Have you heard the story of the three CEOs from competing health-related nonprofits who went to dinner?

No one's saying which CEO volunteered to pick up the check, but all three organizations—the American Cancer Society, American Diabetes Association and American Heart Association—picked up something else. They found a new philosophy of working together to deal with risk factors for the diseases they work with—and eventually new employees, whose salaries are split among all three.

"As the legend goes, they were having dinner together and they said, 'We have so much in common as far as risk factors, why don't we start to work together more around things like nutrition, physical activity, screening, early detection, that sort of thing?' " says Alan Balch, PhD, vice president of the Preventive Health Partnership.

The idea to span the firm organizational boundaries was revolutionary. After all, each organization develops its own donor base to raise money for research and programming, so in some ways it seems risky to create joint messages and activities. However, the CEOs knew it was the right thing to do for patients and the public.

"We're not trying to create a new organization," Balch says. "It's an initiative whereby we look for areas and opportunities where the three of us can work together to have a collective impact and then organize ourselves internally to go out and execute on the ground."

Balch and his staff of three identify ways the organizations can work together around the theme of prevention. The partnership has a steering committee of senior executives from all three organizations and can call on others with internal expertise, such as scientists, to work on specific activities.

"We define prevention pretty broadly,"

Balch says. "We don't try to do everything together because we're still individual organizations. We try to find things where there's significant added value to a collective approach."

During its first three years, the Preventive Health Partnership was primarily a media campaign in collaboration with the Ad Council to do a series of public service announcements revolving around the partnership's core messages: eat right, don't smoke, stay healthy and see your healthcare provider.

But now, the partnership has evolved and the nonprofits routinely work together on key federal advocacy issues. They are jointly creating a significant program that will be announced in early 2011. They have even started making joint fundraising inquiries.

One of the big issues the three organizations tackled together recently was health care reform.

Their collaboration included joint meetings on Capitol Hill with key Senate and House committees.

"That's a very competitive environment, so it's a testament to our organizations that we worked so closely together on several issues, rather than competing for the attention of key Hill offices," Balch says.

The organizations collaborated on trying to eliminate or minimize cost-sharing for preventive services, as well as to create new prevention-oriented visits for Medicare and Medicaid patients.

"We were able to help draft and shepherd along a new prevention planning visit for all Medicare beneficiaries, which starts after their first year of enrollment," Balch says. "The goal was to create a clear space for clinical time for a patient to have a dedicated discussion with a provider around issues related to lifestyle or history with no out-of-pocket cost."

The Preventive Health Partnership hasn't been without controversy. When they got involved in the issue of the use of financial incentives tied to an employee's ability to meet a health standard as part of a workplace wellness programs, some incorrectly portrayed their position on the use of financial incentives as being opposed to worksite wellness programs in general.

"The controversy stemmed from the fact that worksite wellness programs were being defined as simply charging employees significantly more or less for their healthcare cost based on their ability to meet a health standard like weight," Balch says. "From our perspective, properly designed and evidence-based financial incentive programs sometimes can be a useful tool for driving participation in worksite wellness programs, but we don't want to allow the financial incentives themselves to be defined as a worksite wellness program"

One of the partnership's biggest and perhaps most successful activities is focused on helping health care providers and patients start a conversation about screenings for cancer, diabetes, heart disease, and stroke.

The partnership provides free materials for practices to use in waiting and exam rooms, including posters, prescription pads and age-appropriate screening cards. This initiative helps practitioners better serve the whole patient, rather than looking at a fragmented picture of each disease, when, in fact, they have similar risk factors.

All of the Preventive Health Partnership's work spans the boundaries to help people achieve better health.

"It's about looking outside your normal disease silos, and not thinking about it solely from a cancer perspective or a heart perspective or a diabetes perspective," Balch says. "But thinking about it from what are the risks that we all share in common. To me, boundary spanning happens almost automatically when you start thinking about how to get people to change their lifestyle and their behaviors around risk factors in order to prevent disease, detect it early, or slow or delay its progression through chronic disease management."

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