Multisector Partnerships Have the Potential to Transform Health, but Most Aren’t There Yet
The following is a cross-post from the Health Affairs Blog
Click here for limited access to the full Health Affairs article, Multisector Partnerships Need Further Development To Fulfill Aspirations For Transforming Regional Health And Well-Being
The Central Oregon Health Council (COHC) is a unique nonprofit organization that plays a critical role in improving the health of residents across Crook, Deschutes, and Jefferson counties. The 14-member board of directors is made up of executive-level decision makers from multiple sectors that go beyond what is typically considered health care, including behavioral health, local government, housing, education, and more. Together they manage the region’s Coordinated Care Organization, which provides services to their Medicaid population. COHC also conducts a community-wide health assessment and planning process every four years and uses the results to build a regional health improvement action plan (RHIP). The organization has an impressive and broad-reaching strategy. What’s most distinctive about COHC, though, is how it does its work and specifically how it implements its RHIP. As the board began to plan its first RHIP, it quickly became clear that the unique capability of COHC is to serve as a neutral convener.
Donna Mills, COHC’s executive director, explained it this way: “Negotiating a RHIP with all the COHC members, each coming to the table with different perspectives and priorities, is difficult. But our work would be impossible if they did not feel safe and respected in bringing their own perspectives to the table.” With COHC at the center of the work, all the members can help realize the common purpose of better coordinating care for the region’s Medicaid population without having to become experts in coordination and without having to step out of their own organizational roles when they come to the table.
This innovative approach—strategically designing and connecting a community’s health improvement efforts across all major institutional players, with leadership from an effective neutral convener—offers great promise. This is where opportunity lies for a multi-sector partnership for health. Previous research indicates that the presence of multi-sector partnerships is linked to the improved performance of a regional health system over time. In particular, having an organization responsible for and capable of fostering diverse stakeholder collaboration could also help align resources for greater efficiency and strategically coordinate programming or maximum impact, and beyond.
The good news is that multi-sector partnerships for health and well-being are on the rise in the United States. The Pulse Check, a 2016 survey of 237 cross-organizational groups conducted by myself and my colleagues at ReThink Health, an initiative of The Rippel Foundation, showed that while many have existed for decades, their numbers have steadily increased since 2010. We also learned that diverse stakeholders tend to be involved; on average over 10 different sectors participate in a single partnership—most commonly public health, health care delivery, education, social services, and community-based organizations. They most often work at a county or multi-county level, and focus on improving clinical care, health behaviors, socioeconomic factors, and the physical environment. Importantly, we also learned that partnerships, like any organization, go through developmental phases as they progress. The vast majority of the partnerships we surveyed were in early phases of development, indicating that on the whole, multi-sector partnerships across the country may be relatively nascent.
At the same time, The Rippel Foundation’s ReThink Health Ventures project—co-funded by the Robert Wood Johnson Foundation—was just getting underway with the goal of exploring how regions could more quickly create an integrated and high-functioning regional health system. We saw an opportunity to learn more about partnerships much further along than the majority reflected in in The Pulse Check survey—those that presented as well-developed and therefore poised to transform the health of their communities. We wanted to know: What are their structures and priorities? What have they accomplished, and what are their biggest barriers? Have they progressed to coordinating a broad-reaching strategy with many actors, similar to COHC? Have they reached other developmental milestones?
A Closer Look At More Advanced Partnerships
What we learned from a systematic assessment of the more advanced partnerships surprised us. Even those with a reputation for being in mature stages of development were not as well poised for transformation as their reputations implied. You can read details about our findings in the January 2018 issue of Health Affairs, but here’s a quick summary: Many groups are lacking involvement from key sectors, including health care payers and economic development organizations. Their infrastructure to coordinate collaboration is often fragile and underfunded. Often these partnerships focus on only short-term initiatives addressing a specific disease or health outcome, and they are disconnected from other collaborative efforts to improve health in their community. Just a few of these well-established partnerships are focused on an integrated strategy to improve health care delivery, move beyond fee-for-service payment models, enable healthier behaviors, and expand economic opportunities. Finally, these partnerships mostly rely on unsustainable, short-term grant funding, making it challenging for them to plan beyond a two- to three-year time horizon (a longer-term timeframe is a necessity when pursuing systemic change).
Long story short: even the most mature multi-sector partnerships face an uphill battle to advance their ambitions. Not all partnerships need to look like COHC, yet some form of thoughtfully designed collaborative infrastructure is necessary to lead the work of health transformation in regions. While their reputations gave many observers reason to believe that a good number of partnerships were already providing this infrastructure, that’s simply not the case.
So what can be done about it?
At ReThink Health, we’ve concluded that multi-sector partnerships will develop more quickly when the conditions are in place to catalyze their progress. The expectations for them are tremendous, but they are all working from scratch in a nascent field—inventing and experimenting with new norms, standards, and practices. We have little doubt that partnerships can achieve sustainable change with game-changing interventions around stewardship, strategy, and financing. But first, it is important to design, test, and spread those interventions so that “how” to move forward is abundantly clear. We’ve dedicated 2018 to developing the right strategies to accomplish this work, and we look forward to finding partners ready to face these difficult challenges with us. Together, we can make overcoming the limitations of the status quo a real possibility.