Achieving Today. Sustaining for the Future.
The Health Foundation of Central Massachusetts

Grantmaking Agenda

November 2018


Formally established in January 1999, The Health Foundation of Central Massachusetts, Inc. currently has assets of approximately $70 million resulting from the sale of Central Massachusetts Health Care, Inc., a physician-owned, not-for-profit HMO.  Because these assets came from a predecessor organization which provided quality healthcare to its patients, the resulting foundation is committed to furthering that heritage through its broader mission.


The mission of The Health Foundation is to use its resources to improve the health of those who live or work in the Central Massachusetts Region, with particular emphasis on vulnerable populations and unmet needs. The region consists generally of the 60 cities and towns comprising Worcester County and the contiguous communities of Ashby, Ashland, Ayer, Bellingham, Boxborough, Brimfield, Holland, Holliston, Hopkinton, Hudson, Littleton, Marlboro, Medway, New Salem, Orange, Palmer, Shirley, Stow, Townsend, Ware and Warwick.

As guiding principles, The Health Foundation shall:
  • Be cognizant of and responsive to the changing health needs of the region;
  • Combine its charitable mission with a commitment to innovation;
  • Hold prevention, education, provision of health services and research as tenets with a recognition that these concepts are the cornerstone of improving health;
  • Function primarily by awarding grants and may also from time to time initiate its own programs;
  • Endeavor to leverage its resources as a catalyst for positive changes; and
  • Use the term “health” in its broadest sense, drawing upon the World Health Organization’s definition as “complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.”

Created as a “conversion” foundation in an era of accountability with heightened public interest and overview by state attorneys general, the Foundation initially undertook a strategic planning process to develop its grantmaking agenda and formally revisited that agenda through another strategic planning process in 2011-12.

Key factors resulting from the strategic planning which influence the Foundation’s grantmaking agenda are the intention to:
  • Add value by complementing funding streams, rather than duplicating funding traditionally provided by others (e.g., local, state or federal government programs), and encouraging co-funding partners when appropriate;
  • Rely on community leadership to identify health issues that should be addressed, as informed by health status indicators and emerging health issues, rather than the Foundation naming health issues and calling for proposals to address those issues;
  • Encourage partnerships and collaborative projects which combine evidence-based interventions to improve access to medical treatment and prevention (e.g., population health, public health) strategies to address a health issue;
  • Focus funding on a few projects with multi-year support designed to result in systems change in order to sustain evidence-based interventions;
  • Emphasize and support evaluation to facilitate grantee results and sustainability of evidence-based interventions; and
  • Change public policy in order to institutionalize evidence-based interventions by supporting advocacy and lobbying activities, as uniquely enabled by the Foundation’s 501 (c) (4) tax status and incorporating documents.
Based on this information and the capacity to direct approximately $2.5-$3 million each year, the Foundation developed a Logic Model and established two major avenues for funding: the Health Care and Health Promotion Synergy Initiative and the Activation Fund. In 2012, the Board agreed that even if the Foundation’s assets doubled, these avenues have proven effective and have provided flexibility to expand or contract the amount awarded, in response to the impact of volatility in the investment market.

Importantly, the Foundation does not identify specific health issues as its funding priorities, but instead relies on leadership stepping forward from the community to identify a substantive health issue and demonstrate that they have partnerships in place to address the issue. Philosophically, the Foundation’s approach is to “partner” with its grantees to achieve intended results from its grants. Staff work with prospective applicants to ascertain “fit” with the Foundation’s funding avenues, and assist the Distribution Committee and Board’s review of letters of intent and invited applications. Once funded, staff continue to work with grantees to support the projects.

The funding avenues are:

Approximately 75 percent of the annual grantmaking is channeled to a small number of 3-5 year projects through the Health Care and Health Promotion Synergy Initiative. This initiative solicits proposals which target significant anomalies of poor health status in Central Massachusetts, with collaborative, comprehensive strategies designed to redress the disparities by enhancing systemic access to care and promoting healthier lifestyles. Projects are expected to progress from planning, to piloting, to full implementation, with the ultimate goal of documenting evidence-based practices and securing public policy to create systems change and thus continue evidence-based practices after the Foundation’s funding concludes.

