A selection of informational materials to promote further understanding and development of the ACH model

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General ACH Information & Similar Initiatives

Podcast - Mar 2022

Common Goods Podcast on CACHI

Features CACHI Director Barbara Masters and West Sacramento ACH leader Debra Oto-Kent in a conversation about their work with Accountable Communities for Health.

Common Goods
Poem - Mar 2022


Created at the CACHI 2022 convening to capture the themes and ideas discussed at the meeting

Brief - Mar 2022

CACHI Overview-Spanish

Provides an overview of CACHI and an Accountable Community for Health in Spanish

In this overview video, learn how ACH's advance equity and community health in 13 communities across California.

Brief - Feb 2022

CACHI Overview January 2022

Provides an overview about CACHI and Accountable Communities for Health

Provides guidance and resources to assist small cities and rural communities in developing multi-sector approaches to help all individuals to live long, healthy lives.

Build Healthy Places Network

Offers an 11-module curriculum to help communities build and strengthen multi-sector collaboratives and Accountable Communities for Health

Population Health Innovation Lab & CACHI

Provides a step-by-step guide to emulating Rhode Island's initiative to create health equity zones throughout the state.

Rhode Island Department of Health & ChangeLab Solutions

Describes key lessons from examining ACHs across the country and makes recommendations about incorporating multi-sector partnerships, especially to advance equity.

Funders Forum on Accountable Health

Provides a guiding framework for the things that all people and places need in order to thrive, built around vital conditions.

WellBeing Trust & CDC Foundation

Provides practical communications tools and resources to better communicate with the public about public health

de Beaumont Foundation and Aspen Institute

Describes the elements of an ACH for Children and Families, an emerging model for improving childrens health.

Nemours Children Health Services and others

Describes the ACH model with a focus on its central operating principle--collective accountability--as both a driver and an indicator of permanent systems change.

CACHI + Practical Playbook

Describes findings from 19 communities efforts to create systems changes and improve health outcomes

BUILD Health Challenge

Provides links, tools and data sources for community health improvement efforts

100 Million Healthier Lives
Fact sheet - Oct 2019

CACHI Overview

Provides an overview of the California Accountable Communities for Health Initiative


Analysis of California’s state budget finds that health care spending has skyrocketed, leaving fewer dollars to fund programs that prevent illness at the community level

Lown Institute

Provides a vision and definition for a transformed health system to support community health and advance equity and compares and contrasts it with the current system

Tool Kit - May 2019

Upstream Communications Toolkit

Provides tools to improve communications about the social determinants of health to help health care, public health and human services leaders find common ground.

Health Begins

Provides a policy compendium highlighting a promising set of federal, state and (occasionally) local policies to achieve health system transformation goals

Altarum Health Care Value Hub

National effort to advance holistic, value-based, person-centered health care that can successfully impact the social determinants of health.


Profiles and outlines key factors behind the success of California’s HiAP approach, and highlights several policy achievements

Center for Health Care Strategies

Explores a variety of state-level multi-sector actions for addressing the social, economic, and environmental factors that impact health

Center for Health Care Strategies

Describes commonalities of multi-stakeholder collaboratives regarding their structure, initial successes, barriers and best practices

Case Study - May 2018

Healthy Homes Des Moines Case Study

Describes how a BUILD grantee reduced pediatric asthma through home improvements and education.

BUILD Health Challenge

Provides an overview of social determinants of health as well as emerging federal and state initiatives to address them.

Kaiser Family Foundation

Shares information about Accountable Health initiatives supported by various public and private funders.

George Washington University

Review of the literature that describes the fundamentals of ACHs including common characteristics, major challenges, and variations in stakeholder engagement.

George Washington University and National Academy of Medicine

Describes core elements of an accountable community for health for children and families.

Website - Jun 2017

Moving Healthcare Upstream

A partnership between Nemours and the UCLA Center for Healthier Children, MHCU provides case studies and resources regarding innovations to improve community health

Moving Healthcare Upstream
Website - Jun 2017

ReThink Health

ReThink Health conducts research, develops tools and new approaches to help cross-sector teams tackle regional health and healthcare redesign

ReThink Health

A scan of 17 multi-sector community health efforts across the country.

Academy Health

Describes the experience of a learning lab of 10 ACHs in Vermont

Public Health Institute

Review of state efforts to develop and test ACH models within the federal SIM initiative

Center for Health Care Strategies

Provides an overview of whole person care pilots and examples of projects in California safety net systems.

