Brian Osberg, Chairman, Southside Community Health Services, email@example.com
Erin Bruggraff, Governance and Leadership, Gallagher Integrated firstname.lastname@example.org
This paper is intended to help Community Health Centers (CHCs) expand their work to enhance the health of the communities they exist to serve across Minnesota. As hospital system across the US move into population health and accountable care, they are considering how best to form and support new partnertships with local community health centers. The insights from this article can be useful in such planning for community health partnerships.
Community Health Centers (CHCs) are expected to provide services and interventions in their communities that not only enhance health care, but health gain. However, to provide services that protect and promote health, as well as restore health of vulnerable populations in the regions of Federally Qualified Health Centers (FQHCs), new plans and investments are needed to interrupt the social determinants of health, and to ensure the long term economic vitality of the Community Health Center.
Unfortunately, financial and staff resources in CHCs face constraints in today’s uncertain and politically divisive environment.
To achieve sustainable community health impact, and reduce gaps in health disparities within low income communities, superior CHC governance and management demand diverse skills, experiences and funding. No single CHC can “go-it-alone” to achieve significant and sustainable gains in health status of the people and diverse communities they exist to serve.
New partnerships and collaborations are needed. As these community health partnerships get established, they need new governance arrangements and structures. Governing community health partnerships, however, is complicated. Cooperation that leads to “collective impact” and sustainable collaboration is often fragile.
This paper has been developed from the experiences and insights shared at the recent “Many Faces of Community Health” Conference in Bloomington. To help ensure that creative insights, broader resources, and interventions of impact occur throughout Minnesota, the following suggestions are organized into these five (5) spheres of interest:
- What are “Community Health Partnership” and why are they important?
- What are examples of such community health enhancement partnerships?
- What are common obstacles to successful partnerships?
- What are key actions to strengthen community health partnerships?
- What are sources of resources to support the partnerships?
What are “Community Health Partnership” and why are they important?
Community health partnerships are unique networks of community based organizations that reach out to each other to define a shared vision of a healthy community; a plan of action and investment to achieve that vision; shared roles and responsibilities to implement the “Community Health Plan”; and a shared set of governance arrangements and decision-making processes to ensure that progress to plans are monitored; resources are mobilized to sustain the progress; and structures and systems are in place to help govern the network of collaborative programs and shared initiatives.
The origin of such community wide planning and collaborative execution of shared plans traces its origin the WHO’s Healthy Cities movement of the 1970s and the Health Communities work of the American Public Health Association. There are now several planning guides that can be used by community leadership groups to launch and sustain such collaborative endeavors.
The rationale for developing and governing such partnerships is driven by a recognition that the obstacles to healthy communities are tangled in the pervasive challenges of the social determinants of health, poverty, and scarce resources. Only through the three Cs of cooperation, coordination and collaboration can the needed political, leadership and financial resources best be mobilized, targeted, and sustained for meaningful health gains.
What are examples of such partnerships?
Participants in small groups exchanged ideas and insights to illustrate the wide array of partnerships that exist in communities across Minnesota. These examples can inform and encourage others, but also can be looked at as a nucleus to do even more with more partners.
The examples are shared in random order. What other examples can you share?
- Hennepin Health encourages collaboration for housing – through affordable housing (Northpoint, see: http://www.northpointhealth.org/ )
- Children’s and Allina, are using community-based resources in an easy to use software platform – NowPow – see: http://www.nowpow.com/ that seeks to link best organizations to assist local people and their health and social welfare needs
- Tribal Police – in Reservation communities collaborates with local county police in order to provide health and protective services to community members
- Medical legal partnership (MLP) – from University of Minnesota links with health providers to fill gaps to take actions to improve health See: https://www.healthtalk.umn.edu/2017/05/31/cuhcc-medical-legal-partnership/
- Statewide health partnership that helps community service providers deal with chronic health issues, see: http://www.health.state.mn.us/ship/
- MDH collaboration with counties during outbreaks to assist communities and countries to have supplies and support to prevent and treat communicable and chronic diseases, see: http://www.health.state.mn.us/healthreform/ship/Implementation.html
- Collations can be formed among communities to align with existing orgs, such as with PICA Headstart has a health advisory “federal requirement” community partners invested in key issues, see: http://www.picaheadstart.org/
- Center for Community Health at the University of Minnesota provides help for collaborative projects, see: https://www.ctsi.umn.edu/consultations-and-services/community-engaged-research/grant-programs/community-health-collaborative-grants could be for hospitals, health plans, local public health
- Partnership with advocacy associations, like the Cancer society which does partnerships with agencies, see:
- Maximize TA from government agencies for cooperation efforts, Minnesota Department of Health – designate areas as health professional shortage area qualify for other programs.
