Health Affairs

Earlier this month at Grantmakers In Health’s Annual Meeting, my presentation was titled “The Promise. The Tool. The Bargain: Maine Health Access Foundation’s Use of Facebook.” Clay Shirky, in his book Here Comes Everybody, uses this wording and reminds us that these social media platforms are only tools—they are not an end, but a means to an end. Without the accompanying promises and bargains, these tools will simply be curiosities that won’t improve our work. I described to the session attendees why we at the Maine Health Access Foundation (MeHAF) used Facebook as the tool to support Fund for the Future, how we implemented Facebook for our purposes (The Bargain), and what the results were (The Promise).

Fund for the Future is a pilot funding initiative, the goal of which is to “improve the health of Maine people through projects or activities that reach beyond the delivery of clinical health care services by engaging the communities where they live, work, and play” and “address a targeted health issue within a defined community”; proposals, ideally, “should address the root causes of the health issue selected”—including any social determinants of that issue.

The Tool: We chose Facebook to tap into the local wisdom of Maine people, engaging the public through a multichannel platform where MeHAF could communicate with the public, the public could communicate with MeHAF, and members of the public could communicate with each other. We also had a captive audience—approximately 20–30 percent of Maine’s population is on Facebook.

The Bargain: We integrated Facebook into the planning of Fund for the Future from the very beginning of the initiative. As program officer for the initiative, I managed the day-to-day activities of the Fan Page (posting ideas, links, materials, and so forth). The overarching rule for the page was that we would monitor the discussions and take down any comments we felt were inappropriate—everything else was fair game. The public could comment on the initiative (what did they think we should fund, how should we structure the initiative, and so on); on possible project ideas (if they were shared); and on the seven Letters of Interest whose authors were invited to submit full proposals.

The Promise: The stated goals, or promise, of using Facebook was to build a better initiative and better projects, and I think the early results are very positive. Although we didn’t get any feedback from the public on the initiative itself, the majority of the respondents to a survey say that they are now more aware of the social determinants of health than they were prior to the initiative’s launch. And two of the three funded projects altered their final proposals in response to public comments on their Letters of Interest. Time will tell if these projects were strengthened by this process, but engaging the public in new ways, such as on Facebook, can only make our work, and that of our grantees, better informed—and, we hope, more successful.

Those who have worked in the health field for any length of time have surely encountered the “stages of change” model, which posits that individual behavior change goes through five stages: precontemplation, contemplation, preparation, action, and maintenance.

It is my observation that foundations go through a similar process as they enter the realm of social media. In more user-friendly terms, Larry Blumenthal, my copresenter at the 10 March 2010 Grantmakers In Health session, conjured a metaphor that became common language for the panelists and session participants alike to talk about the stage they are in. (Larry recently formed his own venture, Open Road Advisors, to help foundations and nonprofits to use the Web more effectively.) The metaphor is that of a diving board. Some foundations mentioned that they are still climbing the ladder; some foundations, nervous about jumping, are hesitantly standing on the board; and others are in the water, swimming along.

I described the Connecticut Health Foundation’s (CT Health’s) decision to work with online communities and social media as one part of a multipronged strategy to motivate the public to eliminate racial and ethnic health disparities in Connecticut over ten years. CT Health spent quite a bit of time in contemplation and preparation and is now ready to “jump off the diving board.” The initiative will go live in early April 2010.

CT Health’s approach differs from that of many foundations in that we are working in partnership with a grantee. The foundation awarded a $200,000 grant to the Society for New Communications Research (SNCR) to implement a diversified, multiplatform approach to stimulating engaging conversations about health equity in the online communities in which our target audiences already participate (for example, Twitter, Facebook, local blogs, and local ethnic online communities).

The initiative is branded “healthjusticect,” so that the focus is on the expression of public will, rather than on the foundation. Initial research revealed limited public conversations about health disparities both online and offline. Therefore, a cornerstone of our approach is that online and offline social networking need to reinforce each other. In other words, real-world events will be used to lead people to the online activities, and social media will be used to organize real-world action.

