Many entities specialize in a certain type of care, such as physical or behavioral health. Because individuals often have both physical and behavioral health needs, safety-net entities may serve the same populations. All too often these entities do not coordinate with each other, instead operating in silos.
Improving care and access to care for communities requires thinking about policy and practice together. This is because public policies, such as the regulations, guidelines, and reimbursement rates issued by federal and state Medicaid offices, shape the way that care is delivered and paid for. Additionally, they can shape the workforce and whether there will be enough providers to meet the need for care. Supportive policies and sufficient funding are required to sustain practice change efforts.
“It is virtually impossible to effect practice change at the provider level without supporting alignment in the policy, regulatory & financing context.”
—Delta Center Grantee
The integration of behavioral health and primary care is essential to ensure that individuals receive care for both their physical and behavioral health needs. However, this integration has been difficult to achieve given long-standing disparities between funding for behavioral health and primary care services. “Community health centers and community-based behavioral health organizations saw themselves as competitors in a zero sum game for funding within the health policy space,” said Rachel Tobey.
"It was a policy change, block funding for mental health care to states under the Reagan administration, that began that cascade of events that we now see today and it is policy change that will ultimately reverse that course so that people get care when they need it, from the level of provider they need, in a way that is culturally and linguistically aligned with their background."
- Rachel Tobey, Delta Center Director
Rachel Tobey, Delta Center Director
State-level primary care associations (PCAs) and behavioral health state associations (BHSAs) are member-based organizations that represent primary care and behavioral health providers at the state level.
Their role is to educate and advocate for policy and practice change on behalf of their members. Like primary care and behavioral health care providers, these associations often work in silos and can sometimes struggle to coordinate their efforts.
Collaboration through the Delta Center
JSI, together with strategic partners, created the Delta Center for a Thriving Safety Net with the idea of bringing together primary care and behavioral health associations to advance policy and practice change in their states.
Funded by the Robert Wood Johnson Foundation, the Delta Center fostered collaboration between state associations with the goal of cultivating health policy and care systems that better serve the needs of individuals and communities. The initiative was a partnership between JSI, the National Association of Community Health Centers (NACHC), the National Council for Mental Wellbeing, and the Center for Accelerating Care Transformation (ACT Center).
The Delta Center’s name represents a symbol for change while also conjuring a river delta. JSI and partners envisioned the initiative as a confluence of ideas and efforts, where associations could collaborate and take action together. The name also honors the history of the health center movement—one of the first federally-qualified health centers was the Delta Health Center established in Mississippi.
The Delta Center’s State Learning and Action Collaborative funded teams of primary care and behavioral health state associations from 19 states in two cohorts between 2018 and 2024, plus one state-specific initiative in California. Teams received grant funding, coaching, training, technical assistance, and peer-to-peer engagement to advance policy and practice change through collective action.
Working and learning alongside the other states, seeing similarities, was hugely helpful.
You think, how can I do this? And you see others do it.
-Delta Center Grantee
Cohort gatherings created space for meaningful interaction and collaboration between state teams and other experts. The Delta Center led discussions on sharing successes, policy updates, learnings, and deep dives into racial equity and consumer engagement.
State teams shared their experiences, debunked misunderstandings about each other, and ultimately built trust. By joining forces, they didn’t just gain resources—they tapped into the transformative power of collaboration. Collaboration was a pathway for both entities to achieve their goals of improving the health and wellness of the communities they serve. One grantee said, “The fact that we are communicating with other state association partners and that they have a willingness to meet and do things together has been catalyzed by our Delta Center work.”
“I think our proudest moment came with the realization that we didn’t know each other very well and that we needed to understand each other better to be a force to be reckoned with.”
—Delta Center Grantee
Angel Bourgoin, Delta Center Evaluator
Rachel Tobey, Delta Center Director
Nurturing Progress Through Collective Action
As collaborations gained momentum, states saw the fruits of their labor.
