Background on Accountable Communities for Health
Throughout the process of establishing the Texas Accountable Communities for Health Initiative (TACHI), Episcopal Health Foundation (EHF) and its key partners have been working with each of the six sites to successfully set up their own Accountable Community for Health (ACH). EHF is a national thought leader on ACHs and has coauthored two articles in Health Affairs to help others with establishing their own ACHs:
Based on ACH work done to date, ACH initiatives typically include the following key elements:
TACHI Core Curriculum
To facilitate learning and growth in the key elements for the TACHI sites, EHF and the Parkland Center for Clinical Innovation (PCCI) have established a 12-month technical assistance curriculum with topics that touch on the elements above. Recognizing that each TACHI site is at a different place on their learning curve, the goal of the curriculum is to create a common knowledge foundation across all TACHI locations and shared language to facilitate collaboration across TACHI sites. Faculty for the TACHI were selected because of their industry-leading expertise and hands-on experience with ACH programs locally in Texas and across the country.
Topic 1 – Mindsets and Systems Thinking
To start making foundational changes in their communities, it is beneficial for the TACHI sites to adjust their own mindsets and the mindsets of their organizations to have a systems’ thinking perspective. Once they are able to do that, they can see the systemic changes that need to be made to enable their ACH to thrive in their community and really create equity for all community members. Mindsets and systems thinking is an overarching theme that helps ACHs address the key elements above.
Subject matter experts from the Population Health Innovation Lab (PHIL) provided the technical assistance on mindsets and systems thinking. The PHIL team described four specific facilitation tools:(1) backcasting, (2) the iceberg model, (3) the four levels of listening, and (4) framing a design challenge to solicit input, identify the root causes for issues, and initiate solution design. To learn more, visit PHIL’s resource page and check out their new curriculum focused on supporting ACHs and health focused multi-sector collaboratives – Powering Change: Building Healthy Equitable Communities Together Curriculum and a preview of their ACH Start Up Guide.
Topic 2 – Governance
Governance is the cornerstone to all successful ACHs. Without a committed and strong leadership group in place, an ACH will find it difficult to create an aligned vision and the structures needed to sustain an ACH and affect lasting change. Keith Kosel, the lead executive of the TACHI PMO, provided the initial technical assistance to the six TACHI sites on the key elements of governance structure, aligned vision and goals, and shared accountability. Keith continues to provide technical assistance to the sites as they finalize the governance structure, charter, bylaws, and vision for their ACH. To learn more about the importance of governance, check out PCCI’s Building Connected Communities of Care Playbook.
Topic 3 – Health Equity
Health inequities and disparities have been shown to harm individuals, families, communities, and our nation. As the TACHI sites are building their ACHs, they need to consider how their interventions will impact the health of all within their community. Nadia Siddiqui with the Texas Health Institute and Dr. Dora Hughes from the Milken Institute School of Public Health at George Washington University and a contributor to the George Washington University Funders Forum on Accountable Health provided the TACHI sites with the initial technical assistance on health equity. As part of that assistance, the sites learned more about what health equity means, how it impacts their ACH work, why they need to intentionally include it as they set up their ACH, and what options are available for measuring their ACH’s impact on health equity in their community.
Topic 4 – Community Engagement
To make a lasting change in their community, an ACH needs to work closely with members of the community to identify targeted needs and how best to address them. This may seem intuitive, but community engagement is often overlooked when community collaborations and interventions are created. As a leader in community engagement, EHF is working to make sure the communities are not left out of the work that impacts them and includes “Activate Communities” as one of its three main strategic goals as an organization.
Additionally, EHF has been providing technical assistance on community engagement to the TACHI sites. During one session, EHF invited local organizations to describe their own processes for engaging their community members and the lessons they have learned as they have worked side-by-side with their communities. This provided the TACHI sites with practical insights into how they can better align with their community members. EHF also shared resources from the Centers for Disease Control and Prevention (CDC)*, including:
- Ideas for Engaging Community Members found on the CDC website
- Principles for Community Engagement
Visit the EHF website for more information about the work EHF is doing to activate communities.
*CDC.gov (www.cdc.gov) is your online source for credible health information and is the official website of the Centers for Disease Control and Prevention (CDC).
Topic 5 – Portfolio of Interventions
As the TACHI sites continue to plan for their ACH, they need to decide on a portfolio of interventions for addressing the community’s targeted health issue(s). Recognizing that no single intervention, program or policy will improve community health alone, a portfolio is needed that brings together a range of strategies from the clinical setting to the community, which work together to achieve the desired outcomes. To help the sites think through this process, experts from the California Accountable Communities for Health Initiative (CACHI) provided lessons learned, building blocks, and examples from their own initiative (launched in 2016). As the sites establish their ACH, they will work as a team and with their community to select current interventions and/or develop new ones that align with the vision and goals of their ACH.
Topic 6 – Data, Data Agreements, and Information Exchange Technology
Successfully gathering, using, and sharing data within an ACH is crucial to the initiative’s success. Gathering reliable data ensures that each TACHI site will measure and understand where their community is at the beginning of the TACHI initiative and whether the interventions they are providing are making an impact in the community they are serving. Sharing information between the TACHI partner organizations ensures that community members have a streamlined experience as they utilize the various interventions and that the TACHI partners can adjust services and interventions as needed. Keith Kosel, the lead executive of the TACHI PMO, provided the initial technical assistance to the six TACHI sites on the key elements of data, data agreements, and information exchange technology. Keith and PCCI have managed the deployment and maintenance of an information exchange platform in Dallas since 2015 (see here and here for more details). Results have shown positive impacts on key healthcare utilization measures, such as ED usage and overall cost of care and impactful social results via more timely resolution of SDOH needs. As the TACHI sites begin implementing their ACHs, they are working to ensure they have the infrastructure and agreements in place to gather and share data amongst their partners.
Topic 7 – Capacity Building and Planning
Effective capacity planning and building will help the TACHI sites proactively plan and operationalize their initiatives. The goal of capacity planning is to anticipate any potential issues before they occur. During this section, the sites were encouraged to think about how to ensure (1) their interventions address the needs in their community and adjust as needed; (2) their workforce is trained and able to grow with the community’s needs; and (3) they have the correct infrastructure to implement their interventions. Matt Glazer from Mission Capital provided the technical assistance for the TACHI sites, and shared Mission Capital’s 4-phased approach, which includes: (1) Reality Check – Taking Stock, (2) Setting Goals that Matter, (3) Getting to the Specifics, and (4) Implementation and Evaluation. To learn more, visit Mission Capital’s resource page.
Topic 8 – Sustainability
As the TACHI sites finalize their plans for implementing an ACH in their communities, they are also making plans to ensure the sustainability and continuation of their work after the initial funding from EHF concludes. Although this eventuality is still several years out, the sites can prepare today to ensure success. Jeremy Cantor from JSI shared lessons learned from providing sustainability technical assistance to multiple initiatives (including the California Accountable Communities for Health Initiative) and templates from JSI’s Financial Sustainability Mini-Toolkit for identifying a value proposition, measuring outcomes, creating a pitch, and more. JSI has also put together a guide for ACH’s with Strategies for Financial Sustainability. All of these materials will help sites think through their plan for creating a long future for the work they will accomplish in their community through their ACH.