What factors do health and human services leaders assess when considering collaborative opportunities, and what do they worry about? How organizational decision makers perceive risk can influence the success or failure of cross-sector partnerships designed to address social determinants of health. This article captures insights from leaders at twenty-two health and human services organizations in Oregon who were involved in the Centers for Medicare and Medicaid Services' Accountable Health Communities initiative in 2019 and familiar with efforts by their local health systems to identify people with unmet social needs and refer them to community programs. We explore perspectives on the risks and benefits associated with this cross-sector work. Leaders from both sectors perceived collaboration risks to reputation, sustainability, and compliance with regulatory or funder requirements. They also had difficulty gauging the reliability of partners that were sometimes perceived as competitive or coercive. Risk perceptions were manifested differently across sectors, which has implications for the design, implementation, and governance of cross-sector initiatives.
Keywords: Community health; Cross-sector collaboration; Decision making; Federally qualified health centers; Fee-for-service; Health policy; Human services; Medicaid; Oregon; Population health; Social Determinants of Health; Systems of care; health services.