Apply the Whole River Paradigm to Mission-Aligned Investing in 4 Steps
This article also is published on LinkedIn
Over the past year, we’ve continued to advance the Whole River Paradigm - an approach introduced by Multiplier Advisors to help health impact investors deploy all of their assets to improve health outcomes.
The core idea is simple: improving health and wellbeing requires action across the Whole River. That means investing a range of internal assets upstream in the social drivers of health, midstream in community and population health solutions, and downstream in clinical care. Historically, most healthcare and philanthropic investment has focused on midstream and downstream interventions, even though many drivers of health originate upstream.
The Whole River Paradigm is a multicapital approach that encourages health investors to think differently about how they deploy capital and influence.
For health systems, it means aligning assets such as operating reserves, real estate, workforce strategies, procurement, advocacy, and operational investments in population health, community health, and clinical care toward their health mission.
For healthcare conversion foundations and other health-focused philanthropies, it means activating the full balance sheet—not just grantmaking, but also endowment investments—to advance mission.
As a national consultant working with health systems, foundations, and other health investors across the country, we implement the paradigm through four practical steps:
Assess: Understand how your current assets and investments influence upstream, midstream, and downstream health outcomes.
Align: Align internal assets and resources to ensure the organization’s vision and health goals can be achieved.
Prioritize: Determine which assets, strategies, and opportunities will be prioritized to advance those goals.
Implement: Set up the right management and governance strategies to deploy capital, lean into partnerships, and operationalize the work to activate those priorities.
Health investors collectively steward hundreds of billions of dollars in capital and institutional assets. When those assets are aligned across the Whole River, they can strengthen institutional sustainability while improving community health and wellbeing (Multiplier likes to use the Vital Conditions Framework for Health and Wellbeing as an impact framework).
Multiplier’s Whole River IMPACT cohort with health foundations is bearing out this point, and we’re excited to continue working with partners across the country to put the Whole River Paradigm into practice.