California Association of Public Hospitals and Health Systems

Profiles four states implementing ACHs

National Academy for State Health Policy

Outlines the ACH model as it is emerging in California and provides examples of relevant collaborations throughout the country

Prevention Institute

Describes critical elements of an Accountable Community for Health and goals of the Initiative


Provides lessons from states implementing population health improvement approaches under State Innovation Model grants

Institute of Medicine


Summarizes various various, distinct funding opportunities available to help communities and providers transition to Cal AIM.

CA Dept Health Care Services

Provides an overview of the various roles the ACH plays as a cross-sector collaborative in catalyzing community change and health equity.


Provides information in support of the Commentary authored by five leading health foundations calling for investment in Recovery and Equity Councils


Cal Matters Commentary by 5 CACHI funders that describes how federal state & local COVID relief funds could catalyze creation of ACH-like Equity and Resiliency Councils


Provides policy recommendations to the federal government for improving health and equity.

Manatt Health

Provides a comprehensive inventory and roadmap for advancing anti-racism policies & creating community-level conditions that support health and opportunity for everyone

Building Healthy Places Network & Shift Health Accelerator

Proposes a new federal program of Response and Resilience Accountability Councils, modeled on ACHs, to support communities hardest hit by the pandemic.

Funders Forum on Accountable Health and CACHI

Describes how ACHs can support Cal AIM by providing the mechanism to build partnerships, coordinate services, engage community, and incorporate a prevention lens.


In this Capitol Briefing, hosted by CACHI & GWU's Funders Forum on Accountable Health, experts take a deep dive into how ACHs are improving community health.

CACHI and Funders' Forum
Power Point - Nov 2019

Presentation for Legislative Briefing

Provides introduction to CACHI as well as national and Washington State perspectives on the Accountable Community for Health model


Provides evidence of success for the ACH model from California and other states.


Consumer, Community Engagement and Equity

Provides session videos and resources from a September 2022 convening "Operationalizing Equity-Promoting Policies to improve the Social Determinants of Health"

Invest Health

Provides a framework that can be used as both a planning and an assessment tool for all types of collaborative work.

NYC Department of Health and Mental Hygiene

Charts a pathway to strengthen and transform our local democracies.

Movement Strategy Center

Opening commentary of a three-part series that examines the relationship between health and power building.

National Academy of Medicine

Drawn from a longer report, offers the 3 questions to center equity in community health partnerships, with considerations specific to public health agencies.

BUILD Health Challenge

Highlights learnings from RWJF initiative "Lead Local: Community Driven Change and the Power of Collective Action

USC Equity Research Institute

Reflects on the last 10 years of collective impact and identifies the importance of centering equity for collective impact to succeed.


Helps health care organizations to increase the primary care improvement efforts that center racial equity.

Health Begins and CHCF

Provides a framework for how government recipients of American Rescue Plan Act, and potentially other initiatives, can be held accountable for addressing equity.

Funders Forum on Accountable Health

Provides a framework for assessing the role of partnerships between community-based organizations and healthcare in contributing to equitable health outcomes

Non Profit Finance Fund

Provides a range of comprehensive strategies to address the fundamental drivers of health inequities

ChangeLab Solutios

Recommends six key strategies for how payment and delivery system reforms can advance and achieve greater health equity.


Proposes a new health equity assessment framework for ACHs that highlights the main pathways and opportunities to address health equity.

Funders Forum on Accountable Health

Provides case studies, resources and tools related to the principles of equity and justice.

Non Profit Quarterly

Explores the potential of ACHs to address the social determinants of health and suggests a measurement framework to assist ACHs in pursuing a pathway to health equity.

Commonwealth Fund and Funders Forum on Accountable Health
Resource Guide - Jul 2020

Racial Equity: Getting to Results

Outlines a six-part strategic approach geared to address all levels of institutional change to advance racial equity.

Local and Regional Government Alliance on Race and Equity

Highlights the value of ensuring the involvement of those with lived experience in policy and systems change in multi-sector collaboratives.

Report - Mar 2020

Status of Health Equity Report

Examines the underlying socioeconomic factors that have a significant influence on health & well-being, and provides ways to address them through collaboration.

Root Cause Coalition
Report - Feb 2020

Screening for Social Needs

Describes various screening tools used for assessing the social needs of patients.

