Background: Almost 60 million people in the United States live in rural areas and have significantly less access to health care, limited access to healthy food, fewer physicians, insufficient public transportation, limited availability of broadband internet, and financial constraints. Alliance of Community Health Plans (ACHP) members—25 high-performing nonprofit, community-based health plans and provider organizations—provide coverage and care for over 22 million Americans. Approximately 57 percent of the counties they serve are designated by the Health Resources and Services Administration (HRSA) as rural. Residents of these counties experience multiple barriers that compromise their health and limit the effectiveness of traditional methods of outreach and engagement of health plan members. Fortunately, ACHP plans are among the most innovative in the nation, and their deep community roots and strong local partnerships give them a unique understanding of the complexities and needs of the populations they serve. ACHP hypothesizes that interventions designed and implemented in partnership with rural communities, the trusted organizations within those communities, and the people they serve can produce comprehensive, patient-centered approaches to care that are both tailored to the unique strengths and needs of rural communities and extend access and engagement to better meet people’s needs and improve outcomes.

Proposed Solution to the Problem: With the proposed PCORI award, ACHP seeks to continue building the evidence base for effective use of nonclinical, community-based roles to engage and support patients in the healthcare system of the future. Specifically, this project aims to equip health plans serving rural populations with innovative, evidence-based methods of engaging their members and communities in developing population health improvement strategies that build on inherent strengths and expand access to care that is tailored for them. Gaining experience with implementation of these types of patient-centered, community-based approaches is critical for incorporating them into payment and benefits approaches in the future.

Objectives: The primary objective of the project is for health plan leaders to explore evidence on co-developing community partner programs that improve chronic disease outcomes, with an eye toward implementation of co-development methods for innovative population-based health management. The project team aims to (a) promote evidence-based methods for building deep partnerships between ACHP members, their community partners, and health plan members, and (b) advance health plan ability to engage community partners and health plan members in co-development of targeted interventions.

Activities: After disseminating evidence supporting co-development methods, including the PCORI-funded study “Does a program that focuses on lifestyle changes reduce heart disease risk factors in a rural community in Appalachian Kentucky?” by Debra Moser, PhD, and team, during a preconference webinar, ACHP will partner with Spring Street Exchange to analyze the depth and nature of existing partnerships for a subset of ACHP plans. A multi-stakeholder work group will be convened to create an Opportunity Assessment Guide based on the results of the partnership assessment and discussion during the preconference webinar and conference session. The Opportunity Assessment Guide will provide health plans with a starting place for fostering more meaningful collaboration with their community partners and eventual co-development of solutions to address community health needs.

Projected Outcomes and Outputs:

• An increase in health plans’ interest and confidence in their ability to partner more deeply with community-based stakeholders
• Increased number of ACHP members that have used co-development or are interested in learning to use co-development methods in program design
• ACHP will do a pre-post survey of member plans to evaluate their experience with and interest/confidence in using co-development methods.

Patient and Stakeholder Engagement Plan: The primary stakeholders for this project are ACHP’s member health plans and affiliated health systems, their members, and the communities they serve. This proposal reflects the clinical priorities of ACHP’s members, specifically rural health, deeper community partnerships, improvement of chronic illness outcomes, and reduction of risk factors. ACHP member companies will be involved in all aspects of project execution.

Debra Moser, PhD, the PI of the primary research ACHP plans to disseminate, will be engaged throughout the project in a variety of roles. One example is identification of members of her community advisory board to help plan and participate in the preconference webinar and/or serve on the advisory committee for the conference session.

The perspective of the community partners is critical in understanding challenges, pitfalls, and success factors in building deep, collaborative relationships that support co-development processes. ACHP will incorporate them in planning and execution of the preconference webinar, the conference session, and development of the Opportunity Assessment Guide, and will monitor engagement to ensure adequate representation. The project team anticipates having input from no fewer than five community partners across ACHP’s membership and will track engagement throughout.

Project Collaborators:

• ACHP Member Health Plans
• Debra Moser, PhD
• Community organizations and representatives