NASDOH’s mission is to seek material improvement in the health of individuals and communities and, through multi-sector partnerships within the national system of health, advance holistic, value-based, person-centered health care that can successfully impact the social determinants of health. Below we identify important examples from our partners and members of multi-sector partnerships within communities across the nation. Please refer to our resources page where you can read more about the tools available to support multi-sector partnerships. We encourage you to check back as we regularly update this page with new and emerging examples.
The California Accountable Communities for Health Initiative (CACHI) is developing Wellness Funds as an important component of Accountable Community for Health (ACH) multi-sector collaboratives. These Wellness Funds operate by pooling and aligning a variety of resources and develop financial management capacity to allow for innovation and infrastructure building. They are intended to support the goals and vision of each site, including supporting backbone organizations. CACHI recently published an issue brief that highlights early insights on their work to develop Wellness Funds including components of governance, funding sources, administrative models, and key capacities. In addition, the brief lays out important recommendations for policymakers and funder’s including:
The BUILD Health Challenge focuses on multisector, community-driven partnerships to reduce health disparities caused by social inequity. The Healthy Homes Des Moines (HHDSM) initiative worked on reducing pediatric asthma-related hospital visits through improving social, economic, and environmental factors with the greatest impact on asthma. The goal of the initiative was to improve housing, health education, and indoor air quality, while promoting self-care and lifestyle changes. The approach included a four-step process beginning with referrals by examining patient and housing data. Referrals were made by hospitals, emergency rooms, clinics, and school nurses’ offices. Next, a home inspector identified asthma triggers in each child’s home which was followed by contractors making home repairs. Finally, community health workers conducted education programs for participants on how to control asthma symptoms.
HHDSM experienced a handful of successes including the development of a robust, integrated partnership between fifteen partners including the Polk County Housing Trust Fund, three competing nonprofit hospitals, the local health department and school district, and several community organizations and a comprehensive, online data system providing health care providers a method of referring patients. One key of HHDSM’s success was the ability to integrate data throughout the program. The overall referral process was critical and allowed physicians and hospitals to make direct referrals and track patients’ clinical and nonclinical services received through the home intervention, as well as allowing access to data for all partners. Overall, shared data was used to unify all partners involved, to inform and develop the initiative activities, and to measure project impact on return on investment (ROI). The initiative provided 62 families in-home asthma education, 42 homes were repaired including $150,000 worth of repairs, 38 families completed all intervention steps, $17,000 in supplies were given to families, and 6.2 more asthma-free days per month for children was achieved.
The Michigan Health Improvement Alliance (MiHIA), a multi-stakeholder, multi-sector collaborative was established in 2007 to improve the health and well-being of people in a 14-county area of central Michigan. MiHIA is an integrator or “backbone” organization and fulfills the vital functions of guiding strategy, facilitating aligned efforts, supporting shared measurement, advancing policy and mobilizing resources for sustainable systems change. planning. Through their partnership in THRIVE (Transforming Health Regionally in a Vibrant Economy), MiHIA and the Great Lakes Bay Regional Alliance (GLBRA) along with many community organizations, work to address root causes of complex problems in order to advance population health and economic success. Established in 2017 from this shared insight of the need for significant change, THRIVE creates the environment for collaboration across sectors and among stakeholders in order to support positive community outcomes.
Previously, the counties served by MIHIA were facing barriers similar to many other communities across the country. For years, well-designed efforts by numerous individuals and organizations had been active in the region. Despite this ongoing work, a ten-year trajectory showed a disappointing array of deteriorating health metrics, population decline and concerning economic metrics such as an increase in the ALICE (Asset Limited, Income Constrained, Employed) population in the Great Lakes Bay Region.
The THRIVE initiative was designed to overcome the common barrier of increasing positive efforts that lacked the ability or funds to create scale to fully address the population needs, and important community efforts which were struggling for sustainability. Further, the opportunity for a stronger united front and innovation were clear. Among the innovations was the plan to harness and deploy a broad set of funding and financing sources to allow larger scale and create sustainable initiatives to change the arc of both health and economic success measures to a positive direction.
With moving the needle in the right direction in mind, THRIVE’s five priority areas were identified with the help of many community leaders across multiple sectors. A set of actions were developed which went through detailed analysis and testing via computer simulation to project future outcomes to arrive at the final group of interventions.
THRIVE’s five strategic priorities are designed for community advancement through the following focus areas:
The THRIVE Portfolio of 30+ interventions in the five priority areas represents a well-balanced action plan designed to advance health, well-being, and community prosperity when implemented fully through four phases to keep efforts manageable.
At the outset core principles were established which included transparency, inclusive approaches, data-informed practice, outcome-focused goals and clear emphasis on transformation to change the trajectory on health and economic measures.
An effort as broad and big-thinking as THRIVE challenged all those involved to balance planning and strategy work with the sense of urgency and need for action. In reality, some actions started while planning was still underway. THRIVE’s simulation modeling exercises illustrated the imperative for scale and the balanced portfolio to achieve outcomes. In building a balanced portfolio, there was attention on short term impact and investment in long-arc-of-change areas like early childhood. Balance was also important in clinical and non-clinical areas as well as actions which were individual in nature versus placemaking and population-wide items. MiHIA maintains focus on active portfolio management, seizing new opportunities relevant to the work and building capacity.
