Framework for Assessing Accountable Communities for Health

The questions below assess if and how the Common Elements of an Accountable Community for Health (ACH) are implemented. They are meant to be generic to ACH initiatives and may have to be adapted or refined based on a particular initiative. Central to learning about the success of the ACH model – and how best to replicate or scale it – will be having comparable data in response to these questions. 

Read the full Funders Forum on Accountable Health paper, A Common Framework for Assessing Accountable Communities for Health (PDF).

To what extent is the community addressing identified needs together? How have relationships among community partners and residents changed?

• To what extent are community partners aligned behind a shared vision and purpose for action?
  • What was the process for identifying the shared vision and purpose of action?
  • How are resources (human, financial and other) deployed and/or leveraged in a way that is aligned with the vision and community identified priorities?
  • How have community partners aligned their values and mission to the vision?
  • What efforts are underway to institutionalize organizational partnerships and cultivate community ownership? How have these relationships evolved?
• To what extent and in what way is mutual accountability (among the community partners and to the residents) built into the system? 
  • What structures or forums are in place that are deliberate in elevating community voice, and acting on community input? 
    • How is resident ownership cultivated through invited and invented spaces?
    • What is the level of resident and community partner motivation and activation? 
  • How are equity and transparency ensured in decision making and resource allocation? 
  • How is accountability among participating organizations established and tracked? 

To what extent are the activities of the community sustainable and aligned with the shared vision?

• What is the portfolio of interventions that advances the vision?
  • Is there a theory of change or formal strategy that is the basis for the portfolio of interventions?
  • At what (multiple) levels are the interventions targeted (both at the community level and the individual level)?
  • Are the interventions evidence-based?
  • Do the interventions drive towards the same shared outcomes?
    • Do the interventions reinforce each other and build capacity for new activities?
  • Which targeted populations is the portfolio of interventions reaching? 
  • To what extent is the portfolio of interventions grounded in an equity approach/lens?
• Is the ACH financially sustainable? 
  • What were the start-up costs of the ACH and how are they funded? 
  • What are the on-going costs of maintaining the ACH?
  • What are the current sources of financial support for integrator functions?
  • Are there meaningful partnerships with state Medicaid, private insurance, and/or new payment models to support the collaborative’s priorities? Are all partners supporting investment in more upstream interventions?
    • How is the business case being made for policy makers and potential investors/payers?
    • Is a mechanism for braiding and blending of funding planned or established? How inclusive are funding efforts in the community?
  • What has the impact of the ACH been on the work and resources of non-health sectors participating in the ACH?

Is there capacity for continuous learning?

• What are the data systems that support the portfolio of interventions?
  • To what extent is the ACH able to access and use data from multiple participating organizations?
  • What are the mechanisms to ensure communication and feedback among community partners serving the target population?
  • How does data sharing occur among community partners and across sectors?
• To what extent are data and metrics being used to understand the progress or unintended consequences of the ACH?
  • What are the common metrics being used across sectors to assess performance?
  • Are metrics developed relevant to each sector that address the same goal?
  • What is the process by which measurable community level outcomes are identified, including short term, long term, and measures for community health equity?
• What are the communication systems in place (at the systems level and at the intervention level) to ensure a feedback loop among various sectors and to the community partners/residents?
• How are interventions regularly adjusted, started, and/or ended based on new data for multi-sector partners and learning from community input?
  • What are the factors driving a change in the portfolio of interventions?

Graphic: three critical areas of assessment for accountable health projects 

1. Components of Readiness (green): Used to understand a community's capacity to undertake an accountable health initiative and determine any assistance needed to raise that capacity.
2. Common Elements of ACHs (blue): Intermediary structures, policies, and relationships that move a community from pre-implementation to implementation of an accountable health initiative. These elements are based off of the Funders Forum's Principles of Accountable Health.
3. Outcome Goals (purple): Outcomes associated with the goals of any given accountable health initiative. They vary from project to project, and are determined by funders or the communities.

The Funders Forum on Accountable Health is engaged in work to promote assessment of the Common Elements of ACHs in an effort to learn the value, relative value, and dose of those common elements needed to ensure effective accountable health initiatives.