• Collaboration Type: Alliances & Networks
  • Region: NSI
  • Social Issue: Health
  • Size of Organizations: >$10 mil
  • BIPOC Leaders: Yes
  • Successful: Yes

Three federally qualified healthcare centers in the Los Angeles area came together for quality improvement. Through multi-layered collaboration, they now have become an incubator for innovation.

Best Practices for Social Impact Organizations:

  1. The commitment of senior leadership is crucial to catalyze learning across multiple levels of the organization.
  2. In long-term collaborations, adapt the level of commitment based on organizational-member changes.

Outcomes:

  1. Shared grant funding around navigation and HRSNs
  2. Quality Improvement Across Community Health Centers

Best Practices for Funders:

  1. Consider alliances focusing on organizational innovation and learning, not just joint projects, or advocacy.

How can community healthcare centers collaborate to innovate and deliver higher-quality healthcare? Plunum Health, a five-year-old joint venture among three federally qualified healthcare centers in Los Angeles, demonstrates one model. The collaboration has evolved into an innovation hub that benefits all their patients.

Bobbie Wunch of Pacific Health Consulting Group remembers the beginning. “About ten years ago, a couple of things happened. Some of the four members went to a conference where a couple of programs from Chicago were highlighted, and they thought that working together to improve systems and population health work across several health centers might be an advantageous way to go.” In 2015, based on that initial idea, they applied for a grant from the Nonprofit Sustainability Initiative, a Los Angeles-based member initiative of the Sustained Collaboration Network. The Nonprofit Sustainability Initiative provided a negotiation grant for exploratory conversations between what was then four community health centers: Venice Family Clinic, South Bay Family Health Center, Eisner Heath, and Saban Community Clinic. Carrie Harlow, Director of the Nonprofit Sustainability Initiative, recalled, “What was exciting to the funders from the beginning was that it was several very large organizations, community health centers, in Los Angeles County that are collectively serving a huge number of patients. So, in terms of scale and potential impact, the case they were making was enticing.”

An evolving partnership

From that grant, the four health centers initiated the Ensemble Project to identify and test ways to pool resources. They agreed to share best practices such as joint staff training, data sharing, and potentially certain services that were not universally available (e.g., street medicine, substance use disorder programming). The partnership continued to evolve, both in structure and in focus. In 2018, it became a more formal joint venture under the name Plunum Health with fiscal sponsorship from Eisner Health. The entity filed for independent 501c3 status in 2019 and is governed by a board with representatives from each participating health center (CEOs and board members).

Leadership evolved, too. All original CEOs moved on, and two of the participating health centers, Venice Family Clinic and South Bay Family Health Center, merged. While this level of change might have upended many partnerships, several vital factors made this partnership resilient. First, even in the initial conversations, the collaboration planning included both the CEOs and their board chairs; Wunsch noted that “we knew that if anything substantial was going to happen, we needed the boards on board, so to speak.” Second, conversations also involved senior staff and, eventually, staff across the different levels of the health centers—greater participation induced buy-in at multiple levels of the organizations involved.

But perhaps most importantly, each group allowed participation in the long-standing collaboration to evolve as organizations changed. Muriel Nouwezem, Saban Community Clinic CEO, described the permission to step away during the merger:

“While they merged, their focus was really on merging the two cultures. But they kept coming back to the collaboration because they saw the benefit, and they knew that trust allowed them [to take a step back]. We could have an honest conversation about it.  [We could say], ‘We understand you dealing with this merger will give you some space, and we’ll give you some grace. We are going to pick up the slack on this and that. Come back when you have a little bit more capacity and bandwidth.’”

Throughout this evolution, the Nonprofit Sustainability Initiative has continued to support Plunum Health. Harlow explains, “There have been multiple rounds of funding as there typically is with NSI. We provide exploratory funding and implementation funding, and in addition, we’ve had at least once, maybe twice, hosted a convening to give the organizations an opportunity to share their progress with the funders. And not just our current funders within the initiative, but also a broader community of funders interested in the work they’re pursuing.”

Becoming an innovation hub

But more importantly, the real benefit of the collaboration evolved, too. Eleanor Huntington, program manager of Plunum Health, explains, “As the project and program have evolved, it’s focused on quality improvement, metrics, and processes that can be applied across the three clinics. And it has become a method for sharing best practices.”

The organizations set up work groups to address common issues. Nouwezem explains how Plunum Health enabled the clinics to share best practices.

“It started very organic, where we would have various workgroups. I remember at the time, there were a lot of regulatory changes in the pharmacy, reimbursement, and all that. So, there was a workgroup with each clinic’s pharmacy director. Compliance had a different workgroup. From some of my direct reports, I know that [those workgroups] helped. They liked having a peer at another clinic they could call on any given day.”

As the relationships developed, the health centers began thinking about how they could take on innovation projects as a group. Plunum Health has more recently become a hub for innovation, allowing them to research and pilot new ideas, models of service delivery, and technology. Huntington provided some insight into what that looks like in one of their newest projects:

“There has been about a year of conversation leading to this idea of improving the care management and care coordination practices across the three clinics. We recognized that this was an area where each clinic was doing different work, some to a greater extent than others. But the group recognized that we needed dedicated staff for each organization, and some didn’t have that. And so [together Plunum Health went about] finding a method to do that and getting the payers to participate. The quality improvement leaders at the different organizations meet monthly to discuss data practices, and then the clinical teams meet less frequently. But we’re hoping to change that, especially as we start implementing some of the Quality Improvement strategies through an AI learning mechanism that we’re implementing. We want the three clinical implementers to meet to discuss best practices. Some of it is very formal, like the monthly standing meetings. Some of it is more informal as we are heading into this implementation stage across the three clinics, where each clinic is at a different stage.”

Nouwezem explained the value of Plunum Health becoming an incubator. She noted it’s “something we wouldn’t have been able to run independently. And by coming together, we could tap into funding that we wouldn’t be able to tap into had we done this project on our own.” Ultimately, the group hopes to use technology better to understand the complete risk profile of the patient.

The shared case management system is just one of several innovation projects that Plunum Health has taken on. The health centers have supported one another through telehealth, compliance, and now AI-supported case management. By working together, the group has demonstrated how health collaboratives can be more innovative together than the organizations alone could have been.