There are a number of different sustainability strategies that have allowed networks to function for
extended periods of time. Below are several potential resource strategies for networks to consider:
External Funding Sources
Generally, most networks will choose a sustainability strategy that involves applying for funding
from external sources, especially federal and/or state grants and contracts. This strategy is
particularly common among Rural
Health Network Development Planning Program
grantees, who then can apply to other Section 330A grant programs. Other common sources of
network grant funding come from other HRSA
grant programs, the Centers for
Disease Control & Prevention (CDC), and the Substance
Abuse and Mental Health Services Administration (SAMHSA). Less common sources come from private
corporations or private foundations.
Among networks that choose a strategy that relies primarily on responding to request for proposals,
having a devoted grant writer, or an individual responsible for assessing funding opportunities, has
by many network directors as a key to their success.
For networks that were formed in order to improve access to health services, network-related
activities may be sustained through reimbursement from public or private payers. For example,
networks that were formed to expand services through telemedicine can sustain these services through
reimbursement from Medicare. Kentucky TeleCare currently
receives reimbursement from Medicaid and commercial health insurance. Ely Area
Community Care Team is hopeful that its evaluation results will bring about a change in policy
allowing their services to be reimbursable under ACO shared saving models. Occasionally, a network may use
grant funding in order to implement a pilot program with the hope that policymakers and payers will
reimburse its services. While this may be risky, it can result in actionable changes in payer
In some cases, successful networks like the Integrating
Professionals of Appalachian Children (IPAC) in Ohio receive state dollars by providing
policymakers with evidence of their program's impact. Networks should keep in mind that the funding
cycle is largely dependent upon the priorities of the current administration and the annual budget.
Internal Funding Sources
Networks may also be able to fund their activities through support from network members.
Many networks may choose to have members pay a one-time or recurring fee as a prerequisite for
the network. For example, the Virginia Rural Health Clinic
Coalition collects an annual fee from network members in order to fund its activities. The
Alaska Subspecialty Nursing Consortium has two different
tiers of membership, one of which involves an annual stipend.
Other networks are able to sustain themselves through the support of one or more members. The
Tennessee Rural Partnership (TRP) operates almost
exclusively through funding provided by the Tennessee Hospital Association (THA), a member of the TRP
network. As a coalition with a focus on community health and prevention, Healthy
Monadnock was founded and continues to operate with funding from the local nonprofit hospital,
as part of the hospital's fulfillment of its annual community benefit requirement.
Because network members often have particular expertise on an issue or topic, networks may be able to
generate revenue by providing expert services (for example, technical assistance), resources
example, curricula), and by hosting events (for example, annual conferences) for a fee. These
services and events can be marketed to member organizations and/or members of the community who may
benefit from the services. The Montana Health Network is
an example of a for-profit network that develops and sells a range of products and services, such as
different insurance and educational resources, to clinical staff and member (and on occasion,
non-member) provider organizations.
literature review published by Rural Health Network Resources reported that mature networks (more
than 15 years in operation) received the vast majority of their funding through member dues and program
fees. Only about 2-3% came from grant dollars. In contrast, young networks (less than five years in
operation) credited grant dollars as the primary source (90%) of funding.
Because of the variability in the environments in which networks operate, there is not a best practice for
networks to follow. Networks may find that they need to pursue more than one sustainability strategy that
relies upon both external and internal sources in order to continue to operate.
Resources to Learn More
Building II: Maintaining a Coalition
Provides guidance on how to sustain the work of a coalition. Part of the Community Toolbox, a guidebook for
community coalitions to follow as they work to improve community health.
Organization(s): Community Toolbox, University of Kansas Center for Community Health and Development
Tools & Strategies for
Managing Health Networks – Funding & Sustainability
A compendium of resources that health networks can use related to sustainability, including links to
websites where networks can search for funding opportunities.
Organization(s): National Cooperative of Health Networks Association