Much of the basis for the Synergy Initiative was drawn from Medicine & Public Health: The Power of Collaboration, a project and report issued in 1997 by the New York Academy of Medicine. As philanthropy evolved, further justification for this approach was encouraged in the 2009 Foundation Review article “Leveraging Grantmaking: Understanding the Dynamics of Complex Social Systems,” the 2010 article by T.R. Frieden, “A Framework for Public Health Action: The Health Impact Pyramid,” in the American Journal of Public Health and the 2011 Stanford Social Innovation Review article entitled “Collective Impact.”  Indeed in recent years, the healthcare delivery system has recognized the importance of a comprehensive approach that expands beyond individualized health care to also address population health and the social-determinants of health.

The Foundation’s Synergy Initiative grantmaking model was identified in 2017 as leading edge among the nation’s health conversion foundations by Dr. Doug Easterling’s research, “Gaining Leverage over the Social Determinants of Health: Insights from a Study of 33 Health Conversion Foundations,” which was funded by the Robert Wood Johnson Foundation.   The report recognized this Foundation among the top 33 of 240 foundations whose grantmaking is addressing the social determinants of health, an upstream approach that the Foundation began nearly 20 years ago that has only in recent years been embraced by national health funders. 

Approximately 15 percent of the Foundation’s annual grantmaking is invested through the Activation Fund. The Activation Fund is designed to attract applicant-initiated proposals, which fit the Foundation’s mission and complement its Synergy Initiative grant projects that generate action beyond the routine. Typically, the Activation Fund provides for one-year, discrete projects that take nonprofits to a higher level of capacity, which can be sustained beyond the grant.

The remaining 10% of the Foundation’s grantmaking is accomplished through its Board Designated avenue which allows the Board to identify and support a few opportunistic efforts each year that do not fall within the funding avenues outlined above, but are relevant to the Foundation’s mission. In addition, the Foundation funds through this avenue its Marilyn E. Plue Director Recognition Awards and Community Member Recognition Awards, recognizing retiring volunteers via small grants to health-related nonprofits serving the region.

By law, the Foundation is not permitted to provide direct support to individuals for projects or health care, nor may it fund electoral activities or candidates for public office. In addition, with regard to funding exclusions, the Foundation determined that, in general, it will not support the following:
  • projects outside of Central Massachusetts;
  • endowments;
  • capital campaigns;
  • fund drives or sponsorship of events;
  • scholarships; or
  • retirement of operating deficits.
Because the Board established these clear funding avenues and guidelines, prospective applicants and Foundation staff are provided with direction in assessing the appropriateness of “fit” between what the nonprofit is seeking monies for and what the Foundation is seeking to fund. This enables a narrowing of the number of appropriate requests and reduces frustration among the nonprofits and the Foundation. Furthermore, it enables a targeted grant portfolio and increases the likelihood of results.


Beyond supporting the advocacy efforts of Synergy Initiative grantees, the Board has also encouraged the President/CEO to actively support and engage in public policy advocacy efforts from time to time which complement the Foundation’s grantmaking. Examples have included banning soda and junk food from the Worcester Public Schools; statewide legislation creating smoke-free worksites; the repeal of the sales tax exemption on alcohol sold in stores; state funding to train police about mental illness in order to appropriately divert individuals from jail and to behavioral health services; and opposition to the statewide referendum to legalize recreational marijuana.   Most recently, the Board has supported the President/CEO’s leadership work with the Worcester City Manager’s Task Force for Sustaining Housing First Solutions whose goal is to achieve and sustain a “functional zero” level of adult chronic homelessness.


Intent on achieving results and creating systemic changes through its grants, the Foundation has committed a significant portion of its resources to evaluation. Grants are guided by Results-Oriented Grantmaking and Grant-Implementation (ROGG), which embraces a philosophy of partnership with the grantee, funder and evaluator and incorporates ten accountability questions to facilitate a process of planning, monitoring and capturing results. ROGG is based on the same accountability questions incorporated in Getting to Outcomes (GTO), an evaluation process developed by Drs. Abe Wandersman and Pam Imm that was recognized by the American Evaluation Association with its Outstanding Publication Award in 2008.

