Shared financing is “A feature of aligned systems characterized by sustainable methods with appropriate incentives and shared accountability.”⁴⁷ Sustainability in health-focused MSCs refers to the “maintenance or improvement of resources, infrastructure, activities, outcomes, and relationships” that impact community health over time.⁴⁸

“One thing that worked for us was to start a founding member fund. And that was to get key partners, starting with the leadership team, and then others who have always wanted to be involved, like the health plans… And we asked six or seven different entities to contribute $10,000 in the first year, and then look at reupping the second and third year. And that started in 2019. And that first year, we got $55,000… and we’re on target to reach $73,000 this year. So now we’re looking at another fund called the sustainable member fund for smaller organizations that align with some of the priorities and interventions that we’re planning. And so the goal is to sustain all of the backbone operations and some community investment funds.”

– ACH Staff, CA

Key Takeaways

The long-term success of MSCs requires both financial stability and collective buy-in from partners and participants.
Shared financing stimulates and catalyzes aligning efforts.
Aligning efforts that have the shared financing to support staff, partners, and implementation of ideas are best positioned to transform systems.

From the Data

70% of respondents said that their MSC is doing a lot to communicate the value of its work to potential funders/investors (n=174).
65% of respondents said that their MSC is doing a lot to identify the financial resources needed to sustain the work of their MSC name (n=160).
68% of respondents said that their MSC is doing a lot to identify a clear value proposition for sustaining its work (n=174).

“And to represent what the region wants, you need to have at least a portion of an ACH not tied to any funder outside of the region. You really need to have that ability to be independent in your thought and in what you do within that scope of work. And so I think it’s important for the funders or the partners to buy into that and hold the ACH accountable for that. Because ultimately, it’s going to be the region that’s funding it.”

– ACH Staff, WA

Perceptions of Financing and Sustainability

As evidenced by survey results, MSC participants had mixed feelings about their MSC’s approach to financing. Perceptions of shared purpose varied by different local contexts and participant backgrounds. We found that:

MSCs that served larger geographic areas tended to have better perceptions of their MSC’s approach to financing and sustainability.
People from tribal communities and nations, as well as people who worked with the MSC, tended to have better perceptions of MSC financing and sustainability, while people who worked in social services and public health tended to have worse perceptions.

The Influence of Financing

Perceived progress toward robust financing was most strongly influenced by community voices integration, population size of the community served, and amount of ACH startup funding received, with each of these factors having a positive influence on participant perceptions of financing. Median annual income and population density of the community served had a strong negative influence on perceived financing progress.

“I think for the behavioral health organizations and the CBOs, [the ACH] was an opportunity for us to invest in some infrastructure, potentially run some pilot studies, try to innovate in ways that would have an impact and help amplify the voices of the sector, but also of the people that we serve, that wouldn’t have been available otherwise. In some ways… the community providers is a very low margin business. And oftentimes, it’s driven more by mission, vision, and passion than it is by business sense. And so it gets really hard sometimes to have the money or have the resources available to do some of the things that bring us up on par with the medical system.”

– Behavioral Health Care Representative, WA

Related Resources

Building Multisector Collaboration for the Long-Term, a Population Health Innovation Lab (PHIL) research brief (2023)
Powering Change Curriculum: Building Healthy, Equitable Communities Together, a Population Health Innovation Lab (PHIL) and California Accountable Community for Health Initiative (CACHI) curriculum for multisector collaboratives (2021)

View all references for the Data Walk.