Impact Investing
and Health
NEW YORK
641 Avenue of the Americas, 3rd Floor
NewYork, NY
P: 415.982.5045 | www.imprintcap.com
SAN FRANCISCO
353 Sacramento Street, Suite 740
San Francisco, CA 94111
P: 415.982.5045 | www.imprintcap.com
Disclaimer.
This report has been prepared by Imprint Capital Advisors (“Imprint”) based upon the information provided to Imprint by the
firms described herein, as well as from public sources that Imprint believes to be reliable, but such information has not been
independently verified by Imprint. Imprint makes no representation or warranty, express or implied, as to the fairness, accuracy,
completeness or correctness of such information, nor does Imprint accept any liability arising from its use or for any analysis or
assessment derived therefrom. This report is not intended to constitute an offer of securities of any of the firms that are
described in the report. When applicable, investors should completely review all of a firm’s offering materials before considering
an investment in a firm.
Investment advisory services are provided by Imprint Capital, a SEC registered investment advisor. Advisory services are subject
to advisory fees as disclosed on Form ADV. Past performance may not be indicative of future results. Therefore, no current or
prospective client should assume that future performance of any specific investment, investment strategy (including the
investments and/or investment strategies recommended or undertaken by Imprint Capital) or product made reference to directly
or indirectly by Imprint Capital, will be profitable or equal the corresponding indicated performance level(s) shown. Different
types of investments involve varying degrees of risk, and there can be no assurance that any specific investment will either be
suitable or profitable for a client or prospective client's investment portfolio.
The clients in this case study have been selected as representative institutions and individuals engaged in impact investments,
inclusion was not based on performance criteria. The clients do not endorse Imprint Capital Advisors, LLC or any of its affiliates or
of any service provided by the Investment Adviser or any of its affiliates.
The companies, advisors and any securities identified and described herein do not represent all of all companies, advisors or
securities purchased, sold or recommended for client accounts. The reader should not assume that an investment in the
companies or securities identified was or will be profitable. Past performance of third party advisers and securities may not be
indicative of future results.
2
Agenda
I. A bit about me, a bit about you
II. Understanding and navigating the alphabet soup
III. Increasingly diverse set of allies – an illustration
IV. How to get started
V. Your questions (and maybe even some answers)
3
Introductions
□ Me/Imprint – why am I here?
□ You – why are you here?
4
Navigating the Alphabet Soup
Sustainable
investing
Environment,
social and
governance
(ESG)
Social
venture
investing
Ethical
investing
Values
investing
Socially responsible investing (SRI): “Investments
designed to avoid or mitigate negative social and
environmental impacts”
Impact investing: “Investment activity designed to
have a positive impact on social or environmental
issues”
Mission
investing
Venture
philanthropy
Blended
value
Mission-related
investing
Program related
investing
Double/triple
bottom line
5
Sifting through the diversity
Why: Motivations
What: Priority issues
Basic taxonomy of approaches
6
Different rationales for impact investing
Use more
resources for
impact
Use the right
resources for
impact
Values alignment
Impact
investing
Find, support,
and learn about
enterprise
models for
impact
7
RANGE OF SEGMENTS
HEALTH
CARE
WELLNESS
SOCIAL
DETERMINANTS
OF HEALTH
•
•
•
•
Healthcare delivery
IT and admin
Supplying care (drugs, devices & diagnostics)
Organizing and optimizing care
• Food and nutrition
• Fitness
• Wellcare
• Family economic security
• Community infrastructure
• Environmental health
8
SOCIAL DETERMINANTS
ENVIRONMENTAL HEALTH
Workplace
Safety
Green
Products
Air
Quality
Green Built
Environment
Career
Ladders
TransitOriented
Development
HEALTH CARE
Childcare
Small
Business
Support
Public
Transportation
WELLNESS
Safe
Sidewalks
& Trails
Inclusive
Insurance
Access to
Financial
Services
FAMILY
ECONOMIC
SECURITY
Affordable
Housing
Social
Services
Community
Facilities
COMMUNITY
INFRASTRUCTURE
WELLNESS
FITNESS
Play-space
Fitness &
Recreation
Centers
School
PhysEd
School
Food
Baby
Foods
FOOD &
NUTRITION
Urban
Farming
Local Food
Infrastructure
HEALTH
CARE
Exer-gaming
Mobile
Fitness
Apps
Community
Groceries
Mobile
Food Apps
Virtual
Coaching
Remote
Monitoring
Health
Media
DirecttoPatient
Outreac
h
“WELLCARE”
Peer
Groups
Employer
Wellness
Programs
10
HEALTHCARE
Scheduling &
Back-Office
HIEs
Billing &
Payment
EMRs
Healthcare
Workforce
IT & ADMIN
Resource
Allocation
Simulations
& Gaming
Mobile
Diagnostics
DRUGS,
DEVICES &
DIAGNOSTICS
Drug Compliance
& Delivery
Dental
Care
Workforce
Optimization
Self-Health
Low-Cost
D,D&D
ORGANIZING
& OPTIMIZING
DecisionSupport
Risk &
Data
Analysis
DELIVERY
OF CARE
Home
Care
Kiosks
Case & Care
Management
Mobile
Vans
FQHCs &
Safety Net
Clinics
Hospitals &
Med Centers
Specialty
Clinics
Retail
Clinics
Telemedicine
11
Impact on Risk & Return?
There is significant theology on both sides of this question
Negative
Positive

