Sustainability & Wellness Fund

July 9, 2018 - Sustainability and Wellness Fund Workgroup Meeting Summary

July 09, 2018 at 02:00 pm

San Diego Accountable Community For Health Sustainability and Wellness Fund Workgroup Meeting Summary for 7/9/18

Welcome, Review & Accept 5/9/18 Meeting Summary

Christy Rosenbergcalled the meeting to order and welcomed everyone.  She reviewed the meeting summary from last month, which outlines the investingstrategies that will be further explainedat this meeting.  There were nochanges to the meeting summary; the summary will be posted on the SD ACH website.

Introductions were made around the room. Threenew attendees introduced themselves: Steve O’Kane from Health Center Partners,Wendy Hileman from Healthy Adventures Foundation, and Anthony White from Family Health Centers of San Diego.

Background and Refresh

The workgroup reviewed the mission, vision, and values of the SD ACH, as well as the concept of the portfolio of interventions. An overview of the priority outcomes and indicators was provided, including the data sources associated with each; data willbe stratified according to the five lenses of health equityas well as payer source. The time frame for the achievement of 20% improvement is still being decided upon by the Data & Metrics Workgroup, though it will likely be ten years.

Christy summarized the phases of the development of the SD ACH:

• Aligning and Connecting (2017-2018)

• Learning and Designing(summer 2018—current phase)

• Creating and Scaling (fall 2018)

A review of key themes from the May All Workgroup Meeting was presented, includinga summary ofanswers to keydiscussion questions:

• What is unique and compellingabout the SD ACH?

• What is the value to your organization?

• Who loses, and what is disrupted?

The group discussed the broaderquestion of distribution of resources based on true need vs. equality, seeking to clarify the concept of “need” in this context (specifically whether the issue is health need). Workgroup members commented that if the question being asked is where the greatest health impact may be realized, the Workgroup should provide input on this issue. In addition, Workgroup members stressed that a key consideration is the projected impact of the funds that are spent (rather than how the funds are distributed).

Key questions were reviewed, including the ultimate targets for wellness fund investment. In a previous meeting, representatives from the Imperial County ACH presented information on how theirWellness Fund dollars were amassed, as well as the difficulties experienced in making distribution decisions.

Update re: Medicaid Strategy

The Workgrouppreviously decided that the SD ACH should pursuea Medicaid strategy for sustaining the ACH. Kitty will engage with Bobby Wunsch ofPacific Health Consulting Grouponnext steps in exploring opportunities for pursuing Medicaid funding to support the ACH. Workgroup members also suggested exploring Families First, Health and Human Services, and Title IV-E funding.

Update and Discussion re: Making the Value Case

Kitty reviewed key questions facing the Workgroup as it planned for thepotential sources of funding, definition of value, and investment vehicles for the wellness fund. As a way to move forward on the question of valuation, or how to define the value of cardiovascular health, the SD ACH is receiving the assistance ofconsulting firm John Snow Incorporated(JSI). Kitty displayed the logic model created by JSI; the workgroup agreed that the logic model is appropriate. Kitty enumerated key discussion questions related to valuationto be addressed, and will update the Workgroup on JSI’s progress.

Update and Discussion re: Wellness Fund Investment Strategy

Portfolio of Interventions and DiscussionsKitty provided the brief definition of the Portfolio of Interventions (POI), which the group felt appropriately communicated the nature of the endeavor. The POI survey is currently in the testing stage, and will be distributed to all ACH stakeholders in coming weeks. The information gathered will be used to explore whatprogramsthe ACH could potentially fund. Options include: coordinating and linking (i.e. new shared workflows for referrals or technical assistance with coordinationof programs); sharing and aligning data (including supporting building of capacity for data collection, or providing costs of building infrastructure for data sharing); and addressing the gaps (testing new or expanded interventions and programs, or capacity building for fund development). 

The Workgroup provided feedback on this list of options, noting that the ACH might see its role as facilitating conversations between potential partners. In addition, members felt the issue of potential outcomes required more careful deliberation; therefore support should go toward identifying remediable factors in the general San Diego population, and resources should be directed toward programs withthe greatest potential impact. This may be a question for the Data & Metrics workgroup and participating epidemiologists. Kitty noted that key questions of interest to the Data & Metrics Workgroup are whether potential partners can and will share data, given current publicly available data sources have been considered unsatisfactoryfor certain indicators. In addition, the Workgroup is currently workingon constructing a narrowly-defined metric for wellbeing.

