100 Million Healthier Lives - SCALE: Pathway to Pacesetter

1. Pathway to Pacesetter Application Part 1

Welcome! This is the application for the 100 Million Healthier Lives SCALE: Pathway to Pacesetter application. Part 1 includes brief contact information and a set of agreements. It should take less than 5 minutes to complete, once you have decided to apply. For any questions, please email hbrowdy@ihi.org.

Question Title

1. About you

Key contact name: *

Name of Coalition: *

Lead Applicant Organization:

State:

Counties served by your coalition:

Email Address: *

Phone Number: *

Question Title

2. Our community coalition:

Previously completed a full application to SCALE

Is a current member of 100 Million Healthier Lives

Is a community that has substantial equity gaps that we are motivated to close

Other (please specify)

Question Title

3. There are a set of agreements that are required as part of participation in Pathways to Pacesetter. These agreements are listed below:

* We are committed to working together across at least 3 sectors (community health, health care, public health, education, business, etc) to improve the health of our community. If we don't have this in place now, we will work to have this collaboration in place within the next six months.

* We are willing to work to close equity gaps in our community.

* We will commit a team of people who will be on monthly webinars and who will do the work required in SCALE (eg, monthly assignments designed to help your community accelerate its improvement journey in a structured way).

* We embrace being part a peer coaching and mentoring process. We understand that we will be supporting other communities and they will be supporting us to improve.

* We are willing to adopt an improvement approach, including shared metrics which align with our work..

* We are willing to track and report metrics monthly for our community health improvement work, share data with others. and adopt and report on the common metrics of 100 Million Healthier Lives (related to sustainable, equitable wellbeing). We understand that we will receive help and support around this if we don't have a way to do this now.

* We are willing to abide by the core principles of 100 Million Healthier Lives:

* Partner deeply and respectfully in the process of creating change with people, organizations and communities, including with community members with lived experience.

* Build equity, justice, strength and wholeness in the process of creating health.

* Adopt a humble posture of learning and improvement that acknowledges the importance of stories and the value of metrics that matter, co-developed together.

* Intentionally work to remove barriers in critical areas (e.g., payment reform, spread of good ideas) through intentional collaboration with traditional and nontraditional partners.

* Make the way we work an example of what is possible.

We are willing and able to make these agreements at this time.

Yes

Other (please specify)

Question Title

4. Please state the level of support you intend to sign up for (you will be sent an enrollment link and will need to complete Part 2 of the application once you are accepted). The levels of support we would like to sign up for include (mark all that apply):

Core Pathway to Pacesetter program (free)

Improvement coach-supported peer community team- support from a trained improvement coach, who will also offer individualized support and feedback to your improvement plans and help you identify relevant metrics: $100/month ($1200/year; $1800 total)

Access to a low cost online certificate program to help develop deep skills in improvement for key change agents in your community: ($250/person; students free; 50% discount for communities including students)

Face to face opportunity - 1st one on September 29th to October 2nd in Washington DC at the Communities Joined in Action conference: ($150/person for Sept 29th to 30th; $350/person for Oct 1st and 2nd if enroll before August 14th; $450 after that)

Other (please specify) - OK to indicate request for scholarship in something that you feel would make a major difference here

Question Title

5. Please let us know of any special needs here (eg translation services, scholarship for a particular program component that you feel your community really needs but you can't afford without support, etc)

Question Title

6. Please list the names, roles, and email addresses of all others who will be participating in Pathway to Pacesetter as part of your community team:

Team member 1

Role of team member 1

Email of team member 1

Team member 2

Role of team member 2

Email of team member 2

Team member 3

Role of team member 3

Email of team member 3

Team member 4

Role of team member 4

Email of team member 4

Team member 5

Role of team member 5

Email of team member 5

Team member 6

Role of team member 6

Email of team member 6

Team member 7

Role of team member 7

Email of team member 7

Team member 8

Role of team member 8

Email of team member 8

Team member 9

Role of team member 9

Email of team member 9

Team member 10

Role of team member 10

Email of team member 10