Center for Community Engagement and Health Innovation

Step-by-step guide to uncovering root causes of health inequities and a tool to help track progress

County Health Rankings

Provides a planning guide and curriculum for implementing a resident engagement strategy

ReThink Health

Lays out a conceptual framework to organize delivery system and payment reform with health equity, and provides a menu of policy options for reducing health inequities.

Families USA
Report & Toolkit - Mar 2018

Engaging Communities with Lived Experience

Describes the way in which community leaders & community champions formed partnerships with one another as part of 100Million Healthier Lives (report links to Toolkit)

100 Million Healthier Lives

Classifies best practices according to three key outcomes: resident awareness and participation, feedback and input, and active resident leadership.

ReThink Health

Findings from Truth, Racial Healing & Transformation effort including policy recommendations that can help achieve health equity.

Trust for America's Health

Supports nonprofit hospitals, health systems, and other stakeholders to translate data from Community Benefit Insight into better community investments.

Public Health Institute

Issued by the National Quality Forum (NQF), the roadmap guides healthcare providers and payers to use quality performance measures to eliminate healthcare disparities.

National Quality Forum
Website and Toolkit - Aug 2017

Health Equity Guide

Offers a set of strategic practices, including case studies, that health departments can apply to more meaningfully and comprehensively advance health equity.

Human Impact Partners

Provides strategies for incorporating an equity lens into planning processes.

Spark Policy Institute

Offers tools, information, case studies and other resources to help non profits develop and improve core competencies on community engagement

Building Movement Project
Report - May 2017

What is Health Equity?

Provides a framework, definition and principles of health equity


Provides comprehensive data about the extent of disparities in California and a roadmap for how to achieve health and mental health equity.

California Department of Public Health, Office of Health Equity

Data & Data Sharing

Website - Nov 2022

Mapping Tools

Provides a collection of mapping tools for community development and health that can help demonstrate disparities and need, provide baseline data, document trends, etc.

Building Healthy Places Network

Describes the five potential Drivers of Health measures — food insecurity, housing instability, transportation, utility needs, and interpersonal safety — for Medicare.

Commonwealth Fund

Provides guidance guide institutions away from systems that perpetuate harmful practices and towards anti-racist systems that empower communities.

211 CIE San Diego, CA Children's Trust & HealthLeads

Offers five Guiding Principles to inform measurement that effectively aligns systems’ actions with the needs and priorities of the communities to address inequities

American Institute for Research

Provides a reference guide to hep organizations identify, select, and track data indicators related to equitable health outcomes for young children and their families

Project HOPE

Provides guidance on how to address ACH-related data issues, emphasizing connections between outcomes & interventions, and the data needed to track progress.


Provides a "community intelligence platform" and other resources that enable local governments to identify and utilize data for decision-making

Website - Jan 2020

Child Opportunity Index

Provides a wealth of child-related data, particular as they relate to advancing equity

Brandeis University

Summarizes best practices and data sharing bright spots to assist communities in navigating data partnerships with a focus on child-serving sectors.

Nemours Childrens Health System and Mental Health America

Offers a set of common measures to assess and improve population and community health and well-being across sectors.

Well Being Trust & 100 Million Healthier Lives

Provides an online collection of 100+ papers, toolkits, and other resources on privacy and other legal issues related to data sharing

Data Across Sectors for Health & Public Health Law Network
Toolkit - Mar 2019

De-Identification Toolkit

Supports a broad audience of health officials, community organizations, and data managers in developing a modern information infrastructure to provide actionable data

Network for Public Health Law

Identifies the five most common data challenges from the BUILD cohort, as well as reflections and solutions from the practitioners involved.

BUILD Health Challenge
Website - May 2018

California Healthy Places Index

The Index, along with an interactive map, provides overall scores and data on specific areas that shape health, like housing, transportation, and education.

Public Health Alliance of Southern California

Provides several use cases to demonstrate how a public health agency can use electronic health data to address a public health challenge and overcome legal barriers

De Beaumont Foundation

A nationwide learning collaborative that helps communities build capacity to address the social determinants of health through multi-sector data sharing collaborations

All In
Website - Jul 2017

Let's Get Healthy California

Tracks process on indicators aligned with six overarching goals, based on the Triple Aim, in support of a shared vision for health.

California Health and Human Services Agency

A 10-item screening tool, developed by the federal CMS, to enable clinicians to identify patient needs that can be addressed through community and social services.

