Key Points

The U.S. health system’s “sick care” model — as designed — currently spends $4.3 trillion annually to treat its people once they become ill, yet it has done little to meaningfully advance their health and well-being. In fact, research consistently demonstrates that socio-environmental factors and individual behaviors — the social determinants of health — have a far greater impact on health outcomes.

Responding to this research, in 2017 the Episcopal Health Foundation launched the Texas Community-Centered Health Home Initiative. The $10 million, multiyear investment was a proactive, developmental effort to build the capacity of community-based clinics to go beyond clinical services to address the conditions that would enhance the health of its residents. Participating clinics rose to distinct stages in their ability to embrace and engage in community prevention activities. However, the work uncovered a critical tension between doing community prevention and remaining financially sound — clinics had no revenue source to sustain their successful activities beyond grant support.

To overcome this challenge, the foundation seized on recent policy momentum around social determinants of health and value-based care to develop two new initiatives that built on learnings from the 2017 project and leveraged these new payment mechanisms. This article outlines how its adaptive approach in conjunction with its “follow the money” mindset — a focus on identifying and influencing the interest and direction of public and private payers — demonstrates potential to achieve sustainable practices in community prevention.

This article is intended to inform other philanthropic organizations investing in population health. The lessons learned point to the critically influential role that philanthropies can play by assuming an adaptive approach in guiding their initiatives and in leveraging learning and grant investments to create not only community-level impact, but also to influence state and national funding policy to generate sustainable funding options.

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