A limited universe intrinsically
reduces return expectations

Environmental & social drivers
are material to business

New field and managers
equals more risk

Growing market opportunities
(e.g. Clean Tech)

You cannot effectively manage
to multiple bottom lines

Can reduce risk (see BP) and is a
sign of strong management
12
Risk/Return: Impact vs. Non Impact Managers
13
Screening Statistics
Negative Screens - eliminate companies involved in:
Tobacco
Weapons and Firearms
‘Filthy Fifteen’
All Carbon
Estimated
Estimated Tracking Incremental Risk (%)
Error (%)*
(Standard Deviation)*
0.50
0.01
0.41
0.00
0.12
0.00
0.60
0.01
Positive Screens - emphasize companies with better:
Environmental Record
Corporate Governance
0.85
0.85
0.02
0.02
Environmental Revenue
20%
30%
40%
50%
1.00
1.37
1.82
2.58
0.02
0.05
0.08
0.17
14
Mix of approaches
Enterprise
Community
Engagement
15
Portfolio example
Enterprise
Community
Engagement
16
Allies – conventional and otherwise
□Other people in this room!
□Community foundations
□Strategics/corporates
□Jobs and community oriented funders
17
Healthcare as employment engine:
by the numbers
Why healthcare? ‘Cause that’s where the jobs are…
Today:
2020:
16.8M jobs, in 784k companies
+5.7M jobs (half
from growth, half age-out replacement)
Growth segments: ACO’s, managed care, home health, residential
Size of growth:
1.3M home aides, .5M orderlies & clerks, .7M nurses
Median wages:
$20-30k / year; nurses $65k / year
18
Three tiers of healthcare business models:
Seeking non-fungibility of labor
Better jobs = better health = better business
+1
0
-1
Neutral models
Negative models – abusive to labor
19
Business models as driver of health (or not!)
Cost
Good Jobs
Profit
Quality
20
Now that they’re sorted, what to do?
Investing approaches by tier
Better jobs = better health = better business
+1
0
1. Develop and scale aligned models for direct impact and demonstration
2. Build market share - Support broader transition to aligned models
Neutral models
1. Develop clearer ways to identify better practitioners
2. Build business case for better practice
3. Develop levers to support better practice
1. Avoid – screen out
2. Shine spotlight on negative practice
3. Identify “better” version of presumed abusive models
-1
Abusive models
21
Where/how people get stuck
• Actively stuck: Stakeholder divergence
– “Theology” of returns for SRI [negligible financial impact]
– Concern about competing with grant-making
– Questions about deal flow
• Passively stuck
– Overwhelmed/challenge identifying entry point
– Question of “how” – sourcing, execution and
management
22
Learnings and observations
What to do
How you do it
How you get
started
• Diversity of ways to use investments to drive impact
• Context matters – your organization and your goals should drive
many of the tools and approaches
• Be proactive in the marketplace – drives good practice and
multiple returns
• Use or build your strengths – knowledge, networks and capacity
you have or want to build
• Seek, manage and measure what matters – thesis driven approach
• Don’t create disincentives
• Importance of internal leadership
• Action learning – avoid abstract debates
• Be smart about leveraging partners – intermediaries, peer
organizations and other allies
23
Creating a program: Getting to an
investment policy statement
Mission
Objectives
Identify target areas and role of investment capital – key impact driver?
Complement philanthropy? Support interests more broadly?
Financial
Parameters
Integrate with financial management – current assets, anticipated
expenditures/inflows, liquidity needs, and risk tolerances
Context
Investment
Policy
Determine the level and nature of involvement of various stakeholders;
interests, biases, priorities and concerns
Objectives
Allocations (targets and bands/limits)
Investment process
Decision-making and governance
Financial and mission reporting
24
Observations
• The context drives the right approach – there is no
one size fits all approach
• Thoughtful, deliberate execution is critical to success
of any mission investing program
• Finding a clear entry point is critical – you can’t
answer all of the questions on the drawing board
• Leveraging/intersecting with existing strong processes
can be important
• Investing is investing – it is difficult to do well and
takes discipline and care
25