2022 CAC Review

COMMUNITY ADVISORY COUNCIL

ANNUAL REVIEW OF HEALTH FORWARD FOUNDATION 2022

E ACH YEAR the Community Advisory Council (CAC) assesses Health Forward Foundation’s body of work and its impact on our communities. As representatives of these communities and on behalf of the CAC, it is our honor as Review Committee members to undertake this review.

As part of this year’s assessment, we attended board and committee meetings, spoke in greater detail with board members and staff, and conducted our own committee meetings to evaluate Health Forward’s work throughout 2022.

What we learned was nothing short of impressive.

2022 was a year of unprecedented change and transformation for Health Forward as it adopted a new purpose that reimagined how Health Forward would address community health.

The staff completed a tremendous amount of work in a short amount of time. We are incredibly impressed with the strategic and thorough approach to shifting Health Forward’s entire working model. We are also grateful on behalf of our communities for the care and consideration Health Forward has shown in recognizing the importance of our collective voices.

Thank you to all who made this possible.

CONDUCTED BY THE REVIEW COMMITTEE

JaNia Motley (Chair), representing Jackson County, Missouri

Alan Flory, representing Lee’s Summit, Missouri

Helen Hurley, representing Independence, Missouri

Marshanna Smith, representing Jackson County, Missouri

Jennifer Sykes, Health Forward staff representative

APPROVED BY

2023 Community Advisory Council

A YEAR OF TRANSITION NEW PURPOSE AND FUNDING STRATEGIES

In 2022, Health Forward announced a new organizational purpose, new strategies, and a new approach to funding and grantmaking — all of which were the results from a year-long purpose alignment process. Health Forward’s new purpose is embedded in everything the organization does, and guides its work and stewardship.

Most notably, the new purpose allows Health Forward to identify the root causes of the challenges our communities face, and to work toward changing the systems that cause health and racial inequity in our communities.

HEALTH FORWARD’S PURPOSE

Every day we work to support and build inclusive, powerful, and healthy communities characterized by racial equity and economically just systems.

Throughout 2022, Health Forward announced its new purpose strategies and the initiatives that will be core toward creating a fair and just region. The four purpose areas of People, Power, Place, and Platform will drive Health Forward’s decisions in leadership, advocacy, and resources.

PEOPLE

We advocate for the health of people that make communities thrive. Our efforts focus on whole-person care — from physical and behavioral to oral health and social services. And we support innovative ideas that make our health care system more inclusive.

POWER

Powerful communities are healthy communities. We work to adjust the balance of power by encouraging community members to participate in democracy, amplifying community movements, and supporting community leaders and advocates.

NEW PURPOSE AREAS

PLACE

The places we live impact how healthy we are. Our approach to improving where we live focuses on two influential social factors: housing and digital access.

PLATFORM

Health Forward also announced key strategies and outcomes for each purpose area. Though the approaches are different for each area, all initiatives ultimately will impact our region in the following ways:

• High-quality, equitable community health ecosystem

• Strong community organizations and voices

• Equitable and just places that foster health and economic advancement

How healthy we are is strongly influenced by our society’s systems, policies, and stories. To advance racial equity and economic inclusion, Health Forward is partnering with local governments and funders to center equity and race in all policies, systems, and decisions. Visit our website for a detailed look at the strategies, outcomes, and intended impact.

PURPOSE IN ACTION

KC HEALTH EQUITY LEARNING AND ACTION NETWORK

Urban and rural neighborhoods across the Kansas City region continue to experience systemic disinvestment and encounter barriers to mainstream assets that create health and wealth. The consequences of this economic and physical segregation are devastating to the health of residents in underfunded and resource-excluded communities.

This troubling situation was the catalyst for the creation of the Kansas City Health Equity Learning and Action Network (Action Network), a diverse coalition of regional organizations working to understand, address, and overcome the social and economic inequities responsible for Kansas City’s health injustices.

Action Network engages leaders from across Kansas City’s region and health ecosystem to learn and understand what health equity and structural racism are. Leaders represent a full spectrum of organizations and individuals involved in health and health care, including clinicians, health systems, communitybased organizations, public health entities, payers, and researchers. More than 50 organizations completed a series of learning discussions facilitated by the Institute for Healthcare Improvement. Following the learning phase, organizations committed to making sustained improvements toward health equity. Fifteen organizations identified specific steps toward antiracism that they are well-positioned to take based on their role in the health care ecosystem.

Action Network participants will receive assistance with data, coaching, and facilitation support from IHI performance improvement faculty as they continue the work in their organizations and health care sy stems.

