Sustainability Strategies for Rural Community Health Programs

Ongoing funding and resources are essential to sustaining rural community health programs. It may take years before the revenue generated from the program offsets the associated costs, so identifying funding and resources early is critical. Successful rural community health programs often diversify their funding streams by seeking support from multiple funding sources, such as grants, reimbursement through state Medicaid programs or accountable care organizations (ACOs), resources from partner organizations, and fundraising activities.

Types of sustainability strategies include:

• Collecting fees: Some community health programs charge fees for services to help with operating costs. For example, the Virginia Rural Health Clinic Coalition collects an annual fee from members to fund its activities.
• Fundraising: Rural community health programs may use various strategies to raise funds for a program, such as holding fundraising events and offering sponsorships and co-branding opportunities.
• Strengthening partnerships: Partners can offer critical in-kind resources, such as space for trainings, transportation, financial support, and social services. Securing formal agreements with an organization may be appropriate to solidify the relationship and designate the organization's role as part of the program.
• Building capacity: Building capacity could involve training program staff to continue to deliver program activities after an initial period of implementation. Train-the-trainer models can also help ensure that the knowledge and skills gained through trainings are shared and retained in the community. The Rural Health Equity Toolkit offers considerations for building capacity in communities.
• Informing organizational or structural changes: Evaluation findings can inform the decision of which program elements should continue to be provided and by whom. Some rural communities choose sustainability plans that scale down operations, decrease the number of program offerings, participants, and services offered, or distribute responsibilities to willing coalition members. Sometimes, the organization that is leading program implementation may decide to absorb the costs of the program or may transfer ownership of some activities to partners.
• Seeking reimbursement for services: Some community programs may seek reimbursement for certain activities. For more information, see the Reimbursement for Services section of the Care Coordination Toolkit and the Funding and Sustainability Module of the Community Health Workers Toolkit
• Exploring value-based care models: Rural communities are increasingly engaging in value-based payment models to fund health and social care over the long term. The Rural Health Value team developed How to Design Value‐Based Care Models for Rural Participant Success: A Summit Findings Report to discuss best practices in rural communities.
• Applying to grants and contracts: Rural communities often apply for grants from federal, state, and local agencies — or private foundations and charitable organizations — to fund program activities. Engaging a grant writer to assess funding opportunities can help rural community health programs identify and write successful proposals.

Resources to Learn More

Rural Health Value
Website
Provides multiple resources to help facilitate health transformation in rural communities. Includes several tools and informational products related to value-based care.
Organization(s): RUPRI Center for Rural Health Policy Analysis, Stratis Health

A Beginner's Guide to Fundraising
Website
Provides resources to get started with raising money for non-profit organizations.
Organization(s): The Fundraising Authority

Supporting and Sustaining Rural Hospitals
Website
Provides information and resources on rural hospitals and funding. Explores the different avenues of appropriate funding, alternative payment models, and federal grants and programs.
Organization(s): National Conference of State Legislatures

Value-Based Payment Resources
Website
Compiles resources to inform rural practitioners about different value-based payment programs and provides guidance on readiness to engage in value-based care.
Organization(s): National Organization of State Offices of Rural Health