During the discussion portion of the GIH session, two particular points were raised that I have continued to contemplate. One participant asked what foundations are doing to support grantee use of social media. I answered that SNCR will be offering free social media training to other CT Health grantees, partners, and leadership program graduates. To date, I have not seen an applicant factor social media into a grant budget, but I am open to supporting such use of grant funds if the organization can demonstrate how it will use social media to forward the grant objectives. As Larry Blumenthal and Len Bartel of the Maine Health Access Foundation (other GIH session panelists) emphasized, for most organizations, using social media effectively requires some staff time, but many tools are free or cost very little.

A frequent point of discussion at the GIH session was that because Web 2.0 is a two-way street, there is a fear that it can open foundations up to negative comments and criticism. Larry Blumenthal noted that in the experience of the Robert Wood Johnson Foundation, where he used to work, the first challenge is to get stakeholders to participate. When they do, the result is generally positive.

CT Health tries to maintain this view; however, because our topical issue centers on race, which can be polarizing, we have been bracing for some negativity, which we feel will be inevitable. Online communities each have their own norms, and we hope to participate in those whose community members ensure that respectful debate is part of a vibrant conversation and that expression of racist sentiment is not tolerated.

I noticed something a little unusual at a workshop earlier this month.

I’ve been doing a lot of speaking recently on social media and philanthropy, and I often start presentations with some questions to gauge the mindset of the group. It doesn’t take Sherlock Holmes to uncover a lot of skepticism among foundation folks–especially program staff–about social media.

But I heard a different response while presenting at the Grantmakers In Health annual meeting. I was doing a breakout session on social media tools along with Len Bartel from the Maine Health Access Foundation and Elizabeth Krause of the Connecticut Health Foundation. Len has been piloting an effort to get feedback on grant proposals using Facebook. Elizabeth is involved in a fascinating initiative to use social media to advance the issue of disparities in health care.

When I asked for reasons why people were reluctant to get involved with social media, the group listed some fairly typical concerns about adopting this approach, including a lack of resources, a daunting learning curve, skepticism among senior management, and uncertainty about how to measure success. However, when I asked how many people didn’t think social media was relevant to their work, no one raised their hand. Not one. That was a first for me. This group didn’t seem to need convincing. They had already begun to get their feet wet, or at least their toes. I don’t want to leap to the conclusion that philanthropy has undergone a sea change that will alter life as we know it (although I think that would be a good thing). But I did take that as a healthy sign that social media tools are steadily making their way into the foundation world. The first blooms of spring are peeking up through the snow, and it is a beautiful sight.

I spent a lot of years overseeing Web and social media strategy at the Robert Wood Johnson Foundation. We’ve been pretty active with social media recently—launching eight Twitter feeds, several blogs, a YouTube page, a presence on Facebook, user comments and communities, among other things. It has not been without its bumps along the way, but bumps make for great learning opportunities. I shared with the group at GIH some lessons learned while implementing social media at RWJF. Among the lessons:

• Make sure social media efforts flow from the organization’s broader mission. Think about how they fit into the strategy upfront.
• Moving in baby steps is OK. Push out of your comfort zone a little at a time, if that is what it takes to get you going.
• Embrace your failures. We are all learning this stuff together, so you should approach social media as a learning opportunity.
• Emphasize conversation/discussion over one-way broadcasting of information. It is a different mindset, but you’ll figure it out.
• Be realistic upfront about committing resources. This stuff is harder than it looks.
• Don’t let a lack of clear metrics for measuring success stop you from getting started. The metrics will catch up.
• Social media isn’t just a tool for communications. Program staff should be looking at this as well.

