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Place Based Investing

social determinants of health graphic

Social Determinants of Health

The purpose of Intermountain’s Place Based Investments portfolio is to help people live the healthiest lives possible by supporting place-based initiatives that contribute to improved health and well-being. We accomplish this by providing flexible capital for projects that address the social determinants of health within Intermountain Health’s service area. The social determinants of health are the conditions in which people are born, grow, live, work, and age that shape health. They include factors like health behaviors, socioeconomic status, and physical environment. Addressing these conditions is important for improving health and reducing longstanding disparities. Together, health behaviors, socioeconomic status, and physical environment are a greater driver of health outcomes and life expectancy than clinical health treatment.

Intermountain’s Place Based Investments focus on a few key social determinants: housing stability, employment, and financial wellness. These social determinants were chosen based on independent research on needs in the Intermountain West and findings from Community Health Needs Assessments (CHNA). While investments that address any of the social determinants included in the graphic above may qualify, Intermountain is actively working to develop investment opportunities in these key areas.

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Guiding principles

Intermountain’s Place Based Investments are part of our commitment to “move upstream” by addressing community and environmental factors that contribute to health. The following guiding principles were developed to align these investments with Intermountain’s broader upstream strategy.

  • Impact one of our CHNA priority areas
  • Target improvements in the social determinants of health
  • Support local economic development
  • Target communities with low employment rates and low-income populations
  • Provide double-bottom-line returns as measured by financial and social impact metrics

Impact measurement

This type of investment requires the ability to measure and report on the social impact created by an investment. Intermountain uses a framework developed by the Impact Management Project to evaluate the relative effects of potential initiatives and to select reporting metrics at the investment and portfolio level. The Impact Management Project’s framework relies on five dimensions of impact that can be applied to any investment opportunity:

  1. What. Identifies the outcomes the enterprise is contributing to and how important those outcomes are to stakeholders.
  2. Who. Identifies the stakeholders who are experiencing the outcome and how underserved they were prior to the enterprise’s effect.
  3. How Much. Identifies how many stakeholders experienced the outcome, what degree of change they experienced, and the length of time the outcome lasts.
  4. Contribution. Identifies whether an enterprise’s and investor’s efforts resulted in outcomes that were likely better than what would have occurred otherwise.
  5. Risk. Identifies the likelihood that impact will be different than expected.

Organizations receiving investments are required to report metrics. Intermountain then rolls up metrics at the portfolio level to understand total impact. To facilitate the collection of standardized, credible, and comparable impact data, Intermountain Health utilizes the IRIS metrics developed by the Global Impact Investing Network in conjunction with the five dimensions of impact outlined above. These metrics are typically tied to a unit related to the specific social determinant of health addressed by the investment. Examples include number of affordable housing units built and number of jobs created. These metrics are chosen based on their research-based links to health outcomes.

Investment strategy

Intermountain’s Place Based Investments can be categorized into two strategies: intermediary investments and project-level real estate lending. The primary strategy is intermediary investing, which involves debt or equity investments in mission-first funds, community development financial institutions (CDFIs), and other place-based investment vehicles that allow Intermountain to partner with organizations that are aligned with our mission. Intermountain Health is actively pursuing opportunities with mission-aligned partners throughout our service area.

The secondary strategy is direct real estate lending. Direct lending allows for loan origination directly to qualifying organizations for the benefit of a specific project. This capability allows Intermountain to directly support highly-mission-aligned projects and to target very specific social impact outcomes. Available direct-loan products include acquisition and development, renovation, bridge, and semi-permanent financing for qualifying projects. Typically, these will be real estate loans secured by a lien position on real assets. These loans represent an overall small portion of the portfolio and may be reserved for projects that meet a geography- or population-specific need.

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