Capital Impact Council: 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.