Centers for Medicaid and Medicare Services and National Academy of Medicine
Website - Jun 2017

County Health Rankings

Data that help communities assess how health is influenced by where people live

County Health Rankings

Explores strategies that states are using to capture SDOH information on Medicaid beneficiaries

Center for Health Care Strategies

Commissioned by the State Health and Human Services Agency, tool kit provides resources to help communities assess and engage in data-sharing across sectors.

Center for Healthcare Organizational and Innovation Research and CACHI

Identifies a set of core measures to enhance the understanding and focus on better health and well-being for Americans.

National Academy of Medicine

Idenfies priority social and behavioral data that can be incorporated into patient electronic health records


Evaluation and Impact

Evaluation of three Community-Centered Health projects that focused on shifts in health care practices to look beyond the walls of health care facilities.

Blue Cross Blue Shield of North Carolina
Issue Brief - Sep 2022

ACH Insights from the Field

Highlights reflections from ACHs on the benefits and challenges of developing an ACH and what difference they believe ACHs make in their communities.


Identifies four dimensions of value related to cross-sector collaboration: intrinsic benefits, community engagement, outcomes, & sustainable system-level change.

Camden Coalition

Summarizes findings from a study on six ACHs operating in CA and WA, focusing on the role of local context and power dynamics on efforts to improve equity.

Population Health Innovation Lab

Describes progress in establishing ACHs in sites across California, highlighting the value ACHs bring to communities.

CACHI and Desert Vista Consulting

One-page summary of how ACHs are creating value and equity by catalyzing alignment, leveling the playing field and establishing collective accountability.

CACHI and Funders Forum on Accountable Health

Provides examples, including two CACHI sites, and a simplified set of valuation tools that multi-sector collaboratives can use to convey the value of their activity.


Describes how ACHs are creating value for their communities, using case studies from Washington, Oregon and California.

CACHI & Funders' Forum on Accountable Health

Summarizes key observations about the ACH model and provides policy implications for sustaining and scaling the ACH model and similar collaborative efforts.

Funders Forum on Accountable Health

Summarizes evaluation findings of CACHI covering the original six ACH communities and the first three years.


Presents evaluation findings of the federal Accountable Health Communities (AHC) Model, launched in 2017, that screens and connects beneficiaries to community resources.

Center for Medicare and Medicaid Innovation & RTI

Describes how ACHs are helping their communities respond to the COVID-19 pandemic and the five key roles that they are playing

CACHI and Desert Vista Consulting et al.

Funders Forum on Accountable Health interviewed leaders in ten communities, including Imperial and Stockton, CA, to better understand their progress & challenges.

George Washington University

Provides learnings from the Ripple Foundation/ReThink Health Ventures Initiative, which worked with six multisector partnerships working to transform health.

Mt. Auburn Associates

Provides findings and lessons learned from Washington State's experience implementing ACHs.

Center for Community Health and Evaluation

Provides findings from evaluation of the Parks After Dark program, including savings to the county as well as health and social outcomes for youth and young adults.

UCLA Center for Health Policy Research

Provides a mechanism for a multi-sector collaborative to assess its readiness along seven core elements


The Trust Fund supported nine grantee partnerships over four years, with documented improvements.


Using 16 years of data, the study finds that supporting multisector health activities may help close geographic and socioeconomic disparities in population health

Health Affairs

Commissioned by California Health and Human Services Agency, the report provides an evaluation framework for ACHs

Blue Sky Consulting and CACHI

Provides early evaluation findings of the first year of Washington state's ACH initiative

Center for Community Health and Evaluation

Financing, Sustainability and the Wellness Fund

This report shares insights from state public health and Medicaid policymakers to help federal & state leaders think strategically about how to blend and braid funds.

NASHP, deBeaumont & ASTHO
Website - Feb 2022

Local Wellness Funds

Provides a set of online resources, practical tools and information regarding how to develop a local wellness fund, a key element of an ACH.

Georgia Health Policy Center

Describes how a pooled fund could help support collaborative investment in the social determinants of health

National Alliance to Impact the Social Determinants of Health

Provides easy-to-digest key concepts and a practical structure to guide sustainability planning for ACHs and other collaboratives

JSI, Inc.

Identifies 10 promising innovative community investment strategies for Southern California.

