Local leaders engaged in data sharing collaborations often wrestle with how to develop viable financing mechanisms to sustain their momentum towards creating a Culture of Health. The 2016 ReThink Health Pulse Check Survey illuminated the fact that, unlike other sectors such as housing and community development, the population health sector overwhelmingly (89%) relies on grants as its main funding source.
Some communities are beginning to shift their mindset and seek out new financial flows that are more dependable and allow them to sustain their health initiatives over the long term. To explore some of these innovative sustainability strategies, All In: Data for Community Health hosted a webinar and a subsequent plenary session at the All In National Meeting, where experts discussed how they are working to generate reliable sources of ongoing revenue and build capacity to support community health transformation. This blog shares some of their advice for local collaborations looking to sustain themselves not only financially, but also organizationally.
1. Develop a Governance Structure that Supports Long-Term Sustainability
Presenters agreed that bringing leaders from diverse sectors together to set aside self-interests and agree on common priorities is essential for driving ongoing change across and within institutions and ultimately, advancing community health. Jane Erickson, MPA, MAIR, Project Director at Rethink Health Ventures, explained that effective stewardship is at the core of sustaining multi-sector partnerships, noting:
“Governance structures can be used to leverage sustainability. In a multi-sector partnership, set the expectation early on for resource sharing, whether it’s in-kind or monthly membership dues, so that you can meet your basic needs and focus on the actual meat of the work.”
She encouraged governance bodies to move beyond near-term operational and strategic planning and consider sustainability for the long-term (10-30 years out, which is a radical time horizon compared to the typical 3-5 year funding cycle). ReThink Health’s Stewardship Guide is a tool to help local leaders develop and sustain diverse financial stewardship.
2. Continuously Demonstrate the Value of Sharing Data to Partners
Several speakers emphasized the importance of clearly articulating how a collaboration delivers value to partners, which in turn, helps build trust, common understanding, and buy-in. Lindsey Alexander, MPP, Senior Project Director of Regional Financing & Investment at Rethink Health, said that many people think financing happens on a spreadsheet, but beyond the numbers, there is always a system of values. She explained:
“Financing happens in the numerous choices that are made day in and day out in community health partnerships. It’s in the alliances that they form. It’s in understanding the various business models at play and the constraints of others within the system. Behind all financing structures, there are values.”
Sustainable partnerships are focused not just on the numbers, but also on the change and values that they represent. Brad Weining, MBA, Director of Initiatives at Enterprise Community Partners, works to preserve affordable housing in Denver through a social impact bond initiative that conducts rigorous analyses to measure outcomes and cost savings. This research helps his team continue to make the value case to other sectors, streamline efforts, and create efficiencies that mutually benefit all entities involved.
Recognizing the inextricable link between housing and health, Weining hopes that continuing this research will foster alignment so that eventually, financing will become blurred across sectors. He commented:
“Ultimately, we won’t need complicated rigorous structures because the city will understand this is a better model and will figure out ways to fund things upfront because they know it saves them money and allows them to recycle capital into new projects, interventions, and models.”
3. Map Potential Strategies and Their Outcomes
A common financing challenge mentioned by speakers is that various entities within a community often make spending decisions in silos without realizing the ripple effects in the broader system. Although community health leaders lack control over all the financial flows in their system, they can exert their influence to build political will and better align resources around a common goal.
Erickson said one way to bring community stakeholders on board is to map out the entire “health ecosystem” to understand the downstream effects of investments, including how they will save lives, reduce costs, improve quality, or boost productivity. ReThink Health developed a tool for this called the ReThink Health Dynamics Model which simulates how various investment strategies will likely unfold in a community.
Anna Brewster, MS, Program Director at MD Anderson Cancer Center, took this approach in her community by developing a sustainability plan in the early stages of the Harris County BUILD Health Partnership, which is developing a community-supported food system in Pasadena, TX. From the start, the partnership looked at how to move beyond grants by mapping the impacts of potential governance structures and funding streams and outlining recommendations for strengthening sustainability.
4. Build Organizational Capacity to Achieve Your Mission
Maribel Cifuentes, BSN, Senior Program Officer at the Colorado Health Foundation, shared the Foundation’s approach to sustainability, which focuses on building organizational capacity of their local partners throughout Colorado. She encouraged organizations to think creatively about how to include capacity building in grant proposals to ensure their business model is resilient and can withstand transitions and environmental changes.
The Foundation supports activities that improve an organization’s ability to deliver its mission, such as optimizing communications strategies, developing leadership competencies, and improving business acumen. Cifuentes explained:
“We define capacity building as whatever is needed to bring a nonprofit to the next level of operational, programmatic, financial, or organizational maturity. It’s more than a one-time effort—it’s a continuous improvement strategy that leads the organization to deliver and sustain their work.”
5. Use Your Expertise to Generate Unrestricted Revenues
Kate Kohn-Parrott, MBA, President and CEO of the Greater Detroit Area Health Council (GDAHC), a grantee of the Community Health Peer Learning Program, noted the need for collaborations to prioritize sustainability strategies at launch so they’ll be positioned to continue generating revenue when circumstances change and grant-funded projects lose momentum when funding ends.
GDAHC has found ways to leverage their expertise to develop sustainable revenue streams. For example, as a collective impact collaborative, GDAHC is well positioned to collect member dues with the expectation that they will deliver value to their member organizations by helping attract funding and deliver a return on investment. In addition, through GDAHC’s Michigan Patient Experience of Care Initiative, providers and health plans pay them to conduct patient experience of care surveys to help improve health care delivery and close gaps in service. Kohn-Parrott commented:
“We’re doing something that’s really in our comfort zone, but at the same time we’re able to generate unrestricted revenues, which I personally feel is the key to sustainability.”