ROGG has been recognized for its effectiveness among foundations and was featured by FSG Social Impact Advisors in 2007 and again in 2011. The Foundation’s experience using it since 2000 was captured in a chapter authored by Dr. Jan Yost titled “Mission Fulfillment: How Empowerment Evaluation Enables Funders to Achieve Results” in an academic book for professional evaluators entitled Empowerment Evaluation: Knowledge and Tools for Self-Assessment, Evaluation Capacity Building and Accountability, edited by Fetterman, Kaftarian and Wandersman and was released by Sage Publications in September 2015.

The Foundation also engages in self-evaluation. Each year the Board participates in a special session devoted to governance and strategic planning in an effort to update its plan and prepare a budget for the next fiscal year. The President/CEO follows up with a detailed annual statement of goals and objectives to implement the plan, which the Executive Committee approves and then evaluates at the end of the year.

Formal Board self-evaluations were conducted in 2002, 2008, 2013 and 2016, employing recognized governance assessment tools, and occasionally, consultants. The Foundation also commissioned Drs. Wandersman and Imm to conduct a Formative Evaluation in 2001 and an Evaluation of its First Five Years of Grantmaking (2000-2005). Both of these reports commended the Foundation’s grantmaking agenda and offered recommendations for continuous quality improvement. For example, in 2006, the Foundation increased technical assistance to its grantees in the areas of advocacy and evaluation, and later added communications. The Foundation released its evaluation of its first ten years of grantmaking – Analyses of Its First Ten Years of Grantmaking (2000-2010)  in May 2011. This evaluation, conducted by Drs. Pam Imm and Annie Wright, concluded that “the three grantmaking avenues developed and used by the Foundation have been effective and continue to advance the goals of the Foundation in complementary ways.” The report also included a number of suggestions for improvement, which the Board formally reviewed and issued the Foundation’s response. In addition, the Foundation hosted Ibunkun "Buki" Owoputi, one of ten graduate students participating from across the country in the American Evaluation Association Graduate Education Diversity Internship program during the 2015-2016 academic year. Her independent research report entitled An Evaluation of Grantmaking: Lessons Learned for Meaningful Engagement provided the Foundation staff and Board with valued feedback from Activation Fund grantees and input from potential applicants. The Foundation fully considered the report's recommendations and issued a public response, including actions to be taken.  During 2017-2018, Dr. Easterling, from Wake Forest University’s School of Medicine, analyzed the Synergy Initiative model for its impact-orientation, reliance on community-driven issues, and focus on evidence-based strategies, while using evaluation to support learning and continuous improvement, characteristics which distinguish the Foundation among its peers.  Dr. Easterling presented his findings and recommendations to the staff and Board to which there have been thoughtful responses and endorsement; action on approved items is currently underway.


The era of accountability in charitable giving has shaped the Foundation’s grantmaking agenda. Rather than seeking to alleviate a range of health problems by making small grants, the Foundation seeks instead to make an impact on a limited number of issues through documented results that influence systemic change. The ultimate goal of the Foundation’s grantmaking is for its investments to be sustained beyond the grant, thereby continuing the improvement in the region’s health.

End Notes:

Logic Model.

Stroh, D.P.  (2009).       Leveraging Grantmaking: Understanding the Dynamics of Complex Social Systems.

Review, 1 (3), 109-122.

Frieden, T.R. (2010). A Framework for Public Health Action: The Health Impact Pyramid.  American Journal of Public Health, 100 (4), 590-595.

Kania, J. & Kramer, M. (Winter 2011) Collective Impact. Stanford Social Innovation Review.

Easterling, D. (2017).  Gaining Leverage over the Social Determinants of Health: Insights from a Study of 33 Health Conversion Foundations funded by and submitted to the Robert Wood Johnson Foundation.