Founders of the Action Network:

• Health Forward Foundation

• KC Health Collaborative

• Institute for Healthcare Improvement (IHI) Read about the actions 15 organizations are making toward antiracism in the health care ecosystem .

ORIGINAL GRANTMAKING MODEL ENDS

For 17 years, Health Forward’s grantmaking supported healthy communities, mental health, and safety net. It also offered monthly applicant defined grants that were smaller in award amounts but offered more spending flexibility to grantees. Throughout 2022, Health Forward offered transitional funding while gradually phasing out the original grantmaking model.

2022 GRANTMAKING Healthy Communities, Mental Health, and Safety Net

$15.5 million awarded to 97 organizations

TOTAL GRANTMAKING SINCE 2005

$361.4 million awarded to 590 organizations

NEW FUNDING MODEL

The new funding model is considerably different from the model employed since 2005. Funding and partnership opportunities emphasize racial and health equity and economic inclusion. Health Forward also plans to support services that build healthy people, community power, and equitable and just places. The new funding model features:

• A streamlined application process

• A mixture of invitation-based funding and open-funding opportunities

• An increase in multi-year, unrestricted funding that partners can use however they see fit

• Improvement in philanthropic efforts by prioritizing relationships, conversations, and community voices

COMMITTEE REVIEW

We thank the Health Forward staff for their tremendous dedication to an approach driven entirely by advancing the new purpose. They have accomplished a tremendous amount of high-quality work in a short time — something that larger organizations with more staff would struggle to achieve. We are impressed and grateful for the continued commitment to our communities.

The new purpose, strategies, and funding model are radically different from what Health Forward has done historically. As with all major adjustments, we encourage the foundation to monitor these organizational changes and their impact on the community, and be willing to adjust as needed.

FINANCE AND BUDGETING

The finance department and the board’s Finance and Investment Committee adjusted Health Forward’s financial and budget processes to ensure support for the new purpose. They landed on two major changes that emphasize budget flexibility and qualitative results so staff and the foundation could add talent as needed, and support emerging initiatives with a more strategic approach.

CHANGES TO FINANCE AND BUDGET PROCESSES

1. Health Forward reclassifies staff

Health Forward undertook a thorough review of employee positions, and how those were currently classified on Health Forward’s 990 form. Using current industry practices, the finance team reclassified staff into appropriate administrative or direct impact categories for budgeting purposes. The reclassification greatly expanded the direct impact staff numbers and better captured how employees’ work supports the new purpose. By reducing overhead costs in this way, the annual operating budget now allows the foundation more flexibility to hire staff or subject experts as the need arises in order to advance the new purpose. The work to advance Health Forward’s purpose is substantially different than in the past, and requires more expertise internally. Shifting more funding to the direct impact side of the budget allows the Health Forward team to be true collaborators with the community rather than administrators of grants, as was previously the case.

2. Health Forward shifts to a three-year projection

Health Forward moved from a single-year to a three-year budget projection. This increase in budget projection allows Health Forward to provide more multi-year funding opportunities. And, by increasing the budgetary window, staff now have adequate time to strategically develop funding opportunities and deploy assets.

TRANSITION TO INTERNAL OVERSIGHT

Health Forward had partnered with investment manager Aon since 2005. For the first time in its history, Health Forward transitioned to an investment strategy that is led by internal finance staff and the board’s Finance and Investment Committee, with consultation from its new advisor, Investment Office Resources. This move leverages internal expertise and ensures direct oversight that the investment strategy is meeting the new purpose.

For financial and legal purposes, nonprofits must classify staff into two categories: direct impact costs and administrative (also known as overhead) costs. Administrative staff support the internal operation of the organization, while direct impact staff support external programs. Nonprofits and philanthropic entities strive for low overhead costs so they can maximize community impact.

A budget projection is an estimate of expenses over a given timeframe. This estimate is based on historical data in addition to financial, funding, or operating goals.

COMMITTEE REVIEW

These modifications signal a shift in the long-term strategic needs to realize Health Forward’s purpose. These financial adjustments remove barriers to advancing racial and health equity. We find this to be a fitting homage to Health Forward’s past mission of removing barriers to access health. As with all major adjustments, we recommend close monitoring of the changes to protect Health Forward’s financial health.

Health Forward’s purpose emphasizes building health and wealth by championing antiracist systems and practices. To this end, the organization has made a commitment to infuse that value throughout all aspects of its work, including its financial investments and processes. Health Forward’s impact investing — a practice characterized by purposeful financial investment decisions that strive for social good in addition to monetary goals — made great strides over the last year. Health Forward began diversifying some of its investments to firms owned or managed by Black and Latino/a individuals.

