Catalyzing alignment and systems transformation through cross-sector partnerships: Findings from the California Accountable Communities for Health Initiative

Abstract

Objectives: To describe the impact of Accountable Communities of Health (ACHs) on organizational and community partnerships and explore how ACHs contribute to systems change.

Data sources and study setting: The California Accountable Communities of Health Initiative (CACHI) was a 5-year, $17 M investment in community health transformation in 13 ACH sites. Data sources include two surveys, key informant interviews, small group conversations, and ACH meeting observations and document review.

Study design: This was a mixed-methods, observational study. Surveys conducted in 2021 and 2022 focused on ACH progress in building organizational and community partnerships and ACH impact on partners and systems, respectively. Interviews and small group conversations were conducted toward the end of the CACHI grant period and designed to complement the surveys.

Data collection: Survey respondents included ACH backbone agency staff and partner organization representatives (n = 141 in 2021 and 88 in 2022). Semistructured individual interviews and group conversations were conducted with 40 ACH backbone staff and partners. Documents were collected via grant reporting and directly from ACH staff. Data were analyzed descriptively and thematically.

Principal findings: ACHs appear to have supported organizational partnerships and collaboration. Seventy-six percent of survey respondents reported that their ACH had strengthened organizations' ability to work together and 65% reported developing new or deepened connections. While ACH participants reported a better understanding of community needs and priorities, progress on community relationships, and greater attention to equity and racial justice, many saw room for improvement on meaningful community engagement. Systems changes and precursors of systems change observed across ACH sites included strengthened partnerships, enhanced knowledge, increased capacity, more collaborative ways of working, and new funding streams.

Conclusions: The ACH model is effective at strengthening organizational partnerships and catalyzing other systems changes and precursors including enhanced knowledge, increased capacity, more collaborative ways of working, and new funding.

Keywords: accountable care organizations; evaluation research; health care coalitions; intersectoral collaboration; public-private sector partnerships.

FIGURE 1

Conceptual connections between the California Accountable Communities for Health (CACHI) model and the BUILD Health Challenge Outcomes Framework. (1) CACHI Key Elements for ACHs come from program materials for the CACHI model in its first iteration and funding period, from 2017 to 22 (see the 2016 RFP here: https://communitypartners.org/files/documents/cachi/rfp/CACHI%20RFP%20Updated%204‐6‐16.pdf). A new RFP and second round of grants have updated this model to emphasize 5 primary goals: (1) overall infrastructure, (2) equity and community engagement, (3) portfolio of actions and strategies, (4) financing and sustainability, and (5) data and communications. See: https://drive.google.com/file/d/1FsKd9uwIze0iVkkaWKtq‐z‐MJwmfVwRG/view?usp=share_link. (2) The BUILD Health Challenge Outcomes Framework can be accessed at: https://buildhealthchallenge.org/resources/builds‐2‐key‐frameworks/.