A Year of Progress in Texas Accountable Communities for Health Initiative

Written By: The Georgia Health Policy Center Team

The Georgia Health Policy Center (GHPC), in the role of evaluator and thought partner, has been following the TACHI implementation journey of each site and tracking their progress related to the common elements of the ACH model. Using reports, surveys, interviews, and other observational information and data, GHPC is supporting the sites, EHF and the technical assistance provider team in understanding progress, achievements and real-time opportunities for process and program adjustments.

What are we learning?

TACHI’s first implementation year yielded insightful evaluation findings. Based on information provided from more than 50 survey respondents and key informants, which took place in the second half of 2022, here are some early learnings about the progress, successes, and challenges of the initiative.

All sites are making progress on some of the common elements of the ACH model.  A few elements stand out as foundational to the rest as most sites develop their ACHs – shared vision and goals, partnerships, and leadership.  As the work continues to mature, what our team currently understands to be foundational may shift. Also, site partners are continuing to solidify and/or increase their understanding of the model which appears to be key in facilitating their implementation of the model.

A deep level of collaboration among site partners is necessary to do the work of an ACH. Key facilitators of progress in this area include significant and increasing trust among partners, willingness of partners to leverage their preexisting relationships and resources, and a leader or leadership organization adept at convening partners, facilitating them in carrying out their individual and collective roles and responsibilities and building new partnerships as appropriate. Talent turnover at sites and partner organizations sometimes challenge the strength of partnerships and the pace of progress. Some sites are developing clear onboarding processes to minimize the potential adverse impacts of such transitions on the effort.

Especially considering early challenges, sites are recognizing that sustaining their efforts over time requires significant preparation. Because the ACH model is generally focused on addressing the social or non-medical determinants of health, one significant challenge is that there is currently no clear path for sustainably funding that kind of upstream work. More downstream options such as approaches that focus on managed care organization reimbursements seem more feasible. Some sites are beginning to consider additional grants and donated resources as a bridge to setting up the work for the long term. Many sites, at this stage of implementation, are recognizing the importance of developing their value proposition to help them attract funding and partners. They are also recognizing that they will need to more clearly define a cohesive portfolio of interventions to support them in demonstrating and communicating the value of their ACH efforts to potential funders.

Backbone organizations, their partners and technical assistance providers underscore the importance of a commonly held commitment to the vision of the collaborative as key to the ultimate success of these sites and their efforts.  Most are beginning to make their way from understanding the model to engaging in actions that demonstrate the commitment to improving the health of all people, particularly those most affected by disparities in their community.

Sites are discovering roadblocks to seamlessly acquiring and using data together. Barriers include – establishing data sharing agreements, setting up data management systems, and finding the right partners with prior experience in these tasks. Having dedicated personnel to manage data and establishing agreements for data sharing such as memoranda of understanding are early wins that have been achieved in some sites.

Sites that combine the ACH model with the Pathways Community HUB model credit the structure and requirements of the latter with catalyzing their progress. So  far, we are learning that the less rigid structure and approach of the ACH model require more time for assembly.

Throughout the planning and early implementation phases, sites have been negotiating “shapeshifting”, including changes to backbone organizations, leadership structure, and partnerships. Real-time support and technical assistance to these sites are proving important to their ability and capacity to be resilient in the early stages of their development. An expanded technical assistance (TA) team, improved tailoring of learning sessions, and clearly communicated expectations from the funder (e.g., the allowance of flexibility, and using trial and error approaches in establishing their ACHs), appear to enhance site morale and facilitate their progress.

Given our learnings and that of others in the field, there are two considerations or expectations that will continue to influence the initiative’s progress. The first is that the pace of implementation and progress will vary by site due to local and contextual factors. The second is that progress is often a non-linear journey with gains and achievements in one season being followed by setbacks and change in another.

Our team is excited to continue our evaluation into the second year of implementation, with a focus on real-time learning about site progress and early outcomes where they are occurring. With continued learning, dissemination, and adaptation, we hope to provide TACHI with timely data and information to support ongoing refinement to the technical assistance and other provided services, aimed at ultimately allowing the effort to realize its vision of advancing the health of communities across Texas.