Examples of Multisector, Community-Based Partnerships

There is ample evidence that multisector, community-based partnerships can have substantial success in addressing individual and community-level health and social needs by aligning health and social interventions prioritized by the community. Over time, these partnerships can create lasting systems change, improving the success of both public and private sector efforts to enhance a community’s health and wellbeing.

An example of this type of partnership is the Accountable Community for Health (ACH). ACHs are multisector partnerships that bring together healthcare, public health, social services, community-based organizations, and other local partners to develop shared goals, prioritized by the community they serve, and implement community interventions to address those goals.

Below, HCV partners Karen Smith and Meg Taylor share some of their extensive knowledge of and experience with ACH models.

  • CACHI and ACHs Pilot. Karen Smith describes the CACHI ACH model, the importance of a supporting infrastructure, and key learnings that could enhance ACHs and other multisector, community-based partnerships.
  • Pierce County ACH. Meg Taylor’s unique approach to developing this ACH—building infrastructure and assets sustainable beyond a five-year funding period – is the foundation for HCV’s approach to working with community collaboratives.

CACHI and ACHs Pilot

Karen Smith, Chief Health Officer, California Department of Public Health, 2013–2019

Accountable Communities of Health (ACH) is a community organization in which key individuals from across sectors, such as government, education, healthcare, nonprofit sector, come together. They are usually large, relatively stable collaboratives based in that community, and have authentic community voice and leadership. It’s not just the usual suspects; you have to engage the community as well. The concept is that ACHs improve health and wellbeing in the long term. It’s a model that has been shown to work well.

CACHI, The California Accountable Communities for Health Initiative, was a 5-year proof of the ACH concept. Seven California philanthropies pooled money to fund the Initiative. The California Department of Public Health provided some funding for evaluation and data systems development.

Thirteen communities around the State have ACHs, and each community is different. Humboldt County is working on substance abuse, for example, while East San Jose is working on violence prevention. Other ACHs have an explicit focus on improving health outcomes more directly. The priorities, objectives and partners vary, but they all follow a similar model, in terms of key structural elements.

The CACHI ACH model incorporates seven key elements that each community brings into its ACH[1]:

  • Shared vision and goals based on a common understanding of issues facing the community and embedding equity, diversity, and inclusion as core principles
  • Governance, cross-sector partnerships, and distributed leadership for meaningful collaborations
  • Community and resident engagement in shaping the direction and work of the ACH
  • A backbone entity that serves as the facilitator and convener (ideally with 1+ FTE staff)
  • A portfolio of interventions (POI); a set of coherent, mutually reinforcing interventions that address the shared goals
  • A wellness Fund and sustainability plan to support the infrastructure, priorities and activities of the ACH
  • Data analytics and sharing capacity for using data to set direction, monitor, and communicate progress towards goals

CACHI itself currently provides some funding to each collaborative to support a staff person who ensures collaboratives will continue to meet. It doesn’t fully fund the interventions they are doing, but funds the stable partnerships as well as some evaluation of the partnerships.

CACHI staff is a small group with technical assistance (TA) expertise. They provide TA on all aspects of developing and running an ACH; they also evaluate the overall model based on the ACHs’ outcomes. The primary goal for the money from the philanthropies was to create that infrastructure. CACHI is soon coming to the end of the five-year proof of concept period.

No individual ACH was able to solve the ‘how do we become financially sustainable’ challenge, nor solve the issue of data collection and infrastructure and how to do comprehensive evaluation of this kind of collaborative effort. To evaluate the full impact on a community, evaluating a single intervention misses the overall value communities receive from the collaboration and the entire portfolio of interventions. There is also great community benefit in simply coming together across typical silos to work in new ways and through new partnerships.

As a next step, the CACHI central infrastructure is looking to transform from a TA/grant funding provider into an ongoing, sustainable central hub that will not just provide TA but will also help additional communities launch ACHs, and develop—centrally—those aspects of sustainability that individual ACHs can’t do themselves. This will likely include creating a fund, in order to provide a funding structure at the central level. This infrastructure will also include evaluation and data systems support.

What’s important about the CACHI model is the creation of a central structure that provides services that the individual communities themselves cannot do in a sustainable way because it’s just too expensive. Yet, under this model, each community still decides what its priorities are and aligned around improving the overall wellbeing of the community while leveraging their local resources through the ACH.

[1] Based on the 2021 CACHI interim evaluation brief by Desert Vista Consulting https://cachi.org/uploads/resources/CACHI-Evaluation-Brief_-2016-19-Final_2-5.pdf

Pierce County ACH

Meg Taylor, COO and CFO, 2017–2019

The 2017 Washington state Medicaid-funded waiver supported the building of nine regionally-based Accountable Communities of Health (ACH). The concept was initially developed via CMMI grants that led to development of community backbone organizations, typically based in local public health departments. They had space and limited grant funding to explore innovations, mostly in health access, equity, and rural health. The waiver brought in federal Medicaid matching dollars targeted for piloting and evaluating health innovation projects in the nine regional communities. Each of the ACH’s received incentive dollars which could be earned and used over five years to design and build systems for improving community health. When Pierce County ACH (Tacoma, WA) was launched in January 2017, I was brought in as the Chief Operating Officer and CFO.

From the outset, we took a unique approach to building our ACH. Key to our strategy was viewing the waiver dollars as seed capital that would allow the community to build structures and assets that would sustain beyond the five-year period. We were looking for more than just alignment with the Healthier Washington priorities—our goal was to embed those priorities long-term into Pierce County’s social fabric. Improved health was a foundational value for our community, and we wanted to make sure that outcome was shared equitably by all. We organized our work around the core principle that healthy, vibrant people and communities are better able to achieve their full potential, and that better health for all is the cornerstone of community vitality.

To achieve this, we realized we needed to create a central entity that could be not only a convener of partners and stakeholders, but act as the connective tissue for the innovations being piloted. Governmental public health departments were not the ideal places to bring together all of the partners necessary for long-term success while keeping the community voice at the core.

So we took our seed capital and designed a business plan around it. We brought the community together from the beginning to create the governance for this kind of work and to build in authentic community voice, so that any innovations or initiatives really were launched from community-identified needs and priorities. We built around that.

While building a structure that would support projects, this was not a program-driven design. Rather, we were looking to create the enabling structures that would allow new programs and existing successes already occurring in the community to be made more sustainable, have a home and easily partner and share across sectors. We believed the ACH could provide integration of data, technical support, advocacy, convening – being that broker of partnerships – and also provide some of the expensive and high-capacity functions that individual programs or CBOs can’t all afford to create themselves.

Key to our vision was creating something that would sustain beyond the five-year period where we could earn Medicaid incentive funding. Consequently, our business plan was grounded in strategies for building a framework of sustainable financing into the future. As part of that framework, we launched a ‘Community Resiliency Fund’, which was a sister organization to the ACH. We were building a fund that could bring in multiple sources of investment—public, governmental financing, philanthropic foundation support, private equity and social-impact funding—to allow us to be flexible and respond to barriers as we were launching some of these initiatives and to provide a continuous form of support long term.

The Fund was a separate legal entity that had its own community-based Board. It was very much linked into the concerns and issues the ACH was finding in the community and supported the ongoing scaling and spreading of that work.