Investing in Community Health and Community-led Design: Lessons Learned from the RePARE Project

The Research to Pursue and Advance Racial Equity (RePARE) project conducted a community-centered research study examining the financial sustainability and impact of Community Referral Networks (CRNs) in promoting racial health equity. CRNs are essential systems that facilitate referrals between different community stakeholders such as healthcare, social service, and faith-based organizations, to ensure that community members have access to essential resources. These technological infrastructure systems are effective for communities because they also incorporate financial resources and collective collaboration. The results of this study provide valuable insights for future investments in CRNs, paving the way for more equitable and effective healthcare systems and community health initiatives.

Over an 18-month period, RePARE partnered with seven CRNs across the U.S. which reflected the varied landscape of the resources communities need to be healthy or to address the social determinants of health (SDoH). Each organization, whether tackling rural challenges in Virginia or navigating complex urban networks in Arizona, adds a unique voice to our collective understanding of health disparities. As policies and investments regarding SDoH efforts continue to increase, rapid program rollouts, especially those driven only by data only, carry the risk of putting larger, more powerful institutions ahead of systematically excluded community-based organizations. As a result, some of these well-intended SDoH efforts are resulting in the deepening of systemic racism instead of its dismantling.

The full RePARE project report that will be officially released in late February,  highlights essential recommendations from the community on how to design and implement a collaborative learning RePARE CRN model with community members and other stakeholders. Some of our key values include centering community voices, building trusting relationships, embracing racial equity, and understanding the disparities. However, one key recommendation from the community that rose to the top is how investments impact service delivery.

After analyzing the budgets of seven participating network organizations (PNOs), the RePARE analysis uncovered a discrepancy of almost $3 million between the committed funding and the monetized cost of running a CRN network. This was primarily due to the frequently overlooked but significant role of direct service personnel in ensuring the success of CRNs. Whether it is working in call centers, serving as a health navigator, or community health worker/promotore, direct service staff work to ensure that they are providing services that are responsive to the needs of the community. Only four of the seven participating networks have direct service staff, as a budgeted resource navigation investment ranging from 15% to 77.5%, making it a substantial monetary investment.

Our analysis underscores the importance of  government investment and innovative data-sharing methods to ensure long-term sustainability and its impact on the availability of services. To build strong CRNs that will be a critical community-wide service and a key access point to more integrated systems of health, we need consistent investment in members of the community who can directly connect the people with information, support, and resources.

Overall, this RePARE research highlights the intricate nature of community health networks. However, while these networks are valuable, there is significant room for improvement. Specifically, it requires the collective push towards redefined funding systems, shared power, community partnership, authentic stories from those within the networks, and transparent reporting of progress. This research does more than just identify problems; it highlights community-anchored solutions to ensure equitable access to healthcare for all community members.

TAKE ACTION

To advocate for CRNs nationally and in your local area by empowering communities through co-design, technology, and responsive feedback:

• Read the report: Connecting Resources & Driving Equity: Opportunities to Build and Spread Sustainable Community Referral Networks
• Watch recordings of our Investing in Referral Networks to Advance Racial Health Equity webinar series
• Contact us to learn more about a partnership to create a CRN
• Sign up for our newsletter to stay informed on the latest CRN efforts

We extend our heartfelt appreciation to CommonSpirit Health, Blue Shield of California, and California Health Care Foundation for making this research possible.