Dear friends,

Across the country, multi-sector, place-based health collaboratives—from Accountable Communities for Health (ACHs) and Community Care Hubs to Regional Health Hubs and Collective Impact Networks—are proving that health equity is a local imperative, not just a national responsibility. These local partnerships unite health care, public health, social services, philanthropy, and community residents around a shared goal: improving health and well-being for a defined place and population.

They go by different names but share a common DNA: shared governance, cross-sector resource alignment, and deep community participation. And in an era of growing fragmentation and mistrust, they demonstrate that collective effort—when grounded in community power—remains one of the most durable engines for equity.

The Promise and Impact of Collaboration

From Camden to Seattle, these collaboratives are showing what’s possible. I saw their impact up close a few weeks ago at the Funders Forum on Accountable Health convening in Washington, DC. For example, the Camden Coalition’s Regional Health Hub in New Jersey has created a neutral backbone organization trusted by competing health systems to share data and coordinate care for Medicaid beneficiaries. By focusing on shared outcomes—such as improving maternal health and behavioral health—this Hub has proven that trust-based governance and backbone leadership can turn fragmented systems into networks for good.

And in East Texas, the GLOW Initiative, a multi-agency collaboration among local hospitals, mental health facilities, FQHCs, United Way, and city fire and police departments, demonstrated how shared data and governance structures can help align public and private institutions around common goals—improving health and reducing emergency department reencounters and hospitalizations among vulnerable residents.

This is now a maturing field. Across many states, multisector, community-driven partnerships are producing measurable results for vulnerable populations, deepening resident engagement, and building shared infrastructure for integrated care. They’ve become living laboratories for what a fairer, more responsive health ecosystem could look like.

The Challenges of This Political Moment

Yet these collaboratives now face a critical challenge. Massive cuts to Medicaid, SNAP, and public health programs—coupled with political assaults on science, the civil rights of vulnerable populations, and the nonprofit sector—are eroding the infrastructure that sustains community health. Many collaboratives are struggling to maintain staff, sustain data-sharing, or secure flexible multi-year funding. The risk is that a decade of progress in local health initiatives could unravel just when communities need it most.

This challenge is amplified by an underlying tension that Dr. Seth Berkowitz argues in his essay “Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health.” While multi-sector, place-based collaboratives can drive improvements in chronic disease management for those who experience health-related social needs, they often focus on managing harms rather than changing the structures that cause them. By relying on voluntary partnerships and narrow interventions, these initiatives risk leaving fundamental inequalities untouched.

Too often, he writes, many place-based health collaboratives have relied on “voluntarism” and “residualism”—depending on private actors’ goodwill and targeting only the “truly needy”—rather than guaranteeing universal rights to housing, food, or income. They tend to be technocratic by design, avoiding political conflict in favor of pragmatic feasibility. While this approach has led to notable achievements for specific populations in some cases, it has also left many place-based collaboratives struggling to find their footing in a moment marked by severe cuts to vital programs and broad assaults on science and the rule of law.

From Collaboration to Solidarity: A Path Forward

How can place-based health collaboratives evolve to meet this moment? Today’s place-based collaboratives can—and must—become sites of solidarity, not just coordination. That means sharing risks and resources in ways that help communities withstand acute crises like SNAP cuts and Medicaid work requirements, while also defending the institutions and rights that sustain community well-being. Five strategies stand out:

1. Respond strategically to new Medicaid work rule requirements.

Collaboratives can play a vital role in minimizing harm from federal cuts and Medicaid work documentation requirements. For example, Washington’s HealthierHere has outlined ways place-based collaboratives can partner with state agencies to streamline verification processes, reduce administrative barriers, and train navigators and care coordinators to help residents retain coverage. Collaborating with employers to automate documentation and developing exemption workflows can prevent unnecessary disenrollment and stabilize safety nets during the transition.

2. Partner with justice movements to protect rights and the rule of law.

Collaboratives can no longer treat democracy and justice as “outside their lane.” By linking with organizations like the National Immigrant Justice Center and Frontline Justice, they can defend and expand access to justice and legal protections for vulnerable populations who are being targeted and ostracized. These alliances with justice movements can build civic muscle (a core part of the Vital Conditions framework)—helping communities safeguard their rights to health, housing, and participation even as policy environments grow more hostile.

3. Invest in and strengthen “financial backbones.” 

The success of place-based initiatives often hinges on intermediaries that can manage shared funding and infrastructure. The Stanford Social Innovation Review recently explained how funders can engage in systemic investing, where a backbone organization “strategically orchestrate[s] diverse sources of financial capital in pursuit of a collective impact mission” to catalyze systems change. Strategic investment in these financial backbone entities—especially those led by or accountable to residents—can stabilize collaborative ecosystems for the long haul.

4. Shift policy to pool and align resources in local “collaborative funds” 

To sustain progress on shared health needs and address shared threats to local health infrastructure, communities need more than financial backbones—they need enabling policies that make it easier to blend, braid, and share public and private funding. States and localities should align policies that allow communities to combine funds from healthcare, housing, and economic development sectors. Regulatory flexibility and guidance through shared metrics and joint reporting standards, along with incentives for outcomes-based financing like public health bonds, can help unlock and shift more private sector dollars upstream toward prevention and health equity just when communities need them most. HealthBegins’ November 13 webinar, Strategies to Sustain Health Equity Investments Against Headwinds, will outline some of these approaches.

5. Build solidarity with pro-democracy movements.

Finally, health collaboratives must see themselves as part of a larger democratic renewal project. Aligning with pro-democracy movements can help resist authoritarian efforts and advance policies that promote egalitarianism—from living wages and universal child benefits to fair taxation and public investment in care. (Join HealthBegins and our partners at the Health Equity Policy Hub to track policies that affect health equity and opportunities for action.)

Undoubtedly, this will take time. It will require methods, platforms, and clear pathways—some of which we’re actively building at HealthBegins and with partners—to help health equity champions build solidarity within a pro-democracy movement. In this vision, multisector collaboratives become both local anchors and enablers of broader structural change.

Toward a New Kind of Place-Based Collaborative

At their best, multisector, place-based collaboratives are not just vehicles for service coordination—they are microcosms of democracy itself. They remind us that health equity is not just a technical challenge; it is a civic one. At a time when public trust, funding, and rights themselves are under siege, the next chapter of multi-sector collaboration must be about building not only healthier communities, but stronger democracies.

In this precarious moment, their role is not only to help partners manage the consequences of policy decisions but to shape the policies and public imagination that determine whether health—and democracy—can thrive.

Best,

Rishi Manchanda, MD, MPH.