One of the largest federal investments to strengthen local safety nets through community coalitions was the Community Access Program (CAP) and its successor, the Healthy Communities Access Program (HCAP). From 2000 through 2006, HCAP provided grants to local communities to strengthen the health care safety net that serves the uninsured and underinsured. In total, HRSA awarded 265 grants in 45 states plus the District of Columbia and the Virgin Islands. The program was unfunded in the FY 2006 budget.
One of the ways in which CAP/HCAP distinguished itself from other federal safety net programs was by requiring collaboration. Namely, grants were given only to consortia of local providers, not to individual institutions. The program sought to overcome the fragmented nature of safety net care by bringing the major players together and providing funds to address problems that cannot adequately be addressed by individual providers or organizations. The CAP/HCAP-funded coalitions focused on activities such as service integration, expansion of the delivery system, cultural competency, provider education, community and patient education, disease detection and prevention, service integration, and new coverage plans for the uninsured, among others.
The question of what has happened to the CAP/HCAP coalitions during the intervening years since they stopped receiving federal funding is an important one—not only to shed light on the effectiveness of the CAP/ HCAP coalitions, but to learn more about what happens to the dynamics of collaborations that have been built around grant funding once that funding no longer exists. Therefore, ASPE is contracting with NORC to conduct a study that uses the CAP/HCAP experience to learn about the long-term sustainability of federally-funded coalitions. The study will assess:
1. The number of community coalitions funded under CAP/HCAP that are still in existence, and the current characteristics of these active community coalitions;
2. The extent to which coalitions are self-sustaining after CAP/HCAP funding ended, and the barriers to and facilitators of their sustainability;
3. The impacts that CAP/ HCAP coalitions had post CAP/HCAP funding, and the types of outcomes achieved; and
4. How the CAP/HCAP coalitions have evolved to address the changing needs of their communities or the health care delivery system.
Using the CAP/HCAP grantees as a lens to explore sustainability of community coalitions is particularly important today given new federal investments in clinical and community-based strategies through the American Recovery and Reinvestment Act (ARRA) and the Affordable Care Act. Provisions included in both pieces of legislation fund community-based strategies to improve health. Understanding the extent to which programs and coalitions can be sustained post-funding will be of paramount importance as the federal government continues to invest in innovative community-based strategies to improve the health outcomes of Americans.
As part of the study a survey is being administered to the 265 coalitions funded through CAP/HCAP, providing a unique set of data to assess coalition sustainability and the factors that enable and hinder sustainability. The survey will focus on CAP/HCAP coalitions’ sustainability, impact, and outcomes post-funding. The survey design and content is informed by a review of the literature on community coalitions including coalition functions, impact, and sustainability. The survey is designed to be consistent with the data from CAP/HCAP coalitions’ six month monitoring reports (6MMRs) and built on the data collected as part of the national CAP/HCAP program evaluation conducted in 2004.
Results from the survey will not only contribute to answering the study’s overall evaluation questions, but will also inform NORC in the selection of sites for key informant interviews and site visits. Specifically, telephone interviews will occur with a subset of 20 CAP/HCAP coalitions that have been sustained as well as 20 CAP/HCAP coalitions that have not been sustained. The key informant interviews will utilize a structured instrument tailored to the coalitions’ experiences. Site visits will be conducted with seven coalitions that were sustained post-funding.