Public Health Alliance of Southern California

Health Affairs article describing the importance of funding backbone functions of an ACH

Funders Forum on Accountable Health

Provides findings from a legal and policy review of funding streams that could help support the backbone function & infrastructure of an Accountable Community for Health

Funders Forum on Accountable Health

Provides an overview of key elements of a Wellness Fund as well as three examples from around the country

Funders Forum on Accountable Health

Provides detailed information about MHSA funding and how CACHI communities can access those resources in support of their goals.

Third Sector Capital Partners and CACHI

Determines the ROI of health-related social needs to help CBOs and their health system partners plan sustainable financial arrangements for high need patients

Commonwealth Fund

Shares early lessons and recommendations for establishing locally-governed Wellness Funds to support multi-sector collaboratives and prevention.

CACHI and JSI, Inc

Describes results of an initiative in which seven sites pursued a pooled community wellness fund to address primary prevention of chronic conditions.

Georgia Health Policy Center
Toolkit - Dec 2018

Beyond the Grant

Offers modules with practical, user-friendly tools to answer common financing questions and develop action plans for moving beyond the grant.

ReThink Health

Provides a wealth of resources regarding how to bring various funding streams together through the use of two mechanisms: braiding and blending.

Trust for America's Health

Proposes how a properly governed, collaborative approach to financing could enable health stakeholders to earn a financial return on their social determinants investments

Health Affairs

Describes six prominent or emerging forms of impact investments that may be applicable financing approaches for an Accountable Communities for Health

ReThink Health & CACHI

Explores opportunities for Medi-Cal to support community health initiatives such as CACHI and how managed care plans can align resources and partner more effectively


Describes various methods for valuing the tangible and intangible benefits of an Accountable Community for Health

Minga Analytics & CACHI

Provides step-by-step guidance for how to develop a business case for investing in the social determinants of health, along with specific examples.


Recommends a new approach for updating the current rate-setting methodology to advance Medi-Cal’s goals of improving health outcomes and promoting efficient resource use.

California Health Care Foundation

Provides practical advice for state Medicaid agencies and managed care organizations interested in implementing SDOH strategies within managed care.

Academy Health & Nemours

Explores practical strategies that states can deploy to support Medicaid managed care plans and their network providers in addressing social issues.

Commonwealth Fund

Outlines a potential model, call the Healthy Community Funding Hub, to help coordinate and sustain funding for community health improvement.

TFAH and Deloitte Health Solutions

Explores the business motivation for investing in community health, the processes involved, and the challenges stakeholders faced when pursuing these initiatives.

National Academy of Medicine

Provides and categorizes a wide array of funding options by the sources and the process by which the money is acquired.

ReThink Health

Proceedings of a workshop convened by the Roundtable on Population Health Improvement

National Academies of Sciences, Engineer and Medicine

Provides analysis and examples about why and how Medicaid programs should account for social determinants of health in setting payments and measuring quality

Health Management Associates
National Academy for State Health Policy

Illustrates how state Medicaid agencies and their partners can maximize authority that exists under federal Medicaid and CHIP law.

The Nemours Foundation

Identifies various financing innovations to support population heatlh

Georgia Health Policy Center

Using the ReThink Health Dynamics Model, the authors show results from alternative investment strategies

ReThink Health

Provides tools to analyze funding and develop strategies for braiding and blending, along with case studies and other insights.

Spark Policy Institute

Estimates the average ROI for activities of public health departments in California

American Journal of Public Health

Provides an overview of local health trusts roles and structures

Health Affairs

Overview of community integration structures and emerging innovations in financing

Centers for Disease Control and Prevention

Identifies options for sustainable multi-payer investment in population health

JSI, Inc. and CACHI

Approaches and issues in establishing a reinvestment mechanism


Governance, Leadership and Partnerships

Guides health departments through the why and how of partnering with Community Power-Building Organizations (CPBOs) to advance health equity.

Human Impact Partners

Describes the different roles intermediaries can play and provides examples, including several CA ACHs, of where they have been used in practice.

Georgia Health Policy Center & Funders Forum on Accountable Health

Explores the role of leadership in complex systems change strategies

Equal Measure

Provides findings & examples that explores integrative functions and mutii-sector collaboratives (note: the report links to other resources associated w/ the initiative).

Nemours and Moving Healthcare Upstream

Describes five broad categories of integrative activities along with a roadmap or checklist that partners can use to assess itself

Nemours Children's Health System

Offers recommendations of ways to support collaboration between business and public health.

Johns Hopkins and de Beaumont Foundation

Provides findings from a community of practice that explored what it means to engage and include community residents in the operations of ACH collaboratives.