Some of the most interesting work I’ve seen lately is coming from foundations who are integrating social media tools —and the principles behind them—into their program work. The work of my fellow panelists is a good example. RWJF has a lot going on as well. The Pioneer team has been working on ways to open grant-making decisions to a broader community. The Vulnerable Populations team recently launched a forum to pose questions to the field as a way of targeting its work more effectively. The Human Capital team is developing an online community for the more than 2,000 people who have come through its scholars and fellows programs. Although it is intended to help scholars and fellows work more closely together, it also will help the foundation tap into all that expertise to improve its program efforts. More is in the works, and RWJF is not alone.

If you are interested, you can see more details on the lessons I’ve learned on my own blog. I’m having a blast watching these initiatives take hold, but I’m supposed to. It is my job.

What do you think? Are you happy to see social media taking hold in the world of philanthropy? Or are you not convinced, yet?

Are you working on something interesting you want to share?

Mary Jane Koren, an assistant vice president of the Commonwealth Fund, received the Terrance Keenan Leadership Award in Health Philanthropy at an 11 March 2010 luncheon during Grantmakers In Health’s (GIH’s) Annual Meeting in Orlando, Florida. Koren, an internist and geriatrician, heads Commonwealth’s Quality of Care for Frail Elders Program and manages the Commonwealth Fund/Harvard University Minority Fellowship Program in Health Policy.  According to a press release, Koren “has committed nearly 30 years of work to improving the quality of institutional long-term care.” This area “faces considerable challenges and is often overlooked by the broader field of health philanthropy.”

Koren has the “courage of her convictions,” Susan Zepeda, president of the Healthy Kentucky Foundation, said in introducing Koren at the GIH luncheon. Fellow grantmakers Kate O’Malley of the California HealthCare Foundation and Amy Berman of the John A. Hartford Foundation had nominated Koren for the prestigious award, which is named after a long-time staffer of the Robert Wood Johnson Foundation, who passed away in 2009.

The award-winner related to the audience some of her observations as a grantmaker. (Koren has also worked for the Fan Fox and Leslie R. Samuels Foundation, where she was a vice president.) She remarked that there is an interest in moving away from having elderly people live in nursing homes, but this type of care setting won’t go away.

Koren related an interesting anecdote from her days as director of the Bureau of Long-Term Care Services in New York State, where she managed a state grant program to promote innovation in nursing homes. Someone at a small rural facility submitted a proposal that included a suggestion to allow pets to live in nursing homes; doing so was technically against state regulation (and state law, Koren later found out). The state allowed only one pet per nursing home. However, Koren decided to fund this experiment under a waiver to allow pets into this nursing home. The result?  The residents conversed more and enjoyed meals more than they had before, and psychoactive drug use was reduced to near zero, she reported. She recommended to the assembled grantmakers that they be innovative and think outside the box, as in this example of the birth of the Eden Alternative model, which is still helping nursing homes to achieve person-centered care.

Koren concluded her remarks with her recommendations to the audience of grantmakers: (1) stay focused while being creative; (2) be strategic; (3) take chances on new ideas and untried grantees, such as Bill Thomas, who founded the Eden Alternative and now is viewed as one of the really original thinkers in the nursing home field; (4) tell people what grantees of your foundation are working on; and (5) persevere and allow time to work through challenges. (As she noted earlier in her remarks, be willing to try something again, even if it did not work before).

Koren recently authored an article titled “Person-Centered Care for Nursing Home Residents: The Culture-Change Movement,” for Health Affairs. Read the abstract here.

Related reading:

Health Affairs devoted its January 2010 issue  to the the theme: “Advancing Long-Term Services and Supports.”

A Narrative Matters essay, “On the Southern Front,” by novelist Julia Alvarez, looks at elderly caregiving.

After the devastating January 2010 earthquake in Haiti, many foundations have stepped forward with a wide range of funding and assistance. The Council on Foundations lists more than 100 diverse grantmakers who have helped in Haiti. The site describes efforts by various types of foundations, as well as by corporate donors, including Amgen, Baxter International, Glaxo SmithKline, and Medtronic.

