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Emerging Lessons from Clinical-Community Partnerships in North Carolina

Background

Nearly a decade ago, the Blue Cross and Blue Shield of North Carolina Foundation launched Community-Centered Health to increase the capacity of community-based organizations and health care entities to act on the root causes of health and health inequities. This long-term, multidimensional approach centers the perspectives of those most impacted by inequities and through inclusion of all sectors – public, private, and government – supports communities in identifying specific barriers to good health and implementing approaches to overcome them.

Community-Centered Health has been a significant and impactful undertaking, providing invaluable perspective which has extended well beyond the organization’s footprint in the nine funded communities. Community-Centered Health has helped the Foundation focus more explicitly on equity, understand the value of power shifts, elevate the perspectives of residents and community-organizations, and become a more thoughtful, community-centric investor in supporting health equity.

More importantly, this work has had significant impact in the communities in which it is operating, leading to successful stakeholder collaborations, policy and system changes, resident leadership, and a greater understanding of the factors within communities that impact the health of residents. This effort has also surfaced many of the ongoing and pervasive challenges and barriers within communities as well as a wealth of lessons learned.

Understanding the wide-ranging impact of Community-Centered Health, as well as the insights that can be elevated from such a complex and wide-reaching endeavor, the Foundation commissioned a formal evaluation. The objective in doing so is to support our growth as an organization, provide useful perspective to the Community-Centered Health communities, and produce a resource for others who are interested or involved in multisector, community-based health interventions.

Approach

In 2021, the Foundation partnered with Engage R+D to conduct a retrospective evaluation of the Foundation’s three initial Community-Centered Health partnerships. The evaluation, which was grounded in equitable evaluation principles, examined early progress and enduring outcomes through interviews with each community’s grantees, partners, and technical assistance providers; perspectives from Foundation staff, other funders, and researchers involved in similar community-driven initiatives; and a review of initiative-related documents, as well as secondary population-level data.

 

What We Learned

The three partnerships yielding the report’s findings are based in communities experiencing long-standing inequitable conditions, and therefore the evaluation revealed important insights about equitable community-driven change. Among the many findings detailed in the report, the process uncovered that common values and practices – such as addressing structural racism, building trust, and setting realistic expectations – provide a foundation for establishing and growing successful partnerships which can lead to community transformation. It revealed that practices in one community spread to nearby communities and neighborhoods. And, it identified that there are a variety of barriers that must be overcome, as well as approaches to do so, both within partnerships and the greater political and social contexts in which the community sits.

Perhaps most importantly, is the deepened understanding that building the power of community members and cultivating community-led decisions can transform the relationship between institutions and the communities they serve. This has had transformational impact across the Foundation, establishing a priority on community-driven change.

 

Why It Matters

Inequities within communities are widening, fueled by the continued interplay and influence of social, structural, economic, and environmental factors. Addressing these challenges requires many things, from the understanding of what specific barriers are faced by a community and the plan to tackle them, to the coalition of diverse partners and resources essential to carrying forth the necessary work.

Our hope is that this report can be of value to those committed to addressing the root causes of poor health at the community level, including nonprofits, local business, governments and agencies, health care entities, residents, funders, and more. Perhaps the lessons brought forth by our work can be a roadmap for others, offering hope and meaningful lessons and examples for achieving positive, informed change.

Community-Centered Health Cohort 1 Retrospective Report Cover

EVALUATION REPORT

Building Community-Centered Health: Emerging Lessons from
Clinical-Community Partnerships in North Carolina

Nearly a decade ago, the Blue Cross and Blue Shield of North Carolina Foundation launched Community-Centered Health to increase the capacity of communities to act on the root causes of health and health inequities. Understanding the wide-ranging impact of this work, as well as the insights that can be elevated from such a complex and wide-reaching endeavor, the Foundation commissioned a formal evaluation. The objective in doing so is to support our growth as an organization, provide useful perspective to the Community-Centered Health communities, and produce a resource for others who are interested or involved in multisector, community-based health interventions.

Download the report to learn more.