Five years ago, when The BUILD Health Challenge® (BUILD) launched, it received widespread attention. More than three hundred applicants, an announcement at the National Press Club, and numerous articles on this ambitious effort from five funders heralded the start of something new. The initiative had clearly tapped into a deep vein of frustration with the nation’s inability to address rising inequity, healthcare costs, and chronic diseases in the country, and it made space to elevate new ideas and approaches. 

The funders were a diverse group – regional and national, established and start up, traditional philanthropies and a for-profit organization – but each saw an opportunity to change the way that health is advanced in America. And they were bringing their resources together. AKristina Strain, columnist at Inside Philanthropy commented, “Ever since BUILD Health came on the scene, it’s had our attention. It’s ambitious, integrative, and it’s taking aim at a huge roadblock to implementing basic health care improvements in this country: data. […] There’s some real firepower behind this thing.” 

BUILD reflected a moment in time, an opening to incentivize hospitals to invest in impacting public health in new ways, leveraging the new Affordable Care Act legislation that required non-profit hospitals to commit a certain amount of their assets to the community. As Chris McCarthy, Community Health Project Manager at UnityPoint Health-Des Moines remarked, “I’ve been in this field for a very long time and the BUILD Health Challenge grant was like a breath of fresh air… This was the first one that really challenges hospitals to say, “Alright, you need to get upstream on this stuff.” I think it’s kind of a groundbreaking grant process that’s going on right now.” 

BUILD’s funding collaborative members saw value in bringing together partners who had a natural  interest in improving health outcomes in their community, and to encouraging those partners to move upstream to address the root causes of those health inequities – before residents landed in a doctor’s office. And they weren’t the only ones – former National Coordinator for Health IT, Karen DeSalvo, spoke at the announcement, proclaiming BUILD’s model the “key to helping reorient us from the traditional model of health.”   

The first cohort of BUILD communities in some ways looked very similar to the current cohort – the core partners; the five pillars of being bold, upstream, integrated, local, and data-driven; and the innovative hospital investment are unchanged from the original vision of BUILD – but the implementation of the initiative took a difference shape. All BUILD applicants were required to be from cities of 150,000 residents or more – meaning many were focused explicitly on urban health issues. They were eligible to apply for low-income loans alongside their grants. And in perhaps the biggest change, communities could also apply for either Planning or Implementation awards – one year and $100,000 or two years and $250,000 respectively.   

In the end, the cohort came from cities across the country, made up of seven Implementation awardees and eleven Planning awardees – nearly all of which would go on to receive a second year of funding. For many, this kind of challenging collaborative work was new and complex, and the opportunity to dive deep was exhilarating. As they worked with residents, developed data systems, and built trust in their partners, they generously shared the journey with BUILD. In turn, this cohort demonstrated new practices and policies that had great potential. The learnings from these communities helped shape and set the foundation for the future of BUILD.   

Learn more about the seven Implementation communities from the first cohort through BUILD case study series (click to open): 

Albuquerque, NM

Harris County, TX

Ontario, CA

Des Moines, IA

Cleveland, OH

Oakland, CA