Population Health Innovation Lab

Profiles characteristics of people who are impressive stewards of change and are helping to grow the entire field of system stewardship for well-being.

Rippel Foundation

Describes key practices for facilitating regional cross-sector collaboration and alignment that creates the conditions for lasting change.

ReThink Health/Ripple Foundation

Describes how the community development, health, and financial sectors can better align their work to enable neighborhoods to better support health & financial well-being

Building Healthy Places Network
Tool Kit - Nov 2019

Backbone Starter Guide Tool Kit

Summarizes and highlights the major ideas and learnings about the role of the Backbone in collective impact

FSG and Collective Impact

Provides an assessment tool and process for identifying strengths and weaknesses of a collaborative's current leadership efforts

ReThink Health

Provides a playbook to guide community developers toward partnerships with hospitals and healthcare systems to improve health and equity

Building Healthy Places Network

Profile and classify burgeoning initiatives, understand common challenges, and surface solutions to address those challenges.

Commonwealth Fund

Findings from research about the development of multi-sector partnerships and how well they are poised to lead health transformation.

ReThink Health

Describes four case studies to identify core partnership components.

Center for Health Care Strategies

Provides examples of of partnerships between organizations that offer health and social services offers lessons learned from these in depth cases.

Center for Health Care Strategies

Evaluation results about the role of distributive leadership in complex cross-sector systems change strategies, focused on college and career readiness.

James Irvine Foundation, Equal Measure and Harder + Co.
Website - Jul 2017

Practical Playbook

Provides practical implementation tools, guidance, and resources to advance collaboration between public health and primary care in order to improve population health.

Practical Playbook
Report - Jul 2017

Keys to Collaboration

Identifies four stages of collaboration that are key to the development of partnerships aimed at health equity.

BUILD Health Challenge

Explores the many ways that health care organizations and CBOs are partnering in shared pursuit of better health outcomes

Center for Health Care Strategies

Describes options for governance and legal considerations for different approaches.

ChangeLabSolutions and CACHI

Healthcare Providers, Payers and Systems

Defines and differentiates hospitals’ community-level SDOH activities.

Health Affairs

Summarizes the implications of Governor Newsom's 2022 proposed change to hospital community benefits requirements.

Center to Advance Health and Equity

Describes perspectives of Medicaid managed care organizations on emerging promising practices of addressing social determinants of health among their Medicaid enrollees.


Describes the health-related social needs Screening Tool from the federal Accountable Health Communities (AHC) Model & shares promising practices for universal screening


Provides findings from the field about barriers to, and accelerators for, health care to carry out backbone or integrator functions as part of multi-sector collaborative.


Provides a framework for primary care providers to establish social needs screening and referral programs in concert with human services partners.

United Hospital Fund

Examines 40 Medicaid managed care contracts and 25 approved § 1115 demonstrations across the country to identify common themes for how to support SDOH-related activities.

Center for Health Care Strategies

Provides an organizing framework, with examples, to help hospitals and health systems take both internal and external actions to become more "upstream"

Moving HealthCare Upstream

Provides a compilation of resources, strategies, and case studies regarding community benefits strategies to promote healthier food access and healthy food systems.

Health Care Without Harm

Provides toolkits and resources to help hospitals and health systems build community wealth through inclusive hiring, investment, and purchasing.

Democracy Collaborative

Provides insights from hospital executives about how health systems can move upstream to improve community health

BUILD Health Challenge

Describes innovations that safety net providers are implementing to address the social determinants of health.

California Health Care Foundation
Tool - Dec 2017

Community Benefit Insight

Provides direct access to the community benefit spending information from tax-exempt hospitals throughout the United States.

Research Triangle Institute
Report - Oct 2017

Anchor Mission Playbook

Provides guidance for how hospitals and health systems can accelerate their efforts to drive institutional alignment with community needs.

Democracy Collaborative

Findings from a survey of 300 hospitals and health systems to identify what is being done to address health-related social needs and the potential for future efforts

Deloitte Center for Health Solutions

A "playbook" of effective methods, tools and strategies to create new partnerships with hospitals and sustain successful existing ones.