MiHIA began implementation of Phase 1 of the THRIVE Portfolio in 2019, rolling out a series of eight interventions including efforts around patient safety, mental health, an opioid strategy, perinatal/ maternal/ infant health and more. As part of this effort, the region’s health systems signed a Zero Harm statement, an action taken by only 10 percent of health systems. Significant work around patient safety and a large-scale medication safety project are underway. Additional Phase 1 progress includes an increase of 26 additional Medication Assisted Treatment (MAT) providers trained and more rural Buprenorphine providers, and an increase of 112 mental health providers with the help of regional partners in 2019. A population of over 300 women (58% minority) participated in the Centering Pregnancy approach to prenatal care. Results compared to pregnant women not in the program included higher rates of initiating breastfeeding (51% vs 45%), higher rates of delivering after 38 weeks (78% vs 72%), lower rate of C-section delivery (27% vs 31%), reduced NICU admissions (18% vs 21%), and more women reducing or quitting tobacco usage (38% vs 30%).
The organization also helped launch a microbiome analytics and therapeutic food approach for diabetics, one of the first two test communities in the U.S.
Phase 2 was implemented in mid-2020, with a focus on addressing education challenges and preparing youth for STEM career fields, increasing the access and quality of food, addressing financial stability and strengthening primary care and care coordination models.
Moving forward, MiHIA is continuing to progress on implementation of THRIVE’s Phase 1 and Phase 2 interventions with attention focused on impact and outcomes. The organization is also in the planning stages of bringing the entire portfolio to life with the eventual activation of both Phase 3 and 4 interventions. The THRIVE scorecard will be finalized and baseline metrics publicly available on the website along with comprehensive project trackers. Efforts in policy and community engagement are maturing. The THRIVE funding and financing system capabilities are being built and tested with prototype projects.
RWJBarnabas Health’s leadership is at the forefront of ensuring a movement from merely implementing basic community-level involvement and benefit projects to implementing policies, procedures, structures, and resources that drive positive social change as a core component to its system operations. The health system incorporates public policy efforts to encourage healthy communities and continuous evaluation to track and measure change. Through this method, leaders can plan and determine future opportunities for collaboration with many government and community stakeholders in order to achieve a more equitable future for all. RWJBarnabas Health has recently focused on food security initiatives including the Beth Greenhouse and Farmers Market and the Newark Food Security Project.
The Beth Greenhouse and Farmers Market
Healthy communities are food secure. People have opportunities to make healthier food choices if communities produce, rather than import, their own food and have more local food distribution centers (farm and retail).
Food for Thought Documentary
The Newark Food Security Project is an initiative aimed at identifying opportunities to enhance, and create greater access to, Newark’s healthy food supply. The project is a collaborative initiative being spearheaded by Newark Beth Israel Medical Center, the Greater Newark Community Advisory Board, and partner community-based organizations. Food for Thought: The Path to Food Security in Newark, NJ is a documentary that was created in 2017 by young adults (ages 12 to 21) from Newark area schools and community-based partner organizations. 23 youth were trained as citizen journalists to chronicle the spectrum of food resources and food availability in the city.
In October of 2020, the Episcopal Health Foundation launched the Texas Accountable Communities for Health Initiative (TACHI). TACHI is a multi-year initiative designed to provide grant funding, technical assistance, and strategic learning to a cohort of six community-based coalitions in Texas for them to become high-functioning and sustainable multi-sector collaboratives. These six TACHI collaboratives will be driven by a common vision and shared accountability around how to collectively address critical social determinant of health needs in their community with an emphasis on health equity and sustainability. TACHI is being managed by the Parkland Center for Clinical Innovation (PCCI) and independently evaluated by the Georgia Health Policy Center (GHPC).
Despite the importance of addressing SDOH to improving health, unique challenges exist in Texas for upstream SDOH work. These challenges include funding streams being siloed and short-term in nature, individual organizations having competing priorities, data systems being disconnected, equity not being embedded in health policy and practice, and the lack of authentic engagement of communities and stakeholders. Thus, EHF designed TACHI with a focus on providing funding and supports to help collaboratives develop the capacities and skills to overcome these common barriers. In the short-term we hope TACHI will build capacity and competency in the following core domains: 1) shared vision and goals, 2) leadership and governance, 3) data analytics and sharing capacity, 4) community engagement, 5) equity, 6) portfolio of interventions, and 7) sustainable financing. EHF’s long-term goal is that each collaborative will develop sustainable strategies to support their community health interventions as well as be able to track improvements in health outcomes, reductions in unmet social needs, and reductions in disparities.
TACHI is still in the very early stages and it does not yet have measurable outcomes. The only learnings thus far are related to the readiness assessment conducted at the beginning of the initiative to establish a baseline as well as determine technical assistance needs. The readiness assessment demonstrated the ACH sites are diverse in their readiness and capacity needs, which requires creativity about how to create a cohesive learning cohort that is also attuned to the diverse needs of the various grantees. The advice for other funders is to create an authentic partnership with grantees that provides them a sense of ownership over the work and recognize there will be no one-size-fits-all solution for the various collaboratives.
The initiative launched in October 2020 and is currently in the initial 15-month planning and learning phase which is scheduled to end in December of 2021 and will then transition into implementation. The focus now is ensuring the work progresses forward in the way that sets up grantee partners for success. If you have any questions regarding the TACHI initiative please reach to Robiel Abraha at the Episcopal Health Foundation at [email protected].