Yet another powerful earthquake (magnitude 8.8) hit Chile in late February 2010. The Council on Foundations’ United States International Grantmaking project has also developed a Web page on “Responding to the Earthquake in Chile.” GrantWatch will be following the response of foundations to this devastation.

Haiti Lessons for Funders

Susan Sayers, vice president of institutional partnerships at Partners In Health (PIH), gave one of the plenary addresses at Grantmakers In Health’s (GIH’s) annual meeting, held in Orlando, Florida, in March 2010. She described the work of PIH in Haiti to a large number of foundation staffers gathered. The nonprofit organization began with one small clinic in the island nation, she said, and now it has ten sites there.

PIH, which aims to provide high-quality health care and to also address other underlying issues in Haiti (where it has been working for more than twenty years) works in close partnership with Haiti’s Ministry of Health. The nonprofit also is now helping displaced Haitians who are living in “sheet cities” after the earthquake. Its mobile clinics that provide primary care, HIV/AIDS tests, and disease treatment are helping this population.

As a result of the earthquake, an estimated 230,000 people died (this is more than in the tsunami back in 2004, Sayers noted). Included in that count of 230,000 were 150 nursing school instructors and students who perished at the state nursing school. Many earthquake survivors are amputees, she explained.

Short-term needs in Haiti include shelter and sanitation in Port-au-Prince (with an eye to Haiti’s upcoming rainy season), rehabilitative care for survivors, and what to do now with the more seriously ill and injured people who were treated on the USNS Comfort.

There are also medium- and long-term needs in Haiti. These include getting the government of Haiti “back on its feet” (it even lacks laptop computers, Sayers commented); rebuilding medical specialties, such as mental health care, which was available only for the wealth even before the tragic earthquake; and strengthening the public health system.

Sayers then mentioned several ways philanthropy could help Haiti. 

1. Provide flexible funding in this acute phase after the earthquake, such as funds for general operating costs and staffing, which some foundations may not usually fund.
2. Support groups that include local partnerships and experience.
3. Support programs that are accountable and transparent to the Haitian government and its people.
4. Support projects that address poverty in Haiti—for example, by hiring Haitians if possible.

In concluding, Sayers reminded grantmakers that the world’s attention is on Haiti as it has never been before. Because of the increased attention and resources going to Haiti, there is now an opportunity to help the nation markedly improve its health care system.

Foundation Giving for Haiti

I list here a selected sampling of Haiti funding efforts by grantmakers in the United States that fund in health-related areas.

The Atlantic Philanthropies announced that it would be making a grant of $250,000 to Global Links, a nonprofit that recovers surplus medical supplies form hospitals in the United States and redistributes them overseas to help low-income people. Atlantic made a second grant of $250,000 to Partners in Health, for its relief efforts. The foundation said that Partners in Health “is mobilising resources both for immediate aid and long-term recovery and rebuilding efforts.”

The Baxter International Foundation, which is the philanthropic arm of Baxter International Inc. (the health care company), has approved $350,000 in grants “to support both immediate, acute-care and longer-term needs of the region.” The majority of those funds will go for health-related efforts. Grantees include CARE and Project HOPE. The foundation also has activated its Employee Disaster Relief Matching Gift Program. Spokesperson Elaine Salewske noted to Health Affairs that “disaster relief funding is not within the foundation’s regular guidelines.” Established in 1981 and based in Deerfield, Illinois, the foundation focuses its work on helping organizations “increase access to healthcare in the United States and around the world,” according to its Web site. Increasing access to care “particularly for the disadvantaged and underserved—in and near communities where Baxter employees live and work” is of particular interest to the foundation.

