"We have to make a seismic shift in the way we deal with health, and it has to come from the ground up," said foundation CEO Risa Lavizzo-Mourey, describing the shift Wednesday at the Aspen Ideas Festival in Aspen, Co. "It's going to require that we build new partnerships, and stand on one another's shoulders so we can turn small victories into national success. That we help one another by spotlighting and supporting initiatives that are working. And by learning from those that are not."
The foundation is highly influential in health circles, giving away $400 million a year. Active multi-year grants total over $413 million in New Jersey and $128 million in Pennsylvania, including $116 million in Philadelphia.
The foundation has long been devoted to improving access to health insurance and high quality care. It is a strong backer of the Affordable Care Act, which has raised some hackles. And its leaders want to make health costs more transparent to patients.
The new approach has drawn criticism too, because it has forced cuts in long-funded areas. Its Clinical Scholars program is ending in 2017 even though it has trained doctors to be leaders for over 30 years at the University of Pennsylvania and other schools. Nursing and health policy programs are also being ended.
Health futurist Ian Morrison says the new shift is so expansive that it may be hard to measure its success. "There's a danger in dissipating the effort if you go broader," he said. "How do you know you've made a difference?"
Still, Morrison, who has worked with the foundation previously, thinks its efforts are likely to have a large influence.
Officials say the new approach is needed to make bigger, more sustainable leaps. It will need to identify new metrics. "We'll be looking for measures that are trackable and usable," said Jim Marks, Director of Program Portfolios.
In her speech, Lavizzo-Mourey, the CEO, cited the wide use of calling 911 as the kind of transformative idea the foundation is seeking.
Hundreds of humbler examples are in the works. The Flip the Clinic project is reimagining a doctor's visit to give patients more control over their care.
A model of a flipped clinic is the 11th Street Family Health Services center in Philadelphia. Since its inception in 1996, it has worked in partnership with a community advisory board composed of mostly patients. The clinic integrates mental health into primary care and tackles complex issues such as chronic pain and trauma.
"It's all based on what the community needs, rather than what insurance will pay for," said Patricia Gerrity, associate dean for community programs at Drexel University who directs the center.
Nurses often create simple yet innovative solutions. So another project, MakerNurse, seeks to harness their bedside ingenuity. "At its core, we're trying to bring makers and health together," said Jose Gomez-Marquez, director of the Little Devices Lab at MIT, which leads the MakerNurse effort.
Nurses make novel devices, such as plastic IV covers or doughnut-shaped pads for transporting babies with exposed wounds, but often don't know how to share their ideas.
Gomez-Marquez and his team are collecting data on these "MacGyver nurses" - referring to the 1990s tv inventor - and considering how they can be better supported.
Care is ultimately just one facet of health. The County Health Rankings & Roadmaps program compiles data to help communities identify areas of strengths and weaknesses involving health.
Since 2010, this program has annually assessed each county's rankings across many factors, from air and water quality, to education and tobacco use.
"There is so much that can be done upstream to prevent the need for health care," said Bridget Catlin, a senior scientist at the University of Wisconsin who directs the RWJF program.
It now provides community coaches, who are available to anyone, from a Chamber of Commerce member to a school superintendent, who wants to better their county's health outcomes.
"Almost anyone can get a movement going to build a culture of health in the community," she said. "We stand ready to help whoever shows an interest."
Clare County in Michigan ranked last in the state, according to the 2010 data. But community members got to work, targeting areas such as transporting women who need prenatal care.
The county now ranks 72nd in the state, out of 82 counties.
And, of course health needs are vast among workers. The New York City-based Vitality Institute is leading a commission to improve worker health by equipping their employers with ideas.
"Focusing more on the workplace is fundamental to promoting a culture of health," said Derek Yach, Vitality's executive director.
Its commission encourages CEOs to cover employee health information in annual reports. That emphasizes the "most important source of human capital in the company: the workforce and the health of the workforce," he said.
The institute also seeks to "harness the power and enthusiasm of companies to do the right thing," Yach said. CVS Caremark recently announced plans to stop selling tobacco products in some locations. This was met with a rise in the company's stock, an institute report noted.
Campbell Soup Company, headquartered in Camden, is also promoting community health. Working with the foundation-funded New Jersey Partnership for Healthy Kids, Campbell launched the 10-year Healthy Communities Program in 2011.
The $10 million effort first focused on the Camden area, tackling problems such as the lack of a full-service grocery store. About 40 of the 160 corner stores in Camden now have more produce and healthy food. Some even offer cooking demonstrations.. The program is expanding to include the firm's plant in Napoleon, Ohio.
"The significance of our success is reaching out to cross sector partners who share the common vision of the health of our young people," said Kim Fortunato, Campbell's director of the program.
Such partnerships are "going to make a Culture of Health happen," Lavizzo-Mourey noted in her Aspen speech. "Not me standing up here talking about it. But you, embracing the idea. Sharing it with others. And cranking up the volume on the nationwide call for change."