- Partnerships with community groups like Community University, CU HCC separate from U of Minnesota but they support clinic co locate resources law, s work dental. https://www.cuhcc.umn.edu/
- Open Cities Health Center uses grassroots relationships with Asian American and Pacific Islander health coalition to recruit providers and help market a new clinic location which aided in jump-starting clinic patient population
- SAGE/Scopes/MNFit; Health care Partners; Our Lady of Guadalupe – share space; Salvation Hospital in Rochester; proscription assistance in Salvation Army; SS Boutique – providing clothing; Campus Kitchen – MSU provides food for clients in need; Internships/Preceptorships for students; Dental into schools for sealants; community Ed in ESL – presentations to ESL classes; 10 physicals with schools; connections with LGBT community; partner for referrals and ESL teachers in need; Kiwanis for funding; United Way; Welcome Manor Treatment Center – health care in facility; Mankato State University; veterans for permanent disabilities; mastectomy bills; collaboration with rural AIDS network; REACH – teenage shelter; seek help with medication charges and clothes; public health; refugee health services
What are common obstacles to successful partnerships?
While there are many initiatives to collaborate for community health improvement, many fail to launch, are delayed in their accomplishments, or are suboptimal in their results. This painful reality is due to many factors that get in the way of collaborative governance and health partnerships. The Boards of CHCs must prepare to use practical strategies with their staff, managers and providers to remove, reduce or work-around these many obstacles: (all in random order)
- “What is in it for me?” mentality
- “I don’t have time to collaborate”
- Lack of financial support
- Everyone is stimulated only by their own agenda
- Lack of common vision among diverse community groups and populations
- Unclear goals for cooperation
- The obstacles are too big—fear of failure
- Inefficient communication
- Not the right stakeholders involved
- Lack of collaborative leadership
- Territorial issues
- Not a lot of backbone organizations
- Lack of human and other resources
- Funding used just to sustain operations is a priority over just collaborative effort
- Differences in power/ability of stakeholders to offer resources skews collaborative efforts
- Lack of trust, transparency, and open communication
- Loss of interest leads to disengagement
- Staff and leadership turnover
- HIPPA regulations
- Power struggles/how do we share resources
- Honesty about your goals in the collaborative
- Lack of knowledge – educating/sharing information
- Legislative issues – raise payments?
- Too much paperwork for Medicare/Medicaid
- Not enough ortho & dental providers that will take Medicaid/Medicare
- Time: Freeing up CEO time – get them out of the weeds, so they can network
- School/hospital partnerships speak different language and use different planning tools
- Privacy issues HIPAA – to do data sharing; need parents signatures on release forms (cumbersome)
- Grants can get in the way: Organizations choose the grantor’s priorities, not the community’s priorities; and Money bounces off the community and goes to wealthy communities with the people who work on the grant
- Values are not always aligned – scientific-based “values” are not always in the best interest of communities. This breaks the trust with the communities
- We need to listen to the issues from the perspective of the people with an ear and heart to listen to what is meaningful to people in need
- The narrative is not community-based/driven
- Funding is not aligned/coordinated with community priorities
- Measures and incentive structures – outcome scores.
- Leaders lack enthusiasm to meet the Need of the most vulnerable
- The balance of who is benefitting is weighted in favor of professionals who gain more from their “service” to people in need, than to the people they are paid to serve.
What are key actions to strengthen community health partnerships?