The Ford Foundation announced a $250,000 grant to the Clinton HIV/AIDS Initiative. (Former president Bill Clinton started this nonprofit focused on global health.) Ford mentions in a press release that Haiti has “one of the highest HIV infection rates” outside of sub-Saharan Africa. Ford’s grant aims to ensure continuation of HIV/AIDS treatment and prevention services in the Caribbean nation following the earthquake; such efforts will be especially suited to crisis conditions. Luis Ubinas, Ford’s president, said in the release, “It is essential that HIV treatment is integrated into the crisis response. Emerging from this tragedy we have an opportunity, and a responsibility, to build a strong and effective system of prevention and treatment that endures for the future.”

The Bill and Melinda Gates Foundation announced that it had awarded two grants for immediate needs and medium-term needs of people affected by the earthquake. The foundation awarded a $1 million grant to Catholic Relief Services for its initial relief services. Gates also awarded a $500,000 grant to Partners in Health for provision of medical care and essential items, including medical supplies and water.

Health Net Foundation, with a contribution of $50,000 to Project Medishare for Haiti, is adding to employees’ donations to that organization, which was founded “to provide continuing medical care in the Central Plateau, one of the poorest regions in Haiti.” Health Net Foundation, located in Woodland Hills, California, is the philanthropic arm of Health Net Inc.—one of the nation’s largest publicly traded managed care companies. The funder’s mission “is to serve as a resource to improve people’s health in the underserved communities” that Health Net serves.

The Robert Wood Johnson Foundation (RWJF) announced that it has contributed $500,000 to the Salvation Army for its “on-the-ground efforts to bring medical care, food, fresh drinking water and other much needed supplies to the affected region.” The foundation has been monitoring the situation in Haiti and expected to “provide an additional $1.5 million in support as those needs emerge.” The RWJF is also matching contributions of its staffers to the American Red Cross’s relief effort, the announcement said. A spokesperson for the foundation told Health Affairs, “While the foundation is exclusively focused on domestic funding, there have been unique circumstances, such as the 2004 tsunami, where the [RWJF] board made special dispensation for relief funding.”

Kaiser Permanente has contributed $500,000 to four key organizations on the ground in Haiti: Doctors Without Borders, Relief International, Operation USA, and MedShare International. Read Kaiser Permanente’s blog, “Dispatches from Haiti.” The blog lets Kaiser physicians and nurses who are trained in disaster relief and have gone to Haiti share their experiences.

The John D. and Catherine T. MacArthur Foundation announced in a March 11, 2010 press release that it is investing nearly $2.2 million to support relief and reconstruction in Haiti. It is awarding four grants focused on long-range needs in the health and communications areas. One of the grants goes to Partners In Health, which “will build and staff a full-service clinic and hospital to serve about 500 patients a day in Mirebalais, which is experiencing an influx of displaced persons from Port-au-Prince,” the release said. PIH will also use the money for medical and nursing training to fill a gap created when the earthquake destroyed a hospital in Port-au-Prince. MacArthur noted that PIH’s founder, Paul Farmer, is a former MacArthur Fellow.

Another MacArthur grant went to the United Nations Population Fund (UNFPA) for refurbishing and upgrading a maternity unit to meet the needs of a population of nearly 250,000. (An important segment of this population is living in temporary settlements, a UNFPA spokesman explained.) Attached to the Croix de Bouquets health center, the unit will be upgraded to provide comprehensive maternal and newborn care services, including safe delivery and emergency obstetric and neonatal care, including cesarean sections, he said. The International Federation of Gynecology and Obstetrics (FIGO), through its assistance to the Haitian society of obstetricians and gynecologists, is also contributing to this effort.

