Strengthen systems of health

Goal 1

Strengthen systems of health by catalyzing health systems to be accessible, equitable, and deliver health not just health care


Resource allocation and system reform in the health sector reflect the goal of health, not just healthcare

STRATEGY1: support change in healthcare financing to incent investment in improving community health

EHF desires to work with institutions that are willing to look at new ways of paying for improved health outcomes.

Examples of this kind of work include but are not limited to:

  • Pay for Success initiatives that incent spending on prevention by inviting private sector investors to bear up-front costs as well as risk of failure
  • Supporting community-based clinics in undertaking value-based contracts with payers
  • Working with Texas Medicaid so that value-based payment programs incent investment in social determinants of health
  • Supporting Accountable Health Communities

EHF is not accepting Letters of Inquiry (LOIs) under this strategy at this time. If you are interested in discussing this strategy, please contact us at

STRATEGY2: Support community-based clinics in addressing the social determinants of health

Although it is known that the social determinants of health have a larger influence on health outcomes than healthcare alone, there are few structured ways for community-based clinics to identify and address non-medical social needs experienced by patients seen in a clinic setting. EHF supports clinics in collecting, analyzing, and acting on data and information on the social determinants of health that impact their patients.

Examples of this kind of clinic-based work include but are not limited to:

  • Assisting clinics to identify and address the social determinants through the development and implementation of an assessment system that includes screening tools that are applicable throughout a patient’s life 
  • Supporting practices to address the social determinants of health that have been identified by the clinic 
  • Providing and/or developing navigation services within the healthcare system including service linkage and follow-up to external resources
EHF’s Community Centered Health Homes Initiative:

In service of this goal and strategy, we will continue our Community Centered Health Home (CCHH) initiative which provides clinics with coaching, technical assistance, a learning community, and grant funding to enable them to build leadership in the space of community prevention. EHF awarded grants to 13 CCHH clinics in 2017. We will offer opportunities for additional clinics to apply to be part of the CCHH Initiative beginning in 2019. 


Low-income and vulnerable populations access comprehensive care in communities

STRATEGY3: Support community-based clinics to provide comprehensive services, continuity of care, inclusivity, and efficiency in delivery of care

This strategy reflects our interest in helping community-based clinics fulfill their potential on behalf of their patients and communities. We define comprehensive community-based clinics as those that provide a full complement of services, including preventive care, primary care, oral health services, and behavioral health services (see the ‘Behavioral Health’ section below for more on EHF’s interest in this area as a key piece of comprehensive care). These clinics offer the full array of services including immunization and women’s reproductive health services; they charge patients according to a sliding scale; they participate in reimbursement systems; and they seek out a variety of sources of funding for sustainability. Please see “Expectations of Primary Care Providers” on the EHF website for more information.

EHF prioritizes building the capacity of community clinics in key infrastructure and care processes that will develop and/or enhance their delivery systems, embed care coordination and management, provide access to specialty care services, and support use of health information technology/data analytics.

Examples of this kind of clinic-based work include but are not limited to:

  • Access and continuity: increasing access to the primary care team through expanded hours or other alternatives to traditional office visits that help patients get the right care, at the right time, in the right place
  • Care management: improving individualized care, most often for high-risk, high-need patients, by practicing risk stratification, empanelment, and transition from short-term to long-term care; by analyzing data including claims data from payers; and by intensive case management where indicated for chronic disease and serious mental illness
  • Comprehensiveness and coordination: strengthening a clinic’s ability to meet their patient population’s medical, behavioral, and health-related social needs in pursuit of their patient’s health goals; this includes focusing on the depth and breadth of services offered including specialty care referral systems and networks in service to lower overall utilization and costs, reduce fragmented care, and achieve better health outcomes
  • Patient and family caregiver engagement: increasing patient engagement in the design and improvement of their own care and incorporating patient input to structure responsive services
  • Planned care and population health: organizing care to meet the needs of an entire population of patients served including timely and preventive care; using evidenced-based approaches to chronic disease management; and identifying gaps in care
Behavioral Health:

EHF is committed to community-based approaches that reconsider the traditional separation between primary care and behavioral health providers. We want to help communities take action to reduce the impact of mental illness and substance use disorders (SUD) and to collaborate to increase access to behavioral healthcare. This transformation will take time to fully realize, and we look forward to working with provider partners and communities that share our commitment.

Integrated Behavioral Health

Our first priority in behavioral health is to support the expansion of integrated behavioral health services. To that end, we invite applications for funding necessary to plan and implement behavioral health integration that brings behavioral health services into a primary care setting, brings primary care service into a behavioral health setting, or brings SUD service into either a primary care or a mental health setting.

The SAMHSA-HRSA (Substance Abuse and Mental Health Services Administration -Health Resources and Services Administration) Center for Integrated Health Solutions has developed a framework to help primary and behavioral healthcare provider organizations improve outcomes by helping them understand where they are on the integration continuum. Click here to access the “Standard Framework for Levels of Integrated Care.” Applicants interested in applying for this priority should review this website when developing their proposals.

We are most interested in funding approaches that move beyond simply meeting unmet needs and entertain suggestions from applicants as to how this will be accomplished. In urban areas, we anticipate devoting our resources primarily toward organizations devoted to fully integrated physical and behavioral health services. We encourage community clinics to think creatively about what they need to know and learn to build capacity within their organizations as it relates to providing integrated care, and to develop a plan to achieve proficiency in these skills.

Behavioral Health Access in Non-Urban Settings

Our second priority in the area of behavioral health is to increase access to behavioral healthcare implemented in non-urban community settings.

Examples of this kind of work include but are not limited to:

  • The provision of effective and efficient evidence-based behavioral healthcare implemented in community settings
  • Forging new bonds between community-based organizations to locate behavioral health services in accessible settings
  • Changing a behavioral organization’s administrative practices to offer services on evenings/weekends/walk-in basis
  • Technical assistance to revise business practices related to revenue generation or participation in payment reform efforts that support behavioral healthcare

STRATEGY4: Expand and strengthen community-based clinics in rural areas 

EHF understands that rural areas may lack basic preventive, primary, behavioral, and oral health services. Strategy 4 is aimed at increasing the availability of these basic services to those living in smaller towns and rural areas. We seek to work with communities to help them optimize healthcare infrastructure, including communities that have depended on rural hospitals whose futures may be in jeopardy. 

Examples of this kind of work include but are not limited to:

  • Offering technical assistance or operating support for rural health clinics to provide outpatient primary care services 
  • Developing approaches to recruit and/or retain provider staffs including nurse practitioners and other mid-level providers
  • Enhancing use of information technology and data analytics
  • Supporting other practices that improve the sustainability and function of rural health clinics

STRATEGY5: Expand health coverage and benefits

EHF recognizes that true access to health services requires a system of coverage, ideally through a comprehensive health insurance plan. Access to comprehensive, quality health care services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all Texans. Moving the needle on this strategy will require a dual approach to both expand coverage and improve enrollment of eligible beneficiaries. In support of this strategy, we will continue our research and advocacy regarding the need to increase health insurance coverage in our state.

Examples of this kind of work include but are not limited to:

  • A clinic or community-based organization’s work to help low-income and vulnerable populations gain access to care through insurance and other health- related programs including those offered by federal, state, and local governments 
  • Tracking newly-enrolled beneficiaries through to their first use of those benefits– most likely through a visit with a medical provider