Hospital Research and Education Trust

Case study of a large academic medical center that has implemented an upstream population health strategy


Describes an innovative practice that engages hospital leadership in efforts to align vision, priorities, and initiatives of community benefits with community needs

Health Resources in Action

Provides examples of traditional and less traditional ways that hospitals and health systems can invest in their communities

Center for Community Investment

Examples of effective collaborations between hospitals and community development

Low Income Investment Fund

Explores ways that states have incorporated population health goals into ACOs and other models

Milbank Memorial Fund

Portfolio of Interventions

Provides relevant evidence on the costs of health-related social need interventions and/or their impact on health care utilization and cost of care for use with ROI Calc.

Coommonwealth Fund
Website - Jun 2022

ACES Social Media Took Kit

Provides individuals and organizations messaging and graphics to share on social media aimed at raising awareness of ACEs and domestic violence.

Northern California ACES Collaborative

Evaluates the existing evidence for effective interventions to address social determinants of health and social needs and identifies potential next steps.

Department of Health and Human Services & RAND

Describes approaches to ensure that children and their families benefit from SDOH investments and the range of strategies and interventions needed by families.


Describes how California ACHs can support the Network of Care Milestones related to the ACEs Aware Trauma-Informed Network of Care Roadmap.

San Diego ACH

Provides a framework for food system collaborations with health care provides along with legal and policy considerations for food system interventions.

ChangeLab Solutions

Offers recommended strategies that are evidence informed to help ease the mental health and addiction challenges stemming from the pandemic.

Well Being Trust and deBeaumont Foundation

Offers a framework for understanding the relationship between community trauma and violence and how community trauma undermines both individual and community resilience.

Prevention Institute

Provides guidance on key strategies to implement community-clinical linkages that focus on adults 18 years or older.

Centers for Disease Control and Prevention

Highlights examples of how CHW/Ps add value to organizations, how their work is financed, and emerging opportunities to scale and sustain that work within California

Center for Health Care Strategies

Provides a framework with meaningful solutions to help advance mental health policy in this country.

Well Being Trust
Website - Mar 2019

ChangeLab Solutions

Provides a wealth of resources and tools to improve community health, focusing on policy and environmental change approaches

ChangeLab Solutions
Website - Feb 2019

Healthy Food Access Portal

A go-to-resource that harnesses an array of data and information for planning and implementation of policies, programs, and projects to improve access to healthy foods

The Food Trust, PolicyLink and Reinvestment Fund

Repository of high quality research that advances efforts to identify and address social risks in health care settings


Provides resources from trauma-informed care leaders to help improve outcomes and reduce avoidable health care service use and costs in health care and other settings.

Center for Health Care Strategies

Provides resources and examples to advance implementation of CDC’s 6|18 Initiative by Medicaid, state and local health departments, and other payers and purchasers.

Center for Health Care Strategies and CDC
Report - Jun 2018

Making the Case for Prevention

Makes the case for why states should invest in chronic disease prevention as part of a comprehensive approach to chronic disease.

Academy Health & Nemours
Website - Mar 2018

Win-Win Project

Provides a standardized, unbiased economic analysis of interventions to help public-health officials make informed decisions and engage in cross-sectoral collaboration.


A high-level overview of local and state public policy strategies to prevent and address asthma: health care, childcare and schools, home environment and the outdoors.

Moving Health Care Upstream

Provides a collection of evidence-based findings of the Community Preventive Services Task Force to guide selection of interventions for an ACH's portfolio.

Community Preventive Services Task Force
Practice Guide - Dec 2017

Best Practices Guide for CVD Prevention

Describes & summarizes scientific evidence behind 8 effective strategies, which involve community-clinical links, for lowering high blood pressure and cholesterol levels.

Centers for Disease Control and Prevention

Provides policymakers with cost-benefit results, based on literature, of a wide variety of public policies.

Washington State Institute for Public Policy

Provides information regarding financing, certification, education and other elements of Community Health Worker programs across the country.

National Academy for State Health Policy
Website - Jun 2017

Health Impact in Five Years

Identifies non-clinical community-wide approaches that have evidence reporting positive health impacts, results in 5 years and cost-effectiveness and or cost reductions

Centers for Disease Control and Prevention

Outlines key considerations for the design and implementation of ACH-type initiatives focused on trauma and resilience

JSI, Inc

Report to the CA Secretary of Health and Human Services with recommendations from a workgroup established under the State Innovation model design process

CHHS Workgroup

A Review of Emerging Evidence On Interventions for Asthma, Diabetes, and Cardiovascular Care

Center for Healthcare Innovation and Research, UC Berkeley, and CACHI