RWJF Leaders

Equitable Outcomes Funding Convening of Leaders

September 23, 2019 4:55 pm | by

A cross-sector dialogue held in San Francisco

August 2019

There are over 100 Social Impact Bonds worldwide that have raised $400 million to invest in improved outcomes for housing, early childhood education, and health. Did you know that Impact Investing is estimated to be a $250 billion dollar industry, with investors and funders wanting to do good with their dollars? What would it look like if the power of outcomes-focused funding was harnessed much more explicitly to build health equity? Right now, a vast majority of that funding is going toward A) very measurable outcomes, with B) an established base of evidence, and C) to large organizations with a long and proven track record. That’s not the only kind of investment a group of 55 funders, intermediaries, and community organizations believe is needed to more holistically and systemically advance health equity. We need to support community leaders to access the resources they need, to innovate, to shift connected systems, and rebuild a more equitable future.

What if government, philanthropy and community leaders worked together to meet the needs that communities identified for themselves? How would that work and what could be the guiding vision that we could use to build and replicate these collaborations? Those are the questions posed by Shift Health Accelerator, a cooperative initiative of Culture of Health Leaders alumni. On August 29th, twelve Culture of Health Leaders met with more than forty leaders from community-based organizations, social ventures, philanthropy, healthcare, impact investing, and government from communities throughout the United States at the Federal Reserve Bank of San Francisco. The goal was to engage a diverse group of thought leaders to assess the current state of the outcomes funding field and to build and activate a network using outcomes-focused approaches to build an equitable, diverse, inclusive, and healthy society.

The group committed to action in several areas, including:

  • Co-leading and testing funding prototypes that prioritize equity
  • Curating, developing and testing tools for community-led decision-making

Those commitments started with an acknowledgment of the inequities, racism, and white supremacy we live amongst, and a grounding in the care we hold for each other—Thank you Rootwork and Willamette Partnership! Without the history of systemic racism in the room, we cannot work with funders and communities to build power and capacity as a pathway to more equitable policy and systems; these were challenges and responsibilities for the field raised by the Government Alliance on Race and Equity (GARE) and the Bay Area Regional Health Inequities Initiative (BARHII). Nonprofit Finance Fund then provided a critical evaluation of the recent history of outcomes-based funding and the Pay For Success model in particular. The outcomes-funding approach has successfully mobilized millions of private and public dollars to address social outcomes. However, the current structures of outcomes-based funding can recapitulate, and even exacerbate, the existing inequities in funding streams that prevent grassroots, community-based, organizations from accessing these funding models.

From a grounding in history flows vision. Attendees crafted visions for a future we want created by more equitable outcomes-based funding with the Institute for Alternative Futures. We also rooted our visions in tensions—tensions like understanding outcomes in terms of cost saving or community value, “top down” versus “bottom up” decision-making, and readiness versus innovation versus scalability.  The Center for Creative Leadership introduced us to “polarity thinking”, a management approach that says sometimes these tensions are unresolvable and can both lead to good. Polarity thinking helped the group to identify positive and negative outcomes associated with the extremes of a variety of tensions in the field. The goal of this work was both to name the tensions and to explore how they could be managed to maximize the benefits of each extreme and minimize the drawbacks. This exercise led into a discussion of specific barriers that would need to be addressed to change the outcomes-based funding field to support long-term, sustainable pathways for systems change.

And now is the time to follow up on commitments, and invite a wide range of people to join us in turning those commitments into real action!


Shift Health Accelerator is committed to supporting a more equitable approach to outcomes-based funding by living our values in alignment with the vision put forward in this convening. We do this through our efforts at a community level, aiming to simplify access to resources and expertise for community leaders making changes that advance health equity. We also do this at a field level, through partnerships, vision, and communicating the change we believe is needed to achieve an equitable future. Check back in with us on our website or an email for updates and how we can work together. We invite you to join this conversation with us as we all work to build an equitable, diverse, inclusive, and healthy society.


The convening was co-led by Shift Health Accelerator, the Federal Reserve Bank of San Francisco, JSI, Institute for Alternative Futures, Center for Creative Leadership, Nonprofit Finance Fund, GARE and BARHII, with support from the Robert Wood Johnson Foundation, Blue Shield of California Foundation, PacificSource Foundation for Health Improvement, and CommonHealth ACTION.