MDLF Class Day Reflection: Health Policy, Innovation, and Social Determinants of Health
Kiley M. Wanecke, MHA, is Director of Health Impact at IU Health, where she leads state-wide initiatives focused on social determinants of health, maternal and infant health and community partnerships. Her work centers on designing scalable, data-driven strategies that improve health outcomes while advancing access and dignity in care delivery.
During our MDLF class day, the Healthy Indiana Plan (HIP) case study challenged me to rethink how public programs can balance fiscal stewardship with human dignity, especially in a state as politically diverse as Indiana. As leaders, we often frame healthcare policy as a tradeoff between cost control and compassion. HIP offered a different lens: one that sought to preserve individual agency, encourage engagement and thoughtful participation, acknowledging multiple valid approaches and design a Medicaid program grounded in shared contribution.
A central theme of the discussion was the philosophy championed by Pat Rooney of Golden Rule, which emphasized empowering individuals to make their own healthcare decisions. This approach explored alternative approaches to Medicaid design, recognizing the diversity of perspectives and that when services are entirely free, individuals may either overuse care or disengage altogether. HIP was intentionally designed to encourage thoughtful participation by giving individuals control over designated healthcare funds and autonomy to decide how best to support their health and wellness.
The case study highlighted how leaders such as Governor Mitch Daniels sought to preserve two core ideologies in the development of HIP: managing healthcare costs responsibly while honoring the dignity of individuals. The program aimed to foster a sense of ownership and contribution, an approach that required leaders to navigate political constraints, public perception and competing philosophies. The case study highlighted HIP’s bipartisan origins and the collaboration required to advance it in a state that once had one of the most restrictive Medicaid programs in the country.
Beyond policy design, our discussion expanded to Indiana’s broader healthcare ecosystem. Panelists highlighted advancements in data, analytics, and health information exchange, including Indiana’s long-standing partnership with Regenstrief Institute and its position as the nation’s largest and oldest health information exchange. These system-level assets present meaningful opportunities to improve population health, scale innovation and position Indiana as a national leader in healthcare research and biotechnology.
The day concluded with a focus on social determinants of health and the work of the Eskenazi Foundation, which set the stage for a group project centered on improving healthcare access. The winning internal group identified transportation as a critical lever to increase access to care and explored how federal and national grant funding could support sustainable, community-based solutions. This exercise reinforced that non-medical factors, such as transportation, housing, and education, are not peripheral to health outcomes, but foundational to them.
Leadership Takeaways
Design for dignity and agency.
HIP 2.0 demonstrated that it is possible to manage healthcare costs without stripping individuals of agency. This reinforces the importance of designing Medicaid-facing and SDOH programs that promote choice, contribution, and respect, particularly when serving vulnerable populations. There are multiple valid approaches to achieving these goals, and the case study explored one model among many.
Empower engagement, not just access.
The Golden Rule philosophy underscored that access alone does not guarantee appropriate or sustained use of services. This insight translates directly to initiatives that prioritize engagement and follow-through, such as closed-loop referrals, navigation support and patient-centered workflows that encourage informed decision-making. Recognizing the diversity of perspectives on how best to foster engagement is essential.
Build bipartisan and cross-sector coalitions for durable change.
HIP’s success as a bipartisan initiative illustrates that sustainable health policy requires alignment across government, healthcare, philanthropy, and community partners, even when philosophies differ. Durable solutions depend on shared outcomes, not ideological purity. The case study highlighted the importance of openness to diverse perspectives and collaboration.
Leverage state assets to scale population health impact.
Indiana’s data infrastructure and health information exchange demonstrate how system-level assets can accelerate innovation. This reinforces the value of using data and technology to measure outcomes, identify gaps and scale effective interventions, regardless of the policy model chosen.
Treat social drivers as core health strategy.
The focus on transportation and rural access reinforced that social drivers of health are central to outcomes. Investments in SDOH screening, community partnerships, and targeted access solutions are essential components of comprehensive health strategy, not ancillary efforts. Effective health policy recognizes the value of diverse approaches to addressing these drivers.
Ultimately, the class day reinforced that Indiana’s future will be shaped by leaders willing to hold compassion and accountability at the same time. Sustainable policy solutions are rarely about choosing one over the other; they are about designing systems that respect individual agency while demanding stewardship and shared responsibility. If Indiana is to improve health outcomes and opportunity for all Hoosiers, it will require openness to differing perspectives, principled leadership, cross-sector collaboration, and a willingness to challenge simplistic narratives in service of the common good.