Among the roles health systems can assume when addressing social determinants of health, becoming a funder of external organizations and projects is one of the most attractive and foundational. It provides the system a means of advancing community health initiatives that are aligned with its own goals, while stopping short of developing the capabilities to execute on those initiatives independently.

However, becoming a funder is a complex and potentially fraught ambition, particularly if the health system misunderstands the various funding opportunities available. Fortunately, philanthropy teams are skilled at setting overall funding goals, testing the viability of specific funding opportunities (e.g., campaign feasibility studies), structuring impact tracking frameworks with fund recipients, and engaging cross-functional stakeholders in the process. These are capabilities that health systems will benefit from greatly.

Development leaders should advise the hospital or health system on the most effective ways to create high-impact investments. Doing so will not only serve the interests of the health system, it will also afford the philanthropy team an opportunity to actively scope its own further involvement in community partnerships.

Case in brief: Texas Health Resources Foundation reconciles health system and donor goals

• 27-hospital health system in North Texas

Texas Health Resources (THR) sought to develop an infrastructure for funding new community health investments using philanthropy. THR’s leaders initially hoped to ask donors to support a community health impact fund, which would make grants to local organizations aligned with critical health objectives. However, the foundation team was unsure that donors would attach to that idea. Despite showing interest in community health needs, donors weren’t likely to invest in a grantmaking fund without knowing how the funds would be used.

THR Foundation used market research to understand whether donor interests aligned with the health system’s funding strategy and offered evidence-based alternatives. The foundation conducted a feasibility study with donors to determine what type of community health strategy they would fund. Donor feedback helped the foundation design a twopronged, market-informed approach to funding community health improvement programs.

As a result of the foundation’s guidance, THR was able to put $7.4 million of philanthropy and other resources into its community health improvement programs in FY2019.

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Health systems are not traditionally structured to manage an external grantmaking function, an increasingly common strategy for community partnerships. It is administratively cumbersome and requires unfamiliar expertise.

While foundations and development teams exist primarily to raise funds for their hospitals or health systems, they are also responsible for ensuring those funds are distributed and spent in a manner that is consistent with both the donor’s intent and the organization’s goals. As such, philanthropy teams are well positioned to design and even manage a community health grantmaking process, regardless of whether the funds are supplied through donors or the health system’s operating income. With their inherent expertise, philanthropy teams offer the experience and tools the health system needs to source, vet, and select funding opportunities.

To be certain, other health system stakeholders should remain involved in establishing application requirements, evaluating submitted proposals, and selecting award recipients. But philanthropy teams can ensure that the right organizations are selected and that the funds are distributed to maximize impact.

Case in brief: IU Health Foundation administers Community Impact Investment Fund

• 16-hospital health system headquartered in Indianapolis, IN

Indiana University (IU) Health Foundation manages grantmaking activities associated with the IU Health Community Impact Investment Fund, a $100 million commitment to address the social determinants of health. The foundation sources applications from health system employees on behalf of external partners, coordinates an interdepartmental committee review process, and manages the distribution of funds to award recipients. Ownership of these responsibilities has positioned the foundation as an indispensable contributor to IU Health’s community health goals.

IU Health Foundation’s management of the grantmaking process has also encouraged greater pooled funding from community partners and outside donors. The foundation’s application process encourages and prioritizes proposals that demonstrate additional funding commitments to the project under consideration. The foundation is also instrumental in bringing new funders to the table during early project-scoping conversations.

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Community partnerships, by definition, recognize the power of collaborative solutions to intractable challenges. When health systems decide to engage with outside organizations, whether in a funding capacity or in a more active role, they acknowledge a mutual benefit to all parties. They also create the context for joint fundraising activities between organizational collaborators.

Joint fundraising initiatives leverage the brands, expertise, and programmatic contributions of two organizations into a case for support that is often stronger than the same story told by only one organization. Institutional funders and individual philanthropists alike are drawn to support initiatives that show a heightened commitment to creating impact at a larger scale, a notion exemplified by partnership-driven approaches.

Health system philanthropy teams that agree to fundraise in collaboration with external partners can do so within a range of commitment levels. It is possible to co-create and co-brand a strong case for support, while otherwise maintaining relatively independent day-to-day fundraising activities. More ambitious initiatives will involve joint cultivation and solicitation of donors.

Regardless of the scope of activity, both organizations must define their roles and agree to certain parameters at the outset of the relationship. Navigating shared donor relationships, and determining how to appropriately split funds from joint gifts, will be much more efficient if these eventualities have been planned for.

Case in brief: Children’s National Hospital and MedStar Georgetown University Hospital collaborate to raise funds for early childhood behavioral health initiative

• Children’s National is a 323-bed pediatric hospital located in Washington, DC
• MedStar Georgetown is a 609-bed teaching and research hospital located in Washington, DC

Children’s National Hospital and MedStar Georgetown University Hospital are located just a few miles apart in Washington, DC. They share a goal of improving early childhood behavioral health in their region. They also understand that the challenges are too big for any single organization to solve. The hospitals began collaborating and combining their unique strengths in 2012, and then launched their programmatic partnership known as the Early Childhood Innovation Network (ECIN) in 2015.

ECIN is funded by philanthropy, raised through the combined efforts of the hospitals’ development teams. Children’s National and MedStar Georgetown began their fundraising collaboration with a seed grant request from a private foundation, which generated a multi-year, seven-figure investment to launch the initiative. Since then, the two teams have jointly crafted multiple grant proposals and share in ongoing cultivation and stewardship of their institutional and individual funders.

The collaborative efforts of these two organizations have helped ECIN drive impact and expand its reach. In addition to funding new pediatric behavioral health interventions, philanthropy enabled ECIN to hire more than twenty programmatic and clinical staff since its inception.