CDC's Health Protection Game

What must be done to improve the troubled U.S. health system? Different stakeholders have different ideas about what it will take to transform the current system and position America as the healthiest nation in a healthier world. Sorting through the options is challenging because many modifiable aspects of the health system, such as the extent of insurance coverage, the quality of healthcare, workforce capacity, efforts to prevent disease and dozens of other factors are often considered separately rather than as part of a large dynamic enterprise.

This is where the Health Protection Game comes into play. Grounded in an evidence-based computer simulation model, developed by Bobby Milstein (coordinator of CDC's Syndemics Prevention Network), and two veteran system dynamics consultants, Jack Homer and Gary Hirsch, the game allows players to see and feel what various interventions could accomplish. Players may tailor their strategies using more than a dozen intervention options, and then explore the consequences over a simulated 25-year period.

Behind the scenes lies a mathematical model, with a transparent causal structure and several hundred interacting elements, which anchors the game to empirical data and insights from the research literature. The game is not intended to yield precise forecasts, but rather to support experiential learning about how the health system functions and, more importantly, to inspire effective action in the real world. It is meant to be used in multi-stakeholder groups, with a trained facilitator, to support visioning, strategy design and leadership development.

How do you "win" at the Health Protection Game? The most basic victory is to record high scores evenly across four goals: (1) save lives, (2) improve well being, (3) achieve health equity, and (4) lower healthcare cost per capita. Those goals are difficult to achieve, in part, because of inherent tensions among them; for example, many strategies may improve access to care or quality of care, but at a greater cost and with worsening inequities.

Beyond the satisfaction of posting high scores is the prospect of discovering why and how our complicated health system behaves the way it does. CDC's Health Protection Game offers a more comprehensive and neutral framework in which advocates of different transformation strategies can come together, test their proposals, identify potential shortcomings and work together to craft a package of interventions that cuts through the current clutter and inertia to reveal a practical way forward.

The Health Protection Game is a work-in-progress, currently being refined with input from early adopters and peer reviewers. It will soon be available for use by CDC staff and stakeholders across the country. Those interested in convening a game-play session or in becoming a certified facilitator should send an e-mail to BMilstein@cdc.gov.