Andrea Ducas, Senior Program Officer, Robert Wood Johnson Foundation
Shao-Chee Sim, Vice President for Research, Innovation and Evaluation, Episcopal Health Foundation
As funders, our ability to share knowledge, resources, strategies, and lessons-learned is critical for tackling the kinds of complex and evolving challenges we face today. But the “how” of cross-funder collaboration—and knowing where to start—is not always easy to figure out. As colleagues from both a regional and national health philanthropy, we are proud to share insights on our unique journey from relationship-building to collaboration. What started as an unexpected hallway conversation during a conference in 2016 has led to years of fruitful shared learning and co-funding that has benefited both of our organizations and our grantees.
What We Have Done Together
As shared in a recent Health Affairs Grantwatch Blog Article, the Robert Wood Johnson Foundation (RWJF) and the Episcopal Health Foundation (EHF) have partnered to advance a payment reform agenda among safety net providers, address the rural hospital closure crisis, and advance the efforts of Medicaid MCOs (managed care organizations) to address social determinants of health (SDOH) and health equity within Medicaid. In all three areas, we have been very intentional about building on and leveraging each other’s work to either expand a project from a local to national reach, or to dive deeper into the local context of a national initiative. This publication outlines considerations for funders interested in partnering with one another and reflects on the factors that make our partnership effective.
Considerations for Working with Other Funders
State contexts are critical. As the largest non-Medicaid expansion state, Texas had the highest uninsured rate (18.4%) and the greatest number of uninsured residents (5.2 million) before the pandemic. Texas has also experienced the highest number of hospital closures in rural communities since 2010. Currently, the state is home to 4.7 million Medicaid beneficiaries, and its 73 Federally Qualified Health Centers (FQHCs) serve 1.6 million Texans. For RWJF, having the opportunity to go deep in a state like Texas, and to ensure the Texas experience could inform some of our national projects was a no-brainer. For EHF, leveraging the experiences of other states to affect the health and health care needs of millions of Texans made partnering with a national funder a natural fit as well.
Data builds confidence in strategy development. Data has played an essential role in informing and shaping our institutional responses to health and health care challenges. Our FQHC payment reform and MCO SDOH learning collaboratives were launched largely because of the findings from EHF’s FQHC payment reform readiness assessment survey and MCO SDOH survey. Our data showed that many organizations were interested in pursuing alternative payment model arrangements and social determinants of health strategies, but did not have the knowledge and experience to do so. For RWJF, having on-the-ground data and insights from Texas to complement our own national data collection gave us confidence about the potential real-world impact of our own programming.
Relationships matter. Our approach to co-funding has been a win-win for us as national and local philanthropies. By taking a “back seat role,” RWJF program staff have been able to leverage EHF’s local knowledge, relationships, and network to deepen our understanding of payment reform challenges among safety net providers and community driven approaches to address health care needs in rural communities, as well as opportunities and barriers for Medicaid investments in the social determinants of health. Program officers have been able to spend time in Texas and learn from the many rich (and candid!) perspectives and firsthand accounts and pain-points of Texas Medicaid officials, MCO leaders, local safety net providers, and other community stakeholders. EHF has been able to leverage RWJF’s extensive network and platform, which brought national payment reform, SDOH, and Medicaid policy experts and facilitators into the various learning collaboratives that have continued to work with both funders in the years since.
There are no quick fixes and patience is key. Whether figuring out ways to strengthen safety net providers’ capacity to engage in payment reform, address rural hospital closures, or advance SDOH policies and programs with Texas Medicaid and MCOs, there are no quick fixes or overnight solutions to resolving complex health and health care challenges. While the work is complicated and messy, our approach must be grounded in the evolving federal and state policy contexts. Recognizing that this is a “long game,” being patient and flexible is required to manage the uncertainties, policy shifts, and the sometimes lack of alignment among stakeholders’ interests and priorities.
It is important to celebrate small wins along the way. We know it will take years to accomplish fundamental changes in safety net provider payment policy, to “right-size” health care delivery in rural communities, and to integrate an SDOH agenda into the work of state Medicaid agencies and MCOs. But our efforts to date have led to small but important wins. Our initial collaboration with the FQHC payment reform learning collaborative laid the ground for continued safety net payment reform investments by EHF and RWJF, including RWJF’s Delta Center for a Thriving Safety Net and EHF’s Clinics Pathway Approach. Our joint investments in studying rural hospital closures in Texas led to the publication of blueprints for community action, helped expand the reach of a HRSA-funded Center for Optimizing Rural Health, and now are supporting a national study to identify rural bright spots. An important spinoff project of the learning collaborative was also a partnership between EHF, the Center for Health Care Strategies and Texas Medicaid to convene an SDOH expert panel to provide feedback to the state’s Medicaid program as it developed SDOH strategies for Medicaid managed care. Findings from the discussion were used in a larger report to the Centers for Medicare and Medicaid Services (CMS). These wins have undoubtedly energized us to continue our collaborative work.
Why and How Our Collaboration Works
Our collaboration transcends funding. First and foremost, we have intentionally prioritized building our relationship, as opposed to just looking for ways to co-fund. One of the things that sets this relationship apart from others is that we have made a real effort to connect and (prior to the pandemic) visit each other so that we can develop relationships across a large number of staff in Houston and Princeton. In addition to sharing taco breakfasts and enabling a program officer to experience a rodeo for the first time, this face-to-face relationship building made it possible for us to get to a place where multiple program staff from our foundations can easily pick up the phone and bounce ideas off one another with no expectations other than candid advice. It has enabled us to connect as both colleagues and friends.
Transparency and “give and take” are keys to our relationship success. We approach our relationship with openness and transparency. There is no one-sided sharing or trying to read-between-the-lines when we connect. We have mutual respect for our organizational missions, are collegial and candid, and proactively look for ways to work together while being clear about what it is we are hoping for in our interactions with one another. Our initial relationship-building was foundational for supporting this kind of openness, which is why the goal of developing these kinds of partnerships—at least in the beginning—should be purely for the sake of building them. Solid relationships lead to trust and openness, which help foster solid collaborations.
We are in it for the long-haul. Both of our organizations have a bold vision for change and, given the enormous complexity and challenges of our work, we know that strategic partnerships are critical to progress. Given that we are so-mission aligned, relationship-building makes sense for our foundations. As we make progress toward our goals, ongoing communication opens opportunities for EHF to learn about the various priorities that RWJF is developing at the national level and for RWJF to understand how a local funder is grappling with similar issues. RWJF brings a national perspective, connections, and resources to those conversations while EHF brings equally valuable on-the-ground knowledge, expertise, and insights from a very different part of the country than Princeton.
For RWJF and EHF, this meaningful partnership is a clear win for both our organizations, and of course, for the grantees and communities in which we work.