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Sustainability Strategies

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 been cited 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 reimbursement policy.

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 membership in 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 (for 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.

A 2011 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

Coalition 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