CASE STUDY
The Colorado Health Foundation
The Colorado Health Foundation’s equity journey began primarily in 2011 when it transitioned from a public charity to a private foundation and began to examine its strategies for funding and issuing grants. Between 2011 and 2016, the Foundation underwent strategic shifts in how it funded and issued grants, and transitioned from public-charity to private-foundation status.
Theory of change, Programs & activities, Evaluation & learning
Background
The Colorado Health Foundation traces its history back to 1995, when nonprofit hospital system HealthONE formed a joint venture with Hospital Corporation of America, resulting in the creation of the largest healthcare provider in the Denver metro area, HCA-HealthONE. In 2006 the Colorado Health Foundation assumed its current name and form. In 2011 the Foundation sold its equity stake in HCA-HealthONE to HCA for $1.45 billion, triggering a shift in the organization’s identity, the responsibility to positively impact health throughout Colorado, and the determination to move beyond grantmaking toward strategic engagement in public policy. Today the Colorado Health Foundation has $2.8 billion in assets, and in 2020 awarded over $124 million in grants and contributions to bring health in reach for all Coloradans.
The equity journey
The Colorado Health Foundation’s equity journey began primarily in 2011 when it transitioned from a public charity to a private foundation and began to examine its strategies for funding and issuing grants. Between 2011 and 2016, the Foundation underwent strategic shifts in how it funded and issued grants, and transitioned from public-charity to private-foundation status. During this time, the Colorado Health Foundation funded the creation of Healthier Colorado, an independent 501c4 political organization designed to become a voice of the people of Colorado in policy debates influencing health.
Beginning in 2017, the organization’s learning & evaluation department began an effort to better align its work with principles of equity. This effort included a close study of the Equitable Evaluation Initiative, a five-year project to build a field of practice around the Equitable Evaluation Framework, with a specific focus on philanthropic evaluation. At this time, the Colorado Health Foundation adopted new equity-focused cornerstones that affected its mission and vision, resulting in new strategic priorities that emphasized equity. The Foundation also began to send its program officers out into the field for a deeper study of community needs.
Theory of change
The Colorado Health Foundation announced a new strategic direction for its work in 2017. The new strategic direction was an outgrowth of data that the Foundation’s evaluation team collected from communities throughout the state, a new philosophy on community engagement, and the determination to place health equity at the center of all of the Foundation’s efforts. The new strategic direction led to the adoption of a wider view of health and the resolution to work more directly in local communities. With the new strategic direction came four focus areas: maintain healthy bodies; nurture healthy minds; strengthen community health; and champion health equity. The new focus areas underscore the Foundation’s commitment to improve the health of low-income Coloradans in underserved communities, especially rural areas, rely on community information, and undertake all work with the intention of creating health equity. Specifically, three cornerstones emerged from the process of establishing a new strategic direction. These center on engaging only in opportunities that:
- Serve Coloradans who have less power, privilege and income, and prioritize Coloradans of color;
- Intend to create health equity; and
- Are informed by community and those we exist to serve.
Programs & activities
The Colorado Health Foundation’s new equity-centered strategic direction prompted a dramatic change in the roles of its program officers. Instead of implementing strategy design and grantee selection from offices in Denver, program officers are now expected to work in the field at least 40% of the time, interacting with a spectrum of people ranging from CEOs, to community advocates, to staff members of schools and health facilities, and others who might not fall into the pool of potential grantees. Program officers are expected to gather information and perspectives on community and system needs, opportunities, and dynamics, and synthesize the resulting data.
Program officers covered new priorities and geographic regions, seeking out new views and building relationships with organizations previously unfamiliar to them, on subjects that may be equally unfamiliar. The Foundation helped support this change with tools that included professional development, monthly reflective time to debrief on new ways of working, and opportunities to learn more about new topics. Program officers decreased their reliance on grant applications and focused on work in communities to assess whether a potential grantee’s community work aligns with the community’s needs and the Foundation’s interest and values.
Evaluation & learning
When the Colorado Health Foundation adopted its new equity-focused strategic direction in 2017, it also began to look inward at its own evaluation practices to better align them with equity principles. Director of Research and Evaluation Kelci Price, in searching for evaluation methods that advance equity, began to study the Equitable Evaluation Initiative, a five-year project aimed at building a field of practice around the Equitable Evaluation Framework, focusing particularly on philanthropic evaluation. The Equitable Evaluation Initiative helped the learning & evaluation team consider how to alter the Foundation’s practices to align with principles of equity.
In 2019 the learning & evaluation team began to educate grantees throughout the state on an equity-focused approach to evaluation, with the goal of increasing the range of what is deemed valid and reliable, and who is considered an expert, thereby devising more natural ways of carrying out evaluation and measurement. This decentered the Foundation as the main implementer of evaluation in an effort to share power with grantees over evaluation design, methods, questions, and resources. To ensure that the Colorado Health Foundation’s investments are helping achieve its mission, the evaluation model incorporates four major components:
- Providing evidence that helps answer operational and strategic questions;
- Synthesizing the evidence to learn how to make improvements;
- Using what has been learned to inform decisions and make course corrections as needed; and
- Assessing the impact of the Foundation’s work on contributing to the improved health of Coloradans
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