With contributions from Phyllis Meadows.

The Kresge Foundation’s Health team has centered its work over the past few years on a set of strategic goals to address health inequities and persistent health disparities. Our underlying approaches place communities as the anchors in organizing how partnerships, policy, power and leadership can be enhanced to improve health outcomes for vulnerable populations with a resolve towards achieving equity. This focus has led us to examine the structures, systems and policies that influence the upstream determinants of health, such as food, housing, the built environment, climate change and economic security.

Although we do not have direct target investments related to health coverage, we recognize Medicaid is a principal insurer for populations our programs ultimately serve. We know insurers are a critical component towards shifting attention beyond clinical solutions to addressing social and environmental conditions that cause marginalized populations to be more vulnerable to adverse outcomes. We view health coverage as a resource, yet recognize that it is only one among many factors driving solutions for an improved system that can reduce health inequities.

Kresge’s investments over the last decade have expanded from grants advocating for new funding models to stretch the limits of Medicaid coverage to supporting models engaging CMS as partners in advancing innovation and evaluation of health programs. Our general goal has been to assert how insurers might expand or alter their funding models to support non-clinical measures that influence the health of individuals and to explore the value of payment models such as outcome based financing.

Grantees have included community based health systems partners (e.g. BUILD Initiative) working within states to create options and explore waivers to address housing security issues. We’ve also supported several grantees to establish partnerships with CMS to understand and support the needs (capacity building, development, implementation, technical assistance and evaluation) of Accountable Health Communities. We provided initial and ongoing support for the development of the Funders Forum – a collaborative network of funders and insurers investing in health innovation in communities. Our goal has been to support efforts that engage CMS as a funding partner, and to work together where possible to collaborate in support of the work that is occurring in communities.

The Kresge Foundation’s Health team continues to refine its strategies to support community-driven solutions, stimulate investments in communities by anchor institutions, and foster the integration of the health and human sectors to achieve equitable health outcomes. Although COVID-19 has been disruptive, it has not resulted in a detour from these strategies. It caused us to be more flexible with our grantees. Our immediate response and planning for re-gathering has challenged us to re-think our partnerships and re-imagine how we can be more effective. It led us to think more about where we work and to question how we focus more community-based/place-based work and how it links to our investments at the national level. We are still moving forward with our programmatic goals, but recognize how essential and critical the need is for strategic partners on all levels.