
• Treatment: Coordinate with local banks, collectors, lenders, to reduce debt burden for people with diabetes and lower incomes.

Ecosystem-level investment examples

What investments can we make to build cross-sector relationships, capacity, and impact in order to:

Ask yourself...

Review potential ecosystem-level investments to reduce health care inequities

• Promote healthy environments & behaviors
• Prevent disease among susceptible people
• Detect disease and intervene early; and
• Reduce the severity of disease among symptomatic patients.

At the level of individual care, what investments could we make to improve the effectiveness of our services and:

Ask yourself...

• Promotion: Expand financial assistance support for lower income patients.
• Primary Prevention: Connect low-income individuals experiencing food and nutrition insecurity to resources.
• Secondary Prevention: Conduct food insecurity screening & connect to resources.
• Treatment: Provide medically-tailored meals for low-income patients with diabetes complications.

Program & care delivery-level examples:

Review potential program & care delivery investments to reduce health care inequities

• Promote healthy environments & behaviors;
• Prevent disease among susceptible people;
• Detect disease and intervene early; and
• Reduce the severity of disease among symptomatic patients.

• Which population(s) of patients, members, or community residents are you aiming to help?

Consider people who share a clinical condition and a set of avoidable or unjust experiences.

Ask yourself...

Adults with diabetes who visit the ER or are admitted frequently to the hospital

Example

Define a population

• Promotion: Promote equitable cash transfer as well as community development and reinvestment programs.
• Primary Prevention: Support local community-led coalitions to increase minimum wage.
• Secondary Prevention: Advocate to increase SNAP and WIC benefit amounts.
• Treatment: Support Medicaid policy change to sustainably fund medically tailored meals for adults with diabetes complications.

Societal-level investment examples

What investments can we make to promote equitable, evidence-informed societal norms and policies that:

Ask yourself...

Review potential societal investments to reduce health & health care inequities

Advocate to increase SNAP and WIC benefit amounts

• Promote healthy environments & behaviors
• Prevent disease among susceptible people
• Detect disease and intervene early; and
• Reduce the severity of disease among symptomatic patients.

• What outcomes do we seek to achieve?
• What specific health inequities do we want to close based on our target outcomes? (Which subpopulations are experiencing poorer outcomes compared to others?)
• What measures will we use to determine the success of our investments?

Ask yourself...

Define target outcomes

Example

• Improve diabetes outcomes for our population of focus by 40% within 2 years
• Reduce health inequities between subpopulations within our population of focus

In the places identified:

• What individual-level social risk factors might be contributing to this inequity?
• What community-level SDOH might be contributing to this inequity?
• What deeper structural issues or broader policies might be contributing to this inequity?

Ask yourself...

In these zip codes, food and economic insecurity drives harm at the household- and community-levels

Example

Focus on relevant social and structural drivers of these inequities

• Based on your data, what is a specific type of inequity that impacts your population of focus?
• What intersectional patterns define this inequity?

Ask yourself...

Racial health care inequities in quality measures that disproportionately harm adults who identify as Black, especially adults with incomes below 200% of FPL

Example

Define a pattern of inequity

Investment opportunities exist across different levels of intervention

Programs & CareGoal = improve effectiveness of services System:Goal = build or transform institutional capabilities EcosystemGoal = build cross-sector relationships, capacity, and impact SocietalGoal = promote equitable societal norms, structures, and policies