• $322 million in assets committed to firms owned or managed by Black and Latino/a individuals

• 40 percent of current investments are in diverse firms (6 percent women and 34 percent Black and Latino/a individuals)

• Health Forward’s goal is to increase to 45 percent assets committed to owned or managed by Black and Latino/a individuals by end of 2024

IMPACT INVESTING COMMITTEE REVIEW

Once again, we’re impressed by Health Forward’s rapid rate of success. Improving diversity in investments from 0 percent to 40 percent in a year is a major accomplishment and should serve as a model to other foundations considering impact investing. We look forward to marking the completion of the 45-percent goal in two years’ time. While we support Health Forward’s commitment to asset diversification, we eagerly anticipate seeing how Health Forward will continue its impact investing in building health and wealth directly within our communities.

COMMUNITY LEARNING

Health Forward has always placed an emphasis on evaluation and learning, but the organization is furthering that commitment to learning from and centering voices closest to problems and solutions. In 2022, Health Forward engaged in several activities to gather community insight in order to inform its work.

COMMUNITY SURVEY

I n the spring of 2022, Health Forward invited community members to offer their input on areas important within their communities. More than 100 people responded to the 15-question survey covering the following themes:

• Workforce diversity

• Whole-person care

• Homeownership

• Digital equity

• Civic engagement

• Small, community-based nonprofits

• Racial equity and inclusion

Health Forward considered the survey results as it developed success indicators for its funding strategies. Learn more about the survey outcomes

POLICY AGENDA

The latest Health Forward policy agenda included an in-depth community feedback and sensemaking process over the summer and fall of 2022. Sensemaking is the full analytic loop of gathering data, making sense of that data, and then using the resulting understanding to complete a goal.

Health Forward gathered and analyzed responses from a survey sent to more than 100 grantee and community partners. Health Forward then arranged a group meeting with 30 survey respondents to gain insight on their responses. To further enhance their understanding of the issues, the policy team also engaged in one-on-one conversations with organizational leaders who were unable to attend the meeting. The policy team used the survey data and direct interviews to inform, validate, and add depth of understanding to the resulting priorities presented in the policy agendas for Kansas and Missouri. See the Kansas and Missouri policy agendas that incorporated community listening.

STORIES IN POWER

Health Forward partnered with Ad Astra Community Innovations Group to learn how communities define power in their own words. The partnership resulted in Stories in Power, a collection of community voices detailing how they have experienced their own power or their lack of power in making decisions that affect their lives. These stories will be released over the course of 2023.

Visit the Stories in Power website

COMMITTEE REVIEW

We value this holistic, comprehensive approach to learning and understanding our communities. It demonstrates an appreciation for increasing civic engagement and amplifying the work already happening in our communities. These efforts note Health Forward’s commitment to becoming true collaborators while letting our community leaders create their own power. We encourage Health Forward to increase its evaluation on how its changes impact health equity in our community.

MACKENZIE SCOTT DONATES $15 MILLION TO HEALTH FORWARD

In September 2022, Health Forward announced that philanthropist and author MacKenzie Scott had made a one-time, unrestricted donation of $15 million. Health Forward will use the contribution to deepen strategic investments specifically related to health and wealth building through initiatives aimed at increasing representation of people of color in the region’s health sciences workforce. Health Forward will conduct health sciences workforce assessments to inform how to strategically deploy resources.

COMMITTEE REVIEW

This donation was a phenomenal announcement. We are excited to see this donation dispersed through our communities to increase workforce diversity. This dedicated investment will be transformative for our communities once the infrastructure is in place. Aside from the generous monetary contribution, this award also validates the new purpose and shines a national light on Health Forward’s work.

STAFF TRANSITION

In August, Health Forward welcomed Eusebio Díaz as the new vice president of strategy, learning, and communications. He brings nearly two decades of executive-level experience in philanthropy to Health Forward. We look forward to seeing his leadership in action.

We also must honor Graciela Couchonnal, who retired in 2022 after 17 years with Health Forward. She was one of the original employees, serving as the first-ever program officer, the Safety Net Grants team lead, and finally as vice president of strategy and impact. We appreciate the guidance and historic knowledge Graciela provided during Health Forward’s purpose alignment process. We thank her for her time, expertise, and dedication to Health Forward and our communities.

Eusebio Díaz

Vice President of Strategy, Learning, and Communications

Graciela Couchonnal Vice President of Strategy and Impact

COMMUNITY ADVISORY COUNCIL