Capital Impact Council

The Duke-Margolis Capital Impact Council (CIC) supports the development of strategies, tools, and frameworks to enable the private investment community to demonstrate and deliver measurable benefits for health outcomes, access, affordability, and community resilience. 

The Health Value-Evidence Quality Framework

The HV-EQ Framework was developed with guidance from the Duke-Margolis Institute for Health Policy’s Capital Impact Council (CIC), a group of experienced investors committed to advancing resources, evidence, and published best practices, to help assure investments deliver health value alongside financial returns. This Framework complements the CIC’s Health Value Return on Investment (HV-ROI) Framework.

The HV-EQ Framework identifies four stages of evidence quality and demonstrates how an intentional HV-EQ strategy can be incorporated at each stage of an investment’s life cycle. We describe the foundations for the framework, its methods and metrics, and provide examples from CIC member experience that illustrate its practical application in health care investments. We identify promising directions to refine the framework and streamline its application in key areas of health care investment through cross-industry collaborations, partnerships with assessment organizations, and by advancing public policies that support health value returns.

Our review of the CIC case examples and the broader evidence landscape on health value in private investment shows that, despite persistent gaps, private capital investors can take meaningful steps to directly and routinely support their portfolio companies’ efforts to measure health value. These steps reduce long-term risk
and increases their ability to impact health care and health:

• Define and regularly revisit a core health value question set to guide a company’s care model and strategy throughout the entire holding period, i.e., the time it is owned by an investor
• Build a forward‑looking evidence strategy that advances as the company evolves
• Support and disseminate health value assessment best practices based on portfolio companies’ experiences and prioritize funding for organizations that follow these practices
• Increase both the supply of and demand for stronger health value evidence by structuring commercial partnerships that accelerate evidence generation and by leveraging these partnerships to increase market demand for companies with strong health value evidence
• Collaborate with assessment organizations to clarify health value evidence pathways in the company’s value impact area, reducing risk and increasing efficiency
• Participate in collaborative platforms for evidence generation, including those supported by philanthropies aligned with health value creation as well as public-private partnerships that normalize, reward, and scale evidence generation

Building on these strategies, the CIC aims to work with a range of collaborators to advance best practice models for demonstrating health value in private capital investment, and to strengthen and publicize measurement approaches that assess CIC members’ own contributions to health value development. At a time when private investment that positively impacts health care is needed more than ever, the HV-EQ Framework can help assure that financial returns align with better health.

Read the full Health Value Evidence Quality Framework

Watch our recent webinar "Advancing Private Investment That Improves Health Care and Health"

Independent Leadership

Duke-Margolis brings to the Council its extensive experience in convening diverse stakeholder perspectives, rigorous academic expertise, technical guidance for creating evidence-based solutions, implementing reforms effectively, and supporting better public-private collaboration in health care—all from an independent perspective. The Council is an important extension of those Duke-Margolis capabilities. It also will provide a lively community to exchange and refine ideas to enhance and advance the positive impact of private investment in health care.

Capital Impact Council Leadership & Advisors

Capital Impact Council Members

For questions/inquiries related to the Capital Impact Council, please contact:

The Need

Private investment provides critical resources that enable existing and new health care organizations to provide access to better treatments, improve outcomes, increase affordability, and strengthen communities. However, there are real and understandable public concerns about private investment activities that potentially leverage payment and regulatory policies that are not working as intended and leaving critical and urgent health reform goals unrealized. To ensure that private investments are aligned with essential health care reform goals, urgent needs and growing opportunities exist to characterize and assess the measurable impact of private investments on individual and community health, alongside assessments of financial returns.

The Council

The Duke-Margolis CIC is comprised of mission-aligned venture capital and private equity investors and Duke-Margolis Advisory Board members. The Council is dedicated to:

• advancing use of evidence and establishing best practices for achieving measurable health value improvements through private investment in health care. 
• driving the impact of private investment in health care to improve the lives of people and communities.

CIC members draw on their extensive experience and collaborations to develop and disseminate: 

• Resources and tools to assess and evaluate investment returns for health, affordability, and community resilience alongside financial returns 
  • The Council’s initial resource is “Health Value Return on Investment: A Framework to Support Private Investment that Improves Health Care and Health”
• Promising opportunities to increase investments that are more likely to lead to measurable improvements in long-term health, sustainability, and healthier communities
• Further steps to extend this approach beyond the CIC and throughout the private investment community

Independent Leadership

Duke-Margolis brings to the Council its extensive experience in convening diverse stakeholder perspectives, rigorous academic expertise, technical guidance for creating evidence-based solutions, implementing reforms effectively, and supporting better public-private collaboration in health care—all from an independent perspective. The Council is an important extension of those Duke-Margolis capabilities. It also will provide a lively community to exchange and refine ideas to enhance and advance the positive impact of private investment in health care.

The Health Value-ROI Framework 

The HV-ROI framework includes two key elements:

• HV Model and Evidence: A baseline analysis of the positive impact of a proposed investment on health value as well as its potential financial ROI, based on published literature and preliminary evidence. 
• HV Key Performance Indicators: Feasible and worthwhile metrics linked to the model that will be tracked and updated, enabling an organization to be proactive in advancing health value alongside financial ROI.

“Health value” assessment is an essential and increasingly important part of evaluating an investment’s expected financial returns. Health value assessment approaches are not yet consistently, widely, and transparently applied. Better tools and supports for assessing an investment’s expected impact on health value could help make a health value-return on investment (HV-ROI) assessment a more integral feature of investment decisions. 

CIC members are private investors leveraging their individual commitment to drive broad-based health value through testing and sharing results in their own investment activities to improve transparency and share learnings.

CIC Case Studies: Private Investments Aligned with the HV-ROI Framework

These case studies demonstrate examples of how the key elements of the HV-ROI Framework, HV Model and Evidence as well as HV-KPIs, are already being implemented in private investments in health care. Provided by our 2024 Capital Impact Council members committed to adopting the HV-ROI Framework, these examples highlight the Capital Impact Council's aim to develop and share resources to support alignment in investor and health system incentives and advance the positive impacts of private investment in health care. 

Through sharing and developing case examples, tools, metrics and analyses, we aim to strengthen and expand the use of effective health value assessments to increase the positive impact of private capital investments for patients, health care professionals, communities, entrepreneurs and investors and advance a repeatable, evolving model for this work.