"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 at the Aspen (Colo.) Ideas Festival. "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."
The foundation gives away about $400 million a year. Active multiyear grants total over $108 million in New Jersey and $76 million in Pennsylvania, including $63 million in Philadelphia.
It has long been devoted to improving access to health insurance and 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, because it has forced cuts in long-funded areas. The 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 said the 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?"
Officials say the new approach is needed to make bigger and 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.
Lavizzo-Mourey cited the 911 call system as the kind of transformative idea her group is seeking.
Hundreds of humbler examples are in the works. The Flip the Clinic project is reimagining a doctor 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 opening in 1996, it has partnered with a community advisory board composed mostly of patients. The clinic also integrates mental health into primary care. "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 the Massachusetts Institute of Technology, 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 1980s TV character - and considering how they can be better supported.
Care is ultimately just one facet of health. The County Health Rankings and 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 on 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 improve his or her 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."
For instance, Clare County, Mich., ranked last in the state, according to 2010 data. But community members got to work, targeting areas such as transporting women who need prenatal care. The county now ranks 72d out of 82 counties.
Health needs are vast among workers. The New York City-based Vitality Institute is leading a commission to improve worker health by giving recommendations to employers.
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," said Derek Yach, Vitality's executive director.
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 CVS's stock price, an institute report noted.
Campbell Soup Co., based 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 sell more produce and healthy food, said Kim Fortunato, Campbell's director of the program. Some even offer cooking demonstrations. The program is expanding to include the firm's plant in Napoleon, Ohio.
Such partnerships are "going to make a culture of health happen," Lavizzo-Mourey said. "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."