The Regence Foundation, based in Portland, Oregon, has donated $50,000 to Medical Teams International, a humanitarian aid organization that dispatches teams of physicians and trained volunteers to provide medical assistance throughout the world. The foundation is the corporate foundation of Regence, the largest health insurer in the Northwest/Intermountain region of the United States and a nonprofit independent licensee of the Blue Cross and Blue Shield Association. The grantmaker’s primary geographic funding area spans Idaho, Utah, Oregon, and Washington. Mark Ganz, president and chief executive officer of Regence BlueCross BlueShield, said in a press release that “especially at times like these, I am reminded that we are part of a closely connected global community.” He added that the mission of Medical Teams International—providing care to those in need—“aligns with our own focus, and supporting the organization’s efforts is the ideal way to assist those struck by this tragedy.”

Further Reading on Haiti

Read an interview in Health Affairs with Paul Farmer, who cofounded Partners In Health. Farmer discusses “the state of global health and the interplay between equity, and political economy” with physician and George Washington University professor Fitzhugh Mullan, who is also a Health Affairs contributing editor.

Read about what Project HOPE has been doing to help in Haiti. (Project HOPE is the publisher of Health Affairs and is a nonprofit humanitarian and global health education organization.) Volunteer doctors and nurses from Massachusetts General Hospital and other locations served with HOPE aboard the hospital ship USNS Comfort. HOPE has launched a blog about experiences in helping Haitians following the earthquake.

Health Affairs focuses on child obesity in its March 2010 issue and is publishing related content throughout the month of March, including a Web First article and Health Affairs Blog posts from Sen. Tom Harkin and Sen. Mike Enzi. For the GrantWatch Blog, we offer here a round-up of obesity funding news.

RWJF Program Director Testifies at Senate Hearing

Pediatrician Joe Thompson, who directs the Robert Wood Johnson Foundation (RWJF) Center to Prevent Childhood Obesity, testified March 4, 2010 before the U.S. Senate’s Health, Education, Labor, and Pensions (HELP) Committee. The hearing was on “Childhood Obesity: Beginning the Dialogue on Reversing the Epidemic.” Read the rest of this entry »

As health spending in the United States tops 17 percent of GDP, policymakers are asking for higher quality outcomes in health care. A GrantWatch article in the March 2010 issue of Health Affairs, discusses the State Quality Improvement Institute, which was created by the Commonwealth Fund and AcademyHealth, “to assist states in implementing sustainable quality improvement strategies.” The institute is a learning collaborative and technical assistance project, and the eight participating states (Colorado, Kansas, Massachusetts, Minnesota, Ohio, Oregon, Vermont, and Washington) were competitively selected.

Authors Enrique Martinez-Vidal, Anne K. Gauthier, and Allison DiVincenzo point out how states are “uniquely positioned to be leaders in redesigning the delivery system.” They discuss lessons learned through the institute’s work and the policy challenges encountered by the institute (such as current resource limitations). The authors note that the participating states’ experiences “may offer insights for other states seeking to achieve similar goals.”

Since 1987, Health Affairs has published news and insights into health care and health policy philanthropy in its ongoing journal section called GrantWatch. Now GrantWatch has moved to the blogosphere. The GrantWatch Blog will feature news and updates about health grant making, particularly as it relates to current health policy issues. Blog content will include information on foundation-funded reports and on new grants, plus news from foundation meetings, changes in foundations’ funding priorities, and announcements of job openings and RFPs.

Health Affairs’ GrantWatch Blog supplements longer peer-reviewed articles on health philanthropy that will continue to appear in the journal in print and online along with some news highlights. The new GrantWatch Blog coincides with a variety of changes to enhance the timeliness and relevancy of Health Affairs. (Read more about new things going on at the journal.)

If you are on the GrantWatch e-alert list, you will continue to receive twice-a-month e-mail digests with links to new GrantWatch content. You can also sign up for the GrantWatch Blog RSS feed or e-mail alerts, sent whenever new content is posted.

Reader comments are welcome on GrantWatch Blog. Just as on Health Affairs Blog, we ask that commenters use their real name, and comments are moderated for topic relevancy and cordiality. Please contact me at lprina@projecthope.org if you have questions or suggestions for content.