Backbone Sustainability and Backbone Roles

Starting with the principle that all organizations require a backbone, Cheryl Moder presented the roles of theSD ACHbackbone and the anticipated outcomes associated with each of these roles:

• Guide vision and strategy: building a common understanding of problems to be solved, and provide strategic guidance

• Support aligned activities: Cheryl likened this role to that of an air traffic controller—guiding partners to work together more effectively, and in doing so,cultivate feelings of partnership and growing levels of trust

• Mobilize resources: provide effective management of resources, including potentially providing technical support to partners in their own fundraising efforts. This function can be seen across the country, with funding based on aligned goals across multiple organizations working on collective initiatives

• Build public will (an external communications function): creating relationships between and among partners, and ensuring that communities are engaged, aware, and feel empowered to work to achieve goalsin their own community settings(rather than solely in the setting of the ACH)

• Advance policy: a policy agenda will ultimately developed, and the backbone will be in a position to perform advocacy work, which partners maynot have the resources to do

• Establish shared measurement practices: the role of bringing partners together to develop shared measurement systems is often one of the most challenging that backbones must play.Ultimately, this could lead to a shared data system, and increased levels of data and evidence-driven decision making and strategizing

In response to the question of whether thebackbone would support agoverning body, Cheryl affirmed that the backbone can be likened to a staff supporting the governing body, but noted that the backbone serves all partners, not just the governing body.

Backbone Summary Budget

Kitty supplied the Workgroup with details of the summary budget for the ACH backbone, the purpose of which is to build an understanding of the financial resources required for ongoing activities, and assure that partners are supportive of backbone action in seeking base financial resources. 

The Year 2 backbone support budget was described, which includesapproximately $250,000 of “leveraged support,” the funding of which is not guaranteed. The budget described assumes that the ACH is a stand-alone entity not housed as another organization.

Kitty responded to questions regarding the entity receiving this backbone support funding. The San Diego Healthcare Quality Collaborative (SDHQC), a 501c3 organization, the governing structure of which is very similar to Be There San Diego, receives this funding. The questionwas raisedof what entity has the authority to make fundingdecisions; the Sustainability and Wellness Fund Workgroup willsend recommendations to the Stewardship Group to make final decisions. The Wellness Fund may either be housed inside or outside the SDHQC (this question has not yet been resolved). The SDHQC’s budget will be governedby its Board of Directors, while the SD ACH budget will be governed by the Stewardship Group.

Workgroup members raised the possibility of starting a separate 501c3 for solely the SD ACH as a step toward achieving sustainability, as well as eventually expand to issues outside of cardiovascular health.

Kitty reviewed the specific funding needs for Year4, noting that the SD ACH willapply for the funding under the current 501c3, given the process for submitting funding applications must start as soon as possible. Workgroup members asked about other CACHI grantees: what is the CACHI vision, and how do we compare to others? Kitty responded that the SD ACH is unique in terms of how it is structured. The SD ACH should pursue its own vision for Year 4 funding, which would facilitate applying for additional grants. Workgroup members discussed whether the SD ACH needs to create anew entity, and if we aim to apply for additional funding, what is neededto position the ACH to best do so. The POI survey will also inform the construction of the Year 4 program and investments.

Decision Item

The Workgroup accepted the backbone summary budget and will forward it to the Stewardship Group for consideration.

Next Steps

• TheWorkgroup recommended going askingStewardship Groupwhether a new 501c3 should be created for the SD ACH

• A document should be created to provide illustration of what will be required to sustain the backbone, and lay out the vision for Year 4 and beyond

• Criteria for the types of portfolio activities the SD ACH should support should be defined

• Continue to work with JSI to refine the value of cardiovascular health; add reduction in disparities to the set of “high value outcomes” listed in the JSI logic model

• Members were reminded of the upcoming Stakeholders meeting scheduled for September 13, 2018



o loses, and what is disrupted?

What is the value to your organization



o loses, and what is disrupted?What is the value to your organization



o loses, and what is disrupted?

What is the value to your organization



o loses, and what is disrupted?

Date and Time

July 09, 2018 02:00 pm
July 09, 2018 04:00 pm

ACHs build on prior efforts to coordinate and integrate various organizations, programs and services by linking their activities together in a coherent and reinforcing portfolio of interventions across five key domains.