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Aligning Capital with Care: Delivering Health Value Alongside Financial Returns
Mark McClellan1,2, Cheryl Pegus1,2
1Mark McClellan, MD, PhD,is the director of the Robert J. Margolis Center for Health Policy and the Margolis Professor of Business, Medicine, and Health Policy at Duke University in Durham, North Carolina, and Washington, DC. He also serves as an independent board member for Alignment Health Care, Cigna, and Johnson & Johnson, and is an advisor for Arsenal Health, Blackstone Life Sciences, CRG, and MITRE Corporation.
Abstract:
Private capital has been a powerful force in driving healthcare innovation, fueling digital tools, team-based care models, and many other modernizations of care. Yet skepticism remains about whether financial investment can align with improved outcomes, improved access, and lowering of costs based on negative examples. In a healthcare system that spent $4.9 trillion in 2023, with most of the supporting investment funded by nongovernmental sources, the role of private capital is not just influential but essential. Consequently, working to reduce negative implementations and increase transparency is worthwhile based on the needs for innovation in healthcare-digital and physical. This article provides approaches for private investment to analyze not only financial return on investment but also health value return on investment (HV-ROI). That means measuring how well capital deployment improves care outcomes, expands access, targets community needs, and supports providers while impacting healthcare costs. Investors should be true health partners. Adopting HV-ROI practices can help them and partnering healthcare executives align financial goals with value-driving both financial viability and improved outcomes for patients and communities. Key insights include: Blended funding is essential. Public programs, philanthropy, and private investment each play a role. Only together can they support the cost of care, scale proven solutions, and sustain innovation across all communities.Private investment must evolve. While it has enabled telehealth, diagnostics, and behavioral health platforms, instances of private for-profit investment with poorly aligned incentives have also led to staffing cuts, reduced services, and worse outcomes in areas like emergency medicine and nursing homes.HV-ROI offers a solution. This framework proposes embedding health value throughout the investment lifecycle:Evaluating clinical outcomes, access, affordability, and local needsAligning investment key performance indicators with patient, provider, and payer prioritiesBuilding governance structures that reward long-term health impactTransparency and accountability matter. Publishing impact analyses, engaging third-party evaluators, and sharing lessons learned will build trust and legitimacy.
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