A locally controlled pool of funds created to support community well-being and clinical prevention efforts that improve population health outcomes and reduce health inequities. Sources of funding may be public and/or private.
Local wellness funds are a promising approach to sustainably assemble resources to finance community prevention efforts and address other drivers of health outside of the health care delivery system, like housing, education, poverty, food availability, and access to safe recreational areas. Addressing these upstream drivers of well-being provides an opportunity for involvement of a broader group of stakeholders to jointly address health outcomes. Bringing together the right people is an important first step. But communities must also figure out how to fund these initiatives targeting the upstream drivers of health and wellness. Experts increasingly see the ability to tap into and coordinate various funding streams as a key strategy for financial sustainability of community health improvement efforts.¹
Communities around the nation are thinking innovatively about aligning streams of resources to sustainably support initiatives of shared interest and importance. They are blending and braiding resources from a mix of:
Potential population-level benefits from these funds may be seen across sectors.
The concept of a dedicated and sustainable fund to support health and well-being is not a new one. For more than a decade, there has been an evolution of thought and effort on the topic, broadening from an approach where the center of control for the fund was located at the state or national level to more recent adaptations where much of the administration of the fund is locally or regionally held.
At the national level, the Prevention and Public Health Fund was established under the Affordable Care Act in 2010 to provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality. Specific uses to date included:
Over time, the sustainability of the fund, due to waning appropriations, has become increasingly fragile.²
The Massachusetts Prevention and Wellness Trust Fund was one of the nation’s largest, financed with $60 million over a four-year period, through a small assessment fee on health insurers and acute care hospitals. While much of the evaluation of the effort suggested population health improvement gains across the state, ³ appropriations to the fund dried up in 2017. Other states have been experimenting with the concept to varying degrees, including Minnesota, Oklahoma, California, and Hawaii.⁴
Local or regional funds hold the promise of a mechanism that might potentially be more sustainable over time. This is because, as Kindig points out, “they are less expensive, more politically feasible, and present a path to longer-term solutions than counting on unlikely new federal or state appropriations. … They serve as stable and permanently staffed governance bodies, multi-sectoral coordinating entities whose public- and private-sector leaders meet regularly, establish local goals and priorities, and identify resources for substantial and continuous investment in improving overall health and health equity.” ⁵