Financing community partnerships for health equity: Findings and insights from cross-sector professionals

Objective: To enhance understanding of financial alignment challenges facing cross-sector partnerships (CSPs) pursuing health equity and offer insights to guide research and practice.Data Sources and Study Setting: We collected data through surveys and interviews with cross-sector professionals in 16 states, 2020-2021.Study Design: We surveyed 51 CSP leaders and received 26 responses. Following administration of the surveys to CSP leaders, we also conducted interviews with cross-sector professionals. The data are analyzed descriptively, comparatively, and qualitatively using thematic analysis.Data Collection/Extraction Methods: For quantitative survey data, we compare partnership responses, differentiating perceived levels of alignment among partnerships certified by the Pathways Community HUB Institute (PCHI), partnerships interested in certification, and partnerships without connection to the PCHI (R) Model of care coordination. For interviews, we engaged CSP professionals and those who fund their work. Two research team members took notes for interviews, which were combined and made available for review by those interviewed. Data were analyzed independently by two team members who met to integrate, identify, and finalize thematic findings.Principal Findings: Our work supports previous findings that financing is a challenge for CSPs, while also suggesting that PCHI-certified partnerships may perceive greater progress in financial alignment than others. We identify four major financial barriers: limited and competitive funding; state health service delivery structures; cultural and practice divides across healthcare, social service, and public health sectors; and needs for further evidence of cross-sector service impacts on client health and costs. We also offer a continuum of measures of financial sustainability progress and identify key issues relating to financial incentivization/accountability.Conclusion: Findings suggest a need for public policy reviews and improvements to aid CSPs in addressing financial alignment challenges. We also offer a measurement framework and ideas to guide research and practice on financial alignment, based on empirical data.