In addition to overcoming obstacles, CHC leaders must be prepared to accomplish several actions to establish and sustain community health partnerships. Key ideas suggested from the conference are:
- Conduct needs assessment or get voices of community for better strategic planning (bring partners into conversation)
- Form inter-disciplinary and inter Taskforce for improved partnerships and increased advocacy
- Maximize the numbers of Stakeholders to increase buy-in and enhance health programming
- Conduct intergenerational and inter demographic planning groups to develop community health partnerships’ SWOT analysis on how best to improve services
- Form Community partnerships and then collaborate to seek funding for basic planning and backbone organizational support. Think about sustainability ahead of time in order to define How to keep it going after funding ends
- Lobby for local and state Health reforms that can get providers together to coordinate and develop governance strategies to break down barriers
- Define Culturally-appropriate resources and surveys to assess needs (although language isn’t the only issue. Sometimes a population is more oral & will not read brochures)
- Provide for plenty of networking time among program and organizational leaders
- Educate all players about the Importance of social determinants
- Engage with boards of Schools, community agencies, hospitals, and housing organizations
- Seek grant funding to support participation in collaboration planning
- Define Clear metrics and explanation/ clear mission
- Bring resident perspective – provide incentives and child care for women to participate in and lead planning and leadership roles
- Build Trust/transparency among all groups and population segments early in the process
- Commit to Honesty about self-interest motivations
- Avoid political connections that complicate collaboration
- Invest to form small Backbone organization with loaned staff from various partner organizations
- Promote individual collaborations, but also have over-arching goals that are attainable
- Bring the right partners together from the leadership to the front line
- Knowing each leaders’ strengths and utilizing those to build collaboratives
- Specifying each participant’s role, and celebrate their contributions
- Support diverse groups to define the Root cause of health and social welfare problems
- Be very respectful of different views. Be a good listener
- Conduct social network analysis to see who’s involved (not present, overused, and crowded in area). Look for authentic engagement and level of engagement
- Use work groups that are mutually beneficial to all stakeholders, especially the most vulnerable
- Go slow at first
- Collaborate to use External research/environmental scan to help guide and set priorities
- Commit to Accountability to the collaborative work, shared agenda/goal; shared, rotating leadership
- Acknowledge that many Needs that cannot be met alone
- Invest in Publicity; website, news, video – make the stories real and compelling
- Establish Work groups on specific topics
- Data-based; where/what are the most significant health challenges
- Find and celebrate Early wins – build momentum by celebrating progress to plans
- Community member interviews across demographic segments
- Awareness of social determinants – says we must work on multiple social aspects at the same time to impact population health
- Encourage Community school collaborations
- Acknowledge that Reduced reimbursement will force cooperation and innovation
- Need clear metrics of how we define success and progress milestones
- Explore how Community partners can be paid for participation
- Commitment to integrated healthcare is a step towards breaking down silos among previously disconnected providers of care
- Budget for Networking time among staff and managers
- Avoid politics and minimize polarized discussions
- Need a strong quarterback in early planning, but one who is willing to share the credit and the work
- Increased awareness of social determinants of health – brings various sectors together
- Stay away from “politicalizing” – find common ground
- Ensure volume of participants doesn’t impede group discussion
What are sources of resources to support the partnerships?
There is never enough money to do all we would like for enhanced community health and vitality. There are, however, more resources then we think if we change our conceptual framework to embrace: cash, loaned staff and executives, in-kind contribution of resources, donation of space and office support materials etc. Participants in the small groups encouraged creative conversations about these varied sources of resources. (Listed in random order):
- Utilizing Local Groups:
- Faith-based organizations
- Beauty & Barbershops
- Groups that have resources such as transportation
- University-Teaching clinic staff allocated for short term assignments
- Grants from local rural coops or city or county departments
- Grants from Medica/Blue Cross
- Define joint-powers agreements between counties to share costs and spread expense burdens
- Pursue Shared grants with joint work plans
- Approach Private business, housing, transportation;
- Need to involve private business and family foundations -all coming together to solve health issues, see: https://mcf.org/directory
- HUD funding
- Partner with HMO’s
- Teaching/learning experiences collaboration with universities
- Benefits: affordable, free workers
- Compensation for providing learning service to students/university
- FUHN in Metro FQHC network, see: http://www.nhcn.org/
- Clinics (FQHC) collaborating to meet quality measures, QI, improvement, Reduce health cost, Potential for savings to come back to donors
- Utilizing positions already funded or established (rethinking positive roles within the organization)
- City public funding grants
- Grants from payers & government
- Set- up task forces about How to involve multi-layers
- Resources (transportation)
- Funders (public, private)
- Engage multiple groups to work towards change on interest area
- Food sources
- Public safety
- Delta Dental Foundation
- Pharmacists orgs
- Community Paramedic orgs
- Donation of medical supplies (i.e. Mayo)
- Housing and urban development groups and associations
- Cross-county/multi-county services (rural MN); leverage services and resources
- Combine issues/resources under one roof (job services, dental, special school, upstairs)
- City of Minneapolis – healthy corner stores http://www.minneapolismn.gov/health/living/new%20cornerstores
- FQHCs/Community clinics could collaborate with county & statewide health improvement partnership (SHIP) programs to connect patients to healthy food and physical activity and tobacco cessation resources (i.e. using local vendors to produce fruits and veggies at farmers markets, meals on wheels delivering locally-grown veggies to low-income, isolated seniors at home)
- City of Minneapolis, Hennepin County, city revitalization funds, urban development orgs, allocated funds from each orgs/partners’ budget
- Bush foundation – innovative approaches
- University partners – provide student experts, grants
- Insurance companies/larger health care systems
- SHIP – Statewide Health Improvement Program – MDH