Tracing the Origin of the Texas Accountable Communities for Health Initiative (TACHI): Making a Case for Texas

This is the first in a blog series chronicling the TACHI journey from planning to implementation.

Shao-Chee Sim
Shao-Chee Sim, EHF’s VP for Research, Innovation and Evaluation

Texas is the fastest-growing state in the country. Yet, it continues to lag in many health indicators. The COVID-19 pandemic, for example, highlighted how social and economic disparities lead to Black and Hispanic Texans being disproportionally vulnerable to hospitalizations and mortality. Given the growing evidence suggesting that the social determinants of health (SDOH), such as food, housing, employment, transportation, significantly influence health outcomes, policymakers and funders have invested in various community-led approaches to address community health. However, many SDOH initiatives are hampered by siloed funding streams, short-term thinking, lack of clearly shared goals and priorities, disconnected data systems, etc.

Episcopal Health Foundation (EHF) is committed to supporting existing community collaboratives to become high-functioning entities known as Accountable Communities for Health (ACH) to address these challenges. This is the first of a series of blogs chronicling the evolution of the Texas Accountable Communities for Health Initiative (TACHI) during the first 12 months designated as the Planning Period. 

ACHs are community-based partnerships formed across sectors such as health care, housing, social services, public health, employment training, and economic development to focus on a shared vision and responsibility for the community’s health. Essentially, ACHs serve as a local platform for bringing stakeholders and community residents together to transform systems to improve community health and achieve greater equity on a sustainable basis rather than provide “one-time” interventions based solely around a health care delivery system. ACHs require genuine community leadership, intentionality, resources, technical assistance, and opportunities to learn from each other. 

At EHF, ACH is one of the special initiatives within our strategic plan to support health care financing changes to incent investment in improving community health. In October 2020, we launched the TACHI as a major multi-year grant-making effort. TACHI’s development is the product of intentional peer philanthropy learning, community feasibility assessment, and strategic planning conversations over a year-long effort. Instead of managing the initiative in-house, we thought it would be necessary to partner with external entities to provide program management, offer technical assistance, and conduct a readiness assessment and program evaluation. We want to change the cautious and risk-averse mindset among policymakers and service providers in the state, especially in their “short-term” approach in addressing immediate needs, rather than looking at the root causes of poor health. 

Before October 2020, we had taken an intentional approach to learn about similar ACH initiatives, federal initiatives, and research evidence via our participation, alongside other health philanthropies, in the ACH Funders Forum led by George Washington University. In 2018, we contracted with consultants to conduct a feasibility study to assess whether there’s sufficient local capacity and interest in moving forward with an ACH initiative. This initial assessment led us to adopt an intentional and sequential approach in educating, building buy-in, and soliciting interest among community collaboratives. 

EHF hosted two webinars in the Fall of 2019, educating key stakeholders and local community partners about the ACH model. At the end of the webinar series, EHF issued a Request for Information in November 2019, inviting community collaboratives to express interest in developing into an ACH. EHF identified six communities across our region that showed sufficient interest and readiness to take on the work based on the responses.

These six communities are diverse urban, suburban, and rural communities in Williamson County, Bastrop County, Gregg County, the Brazos Valley region, the Greater Northside community in Harris County, and the Rundberg community in Travis County.

We are committed to supporting the critical work of the six TACHI sites in the coming years. While the TACHI sites may not achieve significant policy wins in the foreseeable future, we will be mindful in documenting small wins, challenges, and strategy adjustments along the way. A desirable outcome for us would be for the participating TACHI sites to develop critical elements of local ACH governance and infrastructure on the path to establishing “sustainable financing strategies” to improve health conditions in their local communities.