Examples of braiding and blending to support community health: a compendium of resources

This blog series “Uniting funding streams for health and social innovation” is a collaboration between the Urban Institute’s Pay for Success Initiative (PFSI) and The Brookings Institution-hosted Braiding and Blending Working Group. Though not every post is focused on pay for success, the working group and this blog series aligns with the PFSI mission of researching and supporting innovative financing solutions to today’s most pressing challenges. This series highlights the research of experts in healthcare financing focused on creative approaches.

From opioid misuse to diabetes to asthma, many health conditions and risk factors are rooted in a common set of social and structural determinants of health. Addressing these determinants requires working across sectors.

In recent years, we have seen widespread recognition of the importance of such multi-sector, collective impact work through exploration of the intersection between health and other sectors—including housing, community development, and education— and the proliferation of multi-sector community health improvement efforts like Accountable Communities for Health, Purpose Built Communities, and Invest Health.

Scaling and sustaining such multi-sector efforts remains a challenge, and through our work at Trust for America’s Health, we have identified bringing together a diverse range of funding streams as a necessary prerequisite.

But it’s not always clear how to do so. In a brief released this week, we provide a compendium of resources and examples to help local and state level entities as they explore braiding and blending funds to support multi-sector health improvement initiatives. Below, we provide a sampling of the resources included in our compendium.

Guides and Toolkits

• Blended and Braided Funding: A Guide for Policy Makers and Practitioners (2014) is a guide from the Association of Government Accountants that provides “how to” information on blending and braiding at the federal, state, and local level. The guide notes current federal funding system challenges; highlights federal statutes that authorize blended funding or otherwise increase flexibility; and concludes with a decision framework for blending and braiding.
• Blending, Braiding, and Block-Granting Funds for Public Health and Prevention: Implications for States (2017) is a publication of the National Academy for State Health Policy, based on a convening of state public health and Medicaid policymakers. It examines how federal public health funding for states intersects with Medicaid waiver authorities and proposes state responses – including blending and braiding – to various federal funding scenarios.
• Spark Policy Institute Blending & Braiding Toolkit helps communities begin to blend and braid funds, from identifying a vision and partners to defining the program or services provided. The toolkit also outlines options for developing, implementing, tracking, and improving a coordinated financing plan.

Local Examples

• Florida Children’s Services Councils are funded by counties, which are permitted by state legislation to levy a tax or set aside some of their budget (subject to voter approval) to fund the councils. In turn, these councils help fund organizations that serve children and families in the county, monitor program and provider performance, convene child advocacy partners, and provide leadership, coordination, and oversight.
• Spectrum’s School Health Program at Grand Rapids Public Schools is a partnership between a large health system and school district in Michigan that braids public and private funding streams to enable service provision and reimbursement for different health delivery models. The program utilizes school health teams of nurses and health aides to provide direct services to students in 48 schools and coordinates funding for nurses from the health system, local government, local school district, and State Department of Education.
• Public Health Improvement Fund in Allegheny County, Pennsylvania supports the public health department – with a focus on public health infrastructure and a local health improvement plan – by centralizing and blending funds initially from five local foundations. The fund now includes the two largest health care and insurance systems in the county, with plans to approach local universities as well.

State Examples

• Virginia Children’s Services Act blends funding across state agencies– social services, juvenile justice, education, and behavioral health–and allocates these funds for localities to support at-risk youth through case management. Localities contribute matching funds and report on pool expenditures as a whole, rather than by funding stream. With improved coordination of services, funding, and reporting, case managers have more flexibility and time to tailor services to youths’ needs.
• Louisiana’s Permanent Supportive Housing Program, administered jointly by the state’s Medicaid agency and housing authority, combines housing assistance with individualized services for those with substantial physical and/or behavioral disabilities to reduce homelessness and institutionalizations. The program braids funding from disaster recovery funds, federal rental assistance programs, housing development support from the Low Income Housing Tax Credit, and funding for services from Medicaid, the Substance Abuse and Mental Health Services Administration, and others.
• Rhode Island’s Health Equity Zones initiative braids prevention, categorical disease, and population health funds from federal, state, and local sources to create place-based “Health Equity Zones.” Communities receive combined funding from the state health department that enables them to realign staff, break down organizational silos, and promote cross-sector collaboration to achieve shared goals.

While blending and braiding are not new concepts, it can be challenging for state and local leaders to determine how to blend and braid funds in their communities. We hope that this compendium can serve as a useful tool for those interested in beginning or expanding their efforts to blend and braid funds to support health and well-being.

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The views expressed in the series are those of the authors; as an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research. Photo via Shutterstock.