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Supporting Health for All through REinvestment: the SHARE Initiative

SHARE Initiative

The SHARE Initiative comes from a legislative requirement for coordinated care organizations (CCOs) to invest some of their profits back into their communities. After meeting minimum financial standards, CCOs must spend a portion of their net income or reserves on services to address health inequities and the social determinants of health and equity (SDOH-E). 

The SHARE Initiative is just one way that CCOs respond to SDOH-E, health inequities and the social needs of their members. CCOs may also use their global budgets to address members’ social needs and community SDOH-E through health-related services (HRS).

The SHARE Initiative is defined by the following state law and Oregon Administrative Rule:

SHARE Initiative requirements

According to requirements in OAR 410-141-3735, a CCO’s SHARE Initiative dollars must:
  • Align with community priorities in the CCO's current community health improvement plan;
  • Include any statewide priorities for SHARE spending that are identified in the contract between CCOs and OHA;
  • Include a role for the CCO’s community advisory council;
  • Involve community partnerships, with a portion of dollars going to SDOH-E partners (see definitions below); and
  • Fit into one of four SHARE Initiative domains related to the social determinants of health and equity (SDOH-E): economic stability, neighborhood and built environment, education, and social and community health.

SHARE Initiative spending areas: examples

  • Income/poverty
  • Employment
  • Food security/insecurity 
  • Diaper security/insecurity
  • Access to quality childcare
  • Housing stability/instability (including homelessness)
  • Access to banking/credit
  • Early childhood education and development
  • Language and literacy
  • High school graduation
  • Enrollment in higher education​​
  • Access to healthy foods
  • Access to transportation (non-medical)
  • Quality, availability and affordability of housing
  • Crime and violence (including intimate partner violence)
  • Environmental conditions, such as clean air and water
  • Access to outdoors, parks
  • Social integration
  • Civic participation/community engagement
  • Meaningful social role
  • Citizenship/immigration status
  • Corrections
  • Discrimination (for example, race, ethnicity, culture, gender, sexual orientation, disability)
  • Trauma (for example, adverse childhood experiences)

Reporting templates

Share Initiative Obligation Report in Exhibit L (Report L6.7): Due annually, starting April 30, 2021

SHARE Initiative spending plans and expenditure reporting (templates in development)


The following definitions are taken from OAR 141-414-3735 effective January 2020.

Social determinants of health and equity (SDOH-E) encompasses three terms:

  • The social determinants of health refer to the social, economic and environmental conditions in which people are born, grow, work, live and age, and are shaped by the social determinants of equity. These conditions significantly impact length and quality of life and contribute to health inequities.
  • The social determinants of equity refer to systemic or structural factors that shape the distribution of the social determinants of health in communities.
  • Health-related social needs refer to an individual’s social and economic barriers to health, such as housing instability or food insecurity.

SDOH-E initiatives may involve interventions that occur outside a clinical setting, and may pursue mechanisms of change including:

  • Community-level interventions that directly address social determinants of health or social determinants of equity; and
  • Interventions to address individual health-related social needs.

A SDOH-E partner is a single organization, local government, one or more of the federally recognized Oregon tribal governments, the Urban Indian Health Program, or a collaborative, that delivers SDOH-E related services or programs and/or supports policy and systems change within a CCO’s service area.

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