Innovative funding model will help more Canadians reduce their risk of heart disease and stroke
There’s an old saying that an ounce of prevention is worth a pound of cure.
How you pay for that ounce is another story. As it stands, Canada spends most of its healthcare funds on acute care for sick people, leaving a scant 5 per cent for the public health programs that can help prevent disease in the first place.
But that could change, thanks to a new funding partnership that uses private investment to help tackle big social challenges.
The latest innovation in social finance is called a social impact bond, also known as pay-for-success. This unique model allows non-profits, private sector partners, and private investors to partner with the government to support programs focused on achieving measureable results that can improve social outcomes.
Since they launched in 2010, most pay-for-success projects have focused on improving social outcomes for at-risk populations — such as reducing homelessness or lowering the number of children in foster care.
If a program meets its goals, the investors who funded it earn back their investment, plus interest from the government.
In 2017, Heart & Stroke will launch Canada’s first health-focused social impact bond, in partnership with the Public Health Agency of Canada (PHAC) and the MaRS Centre for Impact Investing.
Together they will launch the Community Hypertension Prevention Initiative to prevent high blood pressure.
We sat down with Doug Roth, chief strategy and financial officer at Heart & Stroke, to understand how pay-for-success could pave the way to strengthen chronic disease prevention in Canada.
Why focus on high blood pressure?
Hypertension or high blood pressure is the number one risk factor for stroke and a leading risk factor for heart disease. Right now, roughly six million Canadians are already living with high blood pressure. And another six million are pre-hypertensive — meaning their blood pressure is heading for the danger zone.
The bad news is that it’s a big problem that affects lots of people. The good news is that you can do something about it. If you can get people to change their lifestyle, particularly people who are pre-hypertensive, there may never be a day that they need to go on medication.
How will the program work?
Our goal is to enroll 7,000 pre-hypertensive individuals into our new Community Hypertension Prevention Initiative (CHPI) and help them prevent their blood pressure from progressing to full hypertension. If we’re successful in meeting those two targets, investors who helped fund the program will get their initial investment back, plus interest from the federal government.
What will the participant experience look like?
Starting next year, we’ll have Heart & Stroke trained volunteers available at select Shoppers Drug Mart pharmacies and Loblaws grocery stores in Toronto, followed by Vancouver in 2018. If you’re interested in participating, our volunteers will sit down with you for 20-30 minutes to complete a risk assessment. They’ll also measure your blood pressure.
If you’re identified as pre-hypertensive, we’ll be inviting you to join our online program, where you’ll receive free coaching and support that will focus on improving your nutrition and physical activity.
Finally, at the end of six months, we’ll invite you back to take a final, in-person blood pressure reading. It’s also an opportunity to discuss what worked, and how you can continue or improve on that behaviour change going forward.
Why pre-hypertensive patients?
We know that people who are pre-hypertensive, statistically it’s a matter of time before they develop high blood pressure. Research shows that 50% of pre-hypertensive seniors are likely to progress to hypertension within four years. Essentially, our goal is to stop that increase from happening. The reason is that prevention is the best medicine. We want to help people avoid heart disease and stroke.
How are pay-for-success models different than other funding models?
A community-based project like this appeals to investors who are philanthropically minded. These are not Wall Street tycoons. These are people who want to have a real social impact.
In the past, if I was one of these investors, the only way I could have this sort of impact is to give a grant. If I give a grant, the money is gone. But if I invest in a social impact bond, I have an opportunity to make a real social impact, get my money back, and then do it all over again.
Will we see more health prevention programs funded through this model?
It has the potential to be a good model for parts of health care. Historically, the government has not been able to fund nearly as much as we might like on prevention. And in a sense, we’ve been able to frame a business case that makes investing in prevention less risky for governments. Government payouts are dependent on previously agreed upon outcomes. If it doesn’t work, investors have assumed the risk and can lose a portion of their capital.
Why is Heart & Stroke taking the lead on the first health-focused pay-for-success program?
We’ve always been about innovation. We’re the largest contributor to research — which at its core is about innovation — after the federal government. So I think it’s exciting to really build on that heritage.
This program also aligns directly with our values. Every piece of this from the Heart & Stroke side is something we’ve done in the past. We’ve had volunteers run screening clinics. We have developed effective digital tools. We’ve worked on every aspect of this. Heart & Stroke is uniquely positioned to execute this new and innovative program.
Could social impact investing replace traditional fundraising?
Absolutely not. A lot of the work that Heart & Stroke does couldn’t and shouldn’t be funded this way. The core purpose of social impact investing is to bring new dollars — outside of traditional tax-receipt donations — to social problems.
We rely on our donors to fund the medical breakthroughs that save lives. That need is more urgent than ever, and our donors and supporters will help us meet that challenge.