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Collective Action in Hard Times
Lessons from the Delta Center for a Thriving Safety Net
A new report, Advancing Systems Change Across 20 States: The Delta Center for a Thriving Safety Net, highlights insights from seven years of fostering cross-sector collaboration and systems change.
The safety net in the United States is facing one of its most precarious moments in decades. The passage of H.R.1 in July 2025 has decimated funding for safety-net services, creating widespread uncertainty for those on the margins of care and the organizations that serve them. Cuts to Medicaid, reproductive health, and public health programs are forcing providers to make very difficult choices just to keep doors open.
When resources are scarce, the instinct is often to turn inward—to protect what we have. But as we learned during the COVID-19 pandemic, retreating into silos is the opposite of what’s needed. A scarcity mindset may offer short-term survival, but it cannot build the conditions for resilience or effective outcomes. Collaboration and collective action can.
Across the country, philanthropic leaders are calling for collaboration over competition, and for a renewed commitment to equity and systems-level solutions, as highlighted in calls to action from Grantmakers in Health, the Robert Wood Johnson Foundation, and The Boston Foundation. The Delta Center for a Thriving Safety Net offers a concrete example of what such collaboration looks like in practice.
The Delta Center was an initiative that helped catalyze policy change, delivery system transformation, and cross-sector collaboration. The ultimate goal was to cultivate health policy and care systems that are more equitable and better meet the needs of individuals and families.
Over seven years (2017-2025), the Delta Center brought together state primary care associations (PCAs) and behavioral health state associations (BHSAs)—two groups that serve many of the same communities, but often operate on separate tracks. PCAs and BHSAs play vital roles in supporting the providers who form the backbone of the healthcare safety net. They bring policy expertise, trusted relationships with state and federal decision-makers, and deep community ties. Yet historically, they’ve worked in parallel rather than together, even as the people they serve face both physical and behavioral health needs that are deeply intertwined.
The Delta Center helped bridge that gap. By investing in structured partnership and shared learning, the initiative funded partnerships of PCAs and BHSAs in nineteen states to align their goals, strengthen their advocacy, and tackle problems too big for any one organization to solve alone. With the Delta Center’s support, associations worked within their states to advance policy and practice improvements from expanding telehealth access, to the growth of Certified Community Behavioral Health Clinics (CCBHCs), to helping align care and payment systems with community needs.
The Delta Center provided PCA and BHSA grantees with three essential supports to enable collaboration:
- A reason to align their activities and work together toward common goals.
- Resources to support their work together, including grant funding, expert coaching, and structured opportunities for peer sharing and learning.
- Relationships within and across states, and with national partners, built through dedicated time for learning, problem-solving, and planning together.
An important aspect of the Delta Center’s work was helping grantees meaningfully incorporate consumer voice and equity into their efforts. Over time, grantees demonstrated significant growth and learning in this area. Through cross-state sharing of expertise, the Delta Center amplified collective knowledge and accelerated progress across participating states. It also extended the impact beyond grantees by disseminating lessons, insights, and innovations through publications and resources that highlighted promising practices from the field and timely national issues.
As philanthropies step up to support the safety net at this critical juncture, the lessons from the Delta Center’s Advancing Systems Change Across 20 States: The Delta Center for a Thriving Safety Net are particularly timely. Meaningful collaboration takes activation energy in the form of shared purpose, investment, and strong relationships. It requires moral courage from funders to sustain the work even when political or fiscal winds shift. In a moment when the healthcare safety net is under threat, the Delta Center’s story is a reminder that collaboration is not a luxury—it is a lifeline.
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.