Grantees used their Delta Center funding to support a broad array of policy activities, including background research, education and training, stakeholder engagement and convening, and building shared policy agendas.
Teams leveraged their strengthened relationships, along with other sources of funding, to advance significant policy victories and practice changes. As one grantee said, “The partnership between the PCA and BHSA has clearly enhanced the credibility of each organization across the state in terms of our shared commitment to integrated care, and it has elevated awareness of the value-based proposition at a critical time in our state.”
“We have seen state associations in 20 states point to concrete things that they have done together that they would not have done otherwise, absent the Delta Center."
—Rachel Tobey, Delta Center Director
Angel Bourgoin, Delta Center Evaluator & Rachel Tobey, Director
Grantee Successes
Responding to Crises
When the COVID-19 pandemic hit, the relationships built through the Delta Center allowed associations—such as those in New York and Alaska—to act quickly. It was critical to maintain continuity of care for both behavioral health and primary care needs. Telehealth policies that had been stalled for years were rapidly implemented to meet the emerging need for virtual care.
Transforming Care Delivery and Payment
The Delta Center team from Kansas helped transition Licensed Community Mental Health Centers into Certified Community Behavioral Health Clinics (CCBHCs) in their state. The CCBHC model is an innovation in the delivery of integrated behavioral health care, and can be established through a federal demonstration grant or state legislation.
Centering the Community
Delta Center grantees strengthened their ability to engage with the individuals and communities receiving services in the safety net. Centering those with lived experience fosters policies and practices that are shaped by those who are most directly impacted by decisions. Grantees explored how to address longstanding inequities to meaningfully improve health and wellness for all.
Carrying Forward the Momentum
The Delta Center started with a question: Can building the capacity of and relationships between primary care and behavioral health associations generate positive change in policy and practice?
Over eight years of Delta Center experiences across 20 states, including nationwide and state-based initiatives, participants proved that the answer is yes.
Member associations play critical roles in shaping more integrated, effective, and equitable health systems and the policies that support them. The progress that Delta Center participants achieved demonstrates the potential for broader, system-level impact.
However, “Systemic change isn’t something that happens like a checklist,” and collaboration requires both investment and structured external support. While the Delta Center has made strides, this work will require continued investment, collective effort, and a sustained commitment to progress from both funders and participants.
“This was an amazing opportunity to partner with like-minded committed organizations under the guidance and direction of the Delta Center. In 40 years, it was the most enriching project I have been a part of.”
—Delta Center Grantee
Angel Bourgoin, Delta Center Evaluator
What Does the Future Hold?
Additional investment has the potential to broaden the Delta Center’s impact by expanding the initiative to new states, collaborations across states, or fostering new collaborations beyond primary care and behavioral health.
The Delta Center model offers a promising opportunity for foundations, state government agencies, and health plans to catalyze systems- and policy-level changes to ultimately improve health and care at scale.
Below, Delta Center staff and grantees share their vision for the future.
“We will continue to collaborate to effectively drive policy and practice change in our state to improve patient care for our collective members and the people they serve.”
—Delta Center Grantee
“I hope they continue to invest in provider associations. The more time I’ve spent in this role and interacting with other associations, the more I believe associations play this critical glue function for the delivery system…As associations, we cross boundaries and connect important conversations across state agencies that they don’t know we are having. That is true about legislators, too.”
—Delta Center Grantee
Corina Pinto, Delta Center Coach
Rachel Tobey, Delta Center Director
Support for this program was provided by the Robert Wood Johnson Foundation (RWJF). The views expressed here do not necessarily reflect the views of RWJF.
Funding stipulations from the Robert Wood Johnson Foundation prohibited the use of Delta Center funds for engaging in direct or grassroots lobbying. Grantees used their Delta Center funding to support a broad array of policy activities, including background research, education and training, stakeholder engagement and convening, and building shared policy agendas. As state associations, Delta Center grantees used other non-Delta Center funding sources when they engaged in lobbying and legislative advocacy to advance policy.