Over the past two years, global events reshaped the health care industry by shifting the priorities of the industry’s key stakeholders. In the post-Covid-19 economy, quick responses to short-term problems such as continuing supply chain disruptions and workforce shortages define success for health care businesses. However, as the industry’s leaders return to remaking health care’s patient-centric future, they are incorporating the evolving demands of key stakeholders in the health care ecosystem to address larger issues of inefficiency, inequity, and inaccessibility in the health care industry. Collectively, these complications raise questions about health care’s sustainability and the ultimate impact of sustainability on delivering patient-centered health care services.

As a generalization, historical inattention to sustainability has squandered opportunities to build efficient, effective, and equitable health care businesses capable of pushing the health care system towards a patient-centric future. Consequently, the health care industry has been criticized as unable to consistently resolve the underlying core problems resulting in costly, underwhelming care that delivers disparate outcomes for some stakeholders. However, the emerging common chorus of key stakeholders calling for sustainability presents an opportunity for industry leaders to positively influence the evolving course of the American health care ecosystem.

By embracing various perspectives on sustainability and committing to building health care businesses that intentionally address them, the health care industry can realign to address the interests of all key stakeholders to deliver a sustainable, and therefore, patient-centric health care system. This aspirational future sits against the backdrop of what the past has taught, which is that when there is not sufficient focus on developing sustainable patient-centric health care businesses that consider the interests of all key stakeholders, opportunities are missed to evolve or transform the health care system in its most efficient and effective direction. There are numerous examples of current state optimized health care; however, there should be appreciation that the health care system is popularly viewed as not evolving to adequately consider sustainability. The consequences of this view are significant, leaving our country with a perceived underperforming and expensive health care system that produces undesirable disparities in access, care delivery, and outcomes. Without conscious commitment to embracing a “sustainability-based” healthcare transformation agenda by key stakeholders, we are at substantial risk of wasting additional time and resources on a suboptimized system of health care.

Capitalizing on this opportunity successfully requires health care businesses to identify the various economic, ecological, and social issues that fall under the umbrella of sustainability. Next, health care businesses must understand how leaders in the health care industry are best responding to the complexity of sustainability challenges. Finally, health care businesses must integrate these insights into their own businesses and embrace the vital role of sustainability in the evolving health care ecosystem. Taken together, a playbook begins to take shape for health care businesses to thrive in the patient-centric future state of health care.

At a high-level, sustainable business models are defined by serving the immediate needs of customers and owners while avoiding or negating impacts on the environment, the community, or society.² In other words, sustainability is increasingly understood to require a balance of positive social, economic and environmental outcomes – also known as the “Triple Bottom Line.”³ In addition to balancing the elements of the triple bottom line, sustainability invokes the fundamental balancing act between the immediate needs of present society and the future state left for generations to come. For the business of health care, the summation of these sustainability considerations requires delivery of affordable, low-or-no environmental impact, and socially positive care services.⁴

However, the broad and all-encompassing concept of sustainability does not readily offer health care leaders the playbook for building sustainable health care businesses. The collective calls for sustainability from key stakeholders with diverse perspectives and often contradicting definitions of sustainability inherently complicate the task of building sustainable health care enterprises. Bridging the gap between the varied definitions and dimensions of sustainability and the operationalization of sustainable health care presents an opportunity for those remaking health care through mergers and acquisitions and innovation activities to accelerate the industry towards the future state of health care.⁵

This white paper uses the following five principal themes, ideas, and concepts to distill the various incongruent notions of sustainability in the status quo into a consistent and operationalized vision of the future state of sustainable health care services that satisfies and aligns the demands of key stakeholders:

• Triple Aim of Health Care

• Environmental, Social and Governance

• Systemic Resiliency

• Conscious Capitalism

• Social Determinants of Health

Unpacking these themes, ideas, and concepts defining sustainable health care builds upon the seminal Health Care “Prime” observation that the health care ecosystem is moving towards an ultimately patient-centric future state - a future state that cannot be fully realized without sustainable health care enterprises.⁶ Progressing the Health Care “Prime” thesis, this white paper identifies health care businesses, enabled by mergers and acquisitions and innovation activities, that embody the principal themes, ideas, and concepts defining sustainable health care, and thus, deliver on the promise of sustainable and ultimately patient-centered health care. Furthermore, because sustainability shares a unique relationship to achieving the future state of health care (i.e., health care cannot function effectively in an evolving health care ecosystem without sustainable practices), this white paper explores how the themes, ideas, and concepts for defining sustainable health care are symbiotic with the six original Health Care “Prime” themes and outcomes - together ultimately describing the patient-centric reality of the future state of health care.

Each of the interrelated themes, ideas, and concepts of sustainable health care is derived from the various perspectives on the role of health care services in America:

• Health care and its relationship to the individual;

• Health care and its relationship to the environment; and

• Health care and its relationship to inequality.

In turn, each perspective is informed by observations about the perceived inefficiencies in status quo health care (poor quality and access, high costs, environmentally unsustainable practices, and ignorance of broader socio-economic influences on poor health) and each, independently, offers value to the key stakeholders seeking a sustainable future for health care. Considered in isolation, however, each of these dimensions cannot create a congruent means to achieving sustainable solutions for health care businesses. By unifying these perspectives under the umbrella of the principal themes, ideas, and concepts of defining sustainable health care, this white paper creates a lens for analyzing how current mergers and acquisitions and innovation activities enable health care leaders to build sustainable health care businesses that address stakeholder concerns to ensure the arrival of the patient-centric future state of health care.

FOOTNOTES

¹ The Polsinelli authors, Jon Henderson, Taylor Maun, Silmon Ghebreyesus and Julia Rix, are resident across the firm’s Dallas, Los Angeles, Kansas City and Washington, D.C., offices and members of Polsinelli’s Corporate and Transactional Practice Group and Health Care M+A Practice. Jacob Loehr, who carried the heaviest laboring ore of our authors, is a former Polsinelli associate in the Corporate and Transactional Practice Group who relocated to Austin during our research and writing process but continues as a key thought partner on this white paper’s thesis. The authors thank James W. Walton, President and CEO of Genesis Physicians Group, a Dallas-based 1,200 member-independent practice association, for his insights and contributions in the writing process derived from over 30-years as a practicing internal medicine specialist prior to becoming a physician executive and leader in hospital and physician organizations. And, lastly but not least, the authors thank Abbie Kate Henderson, a sophomore majoring in Sustainability Studies in the College of Liberal Arts at The University of Texas at Austin, for her insights and contributions as a student learning and passionate about sustainability and the application of design thinking. But for the contributions of this team, our white paper would have been lacking in its potential to have the greatest intended impact.

² See Alexandra Spiliakos, What Does “Sustainability” Mean in Business? Harvard Business School Online (Oct. 10, 2018), https://online.hbs.edu/blog/post/what-is-sustainability-in-business/.

³ See Kelsey Miller, The Triple Bottom Line: What It Is & Why It’s Important, Harvard Business School Online (Dec. 8, 2020), https://online.hbs.edu/blog/post/what-is-the-triple-bottom-line/.

⁴ Introduction to Sustainable Healthcare, The Centre for Sustainable Healthcare, https://sustainablehealthcare.org.uk/courses/introduction-sustainable-healthcare/.

⁵ See Josh Karliner et al., Health Care’s Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis and Opportunities for Action, Health Care Without Harm & ARUP (Sept. 2019), https://noharm-global.org/sites/default/files/documents- files/5961/HealthCaresClimateFootprint_092319.pdf.

⁶ Jon Henderson, Andrew Kinworthy, & Kevin McDonnell, Health Care ‘Prime’ – The Shaping of Health Care in America Through M+A and Innovation, Polsinelli (Oct. 2018), https://www.healthcarema.polsinelli.com/health-care-prime-white-paper-series/.