Understanding and Supporting Veterans’ Health Needs


May 28th, 2010

When the presenters at a Veterans’ Mental Health Training Initiative symposium last week in New Paltz, New York, played the “Raise your hand if you…” game, very few participants raised their hands to indicate that they or a family member had been in the military, or even that they were currently working with clients or patients who had returned from combat.

By and large, the people in the room–most of them social workers and other mental health professionals–had almost no experience with or understanding of the unique military culture or the special needs of veterans returning from combat. For many clinicians, attending the symposium was a first step toward developing a new kind of cultural competency as they anticipate working with military families and returning veterans, because they recognize that the need for services is tremendous.

A seminal national study by the RAND Corporation, Invisible Wounds of War, found that nearly 20 percent of the servicemen and women returning from Iraq and Afghanistan have depression and/or post-traumatic stress disorder (PTSD), and approximately the same percentage reported combat-related traumatic brain injury (TBI). Only 53 percent of those with PTSD or major depression sought care, and of those who did seek treatment, half did not receive even minimally adequate services.

The unprecedented rate of suicide among this generation of military personnel and veterans is also a devastating symptom of the untreated mental health needs of this population. At last week’s symposium, many of the presenters noted that more military personnel serving in Iraq and Afghanistan have died as a result of suicide than from physical injuries related to combat. They also reported that as many as 50 percent of female veterans and one-third of male veterans have experienced military sexual trauma.

These statistics are a clear indication that we must do more to increase access to behavioral health services and improve the quality of those services for returning military personnel and their families. At a minimum, services must be made available in the communities these veterans call home—not just through the Department of Veterans Affairs (VA) medical centers and clinics, where there are often real and perceived barriers to care for many returning servicemen and women.

Some good resources do exist for veterans and their families. At the symposium last week, we heard about the program for veterans at Samaritan Village, a long-term residential treatment program where approximately 70 percent of clients are coping with both substance use and mental health issues at the same time. And throughout the country, Readjustment Counseling Centers (better known as Vet Centers) provide veterans and their families with confidential services ranging from marital and bereavement counseling to employment and educational assistance. The centers also can help veterans navigate the VA system to file claims and receive benefits. But we need to do a better job of getting the word out about those resources, and sharing and replicating effective models and approaches.

People are sometimes surprised, at least for a minute, when I tell them that we at the New York State Health Foundation (NYSHealth) have a particular interest in the needs of returning veterans and their families. Most people assume that there are plenty of people who are working on military and veterans’ issues, and that there’s a ton of government money being poured into this area. But in fact the fit is a fairly natural one for a foundation committed to improving the health of all New Yorkers.

In New York State there are an estimated 90,000 servicemen and women who have returned from Iraq and Afghanistan and are working to reintegrate themselves into their families and their communities.

We see it as a community health issue, a public health issue, that so many veterans are returning home in need of care and services—not only for their physical wounds, but for their mental health and substance use issues as well. It’s not just the veterans themselves—their family members also require support and services. When one person in the family is called to duty, the entire family is affected. Family dynamics have probably changed during the time of deployment, and readjusting once the veteran is back home is a stressful and difficult process for everyone.

So NYSHealth has committed $2 million to support the urgent and long-term reintegration needs of returning veterans and their families, with a focus on improving access to timely primary care and services dealing with mental health and substance use.

To help us get a more detailed picture of what some of those needs are, and a more comprehensive understanding of what resources already exist, we have commissioned RAND to conduct a statewide assessment—looking at some of the same issues that it explored in its national Invisible Wounds of War study—that will include both qualitative and quantitative data about New York State. We expect to release the study later this year (sign up here to make sure you receive an e-mail alert when it’s available!), and we hope that it will serve as a road map for a range of actors in the state.

It was encouraging to see last week that so many clinicians across New York State are taking an interest in understanding the unique challenges that returning veterans and their families face. We all have a role to play in ensuring that our servicemen, women, and their families have access to the support and services they need once the veterans are back home.

The Most-Read GrantWatch Blog Posts


May 24th, 2010

A piece on the potential health-related effects of Arizona’s new immigration law is the most-read GrantWatch Blog post since the blog debuted on March 16. Other posts on the most-read list focus on “bending the cost curve” and foundation activities regarding health reform and primary care.

Here are the top five posts: 

Arizona’s Immigration Law: Bad for Health
by Roger Hughes

Health Reform: What Foundations Are Saying and Funding
by Lee-Lee Prina

GrantWatch Blog’s Periodic Round-up of Foundation News
by Lee-Lee Prina

Bending the Cost Curve: Rhode Island Looks North
by Owen Heleen

Foundation-Funded Efforts Related to Primary Care
by  Lee-Lee Prina

Foundation Blog Round-Up: Health Reform and More


May 21st, 2010

Here are some posts of interest on other health philanthropy blogs.

Health Reform:

Cali[fornia] Urged to Start Early on New Health Insurance Exchange: This May 12 post reports on remarks of Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority (Massachusetts’s insurance exchange), at a joint hearing of the California Senate and Assembly health committees. California Health Report blog is part of HealthyCal.org, “an independent, non-profit journalism project supported with initial funding from the California Endowment.” Daniel Weintraub is editor and director of HealthyCal.org.

In Healthcare Reform Opportunities, by Pat O’Connor, vice president and chief operating officer of the Health Foundation of Greater Cincinnati (Ohio), she notes that foundation staffers “abstracted some key provisions affecting consumers and providers” from some Henry J. Kaiser Family Foundation reports. She then makes some useful observations regarding the “many quality of care and cost containment provisions” that are included in the new federal health reform law. For example, “quality and cost are linked” in several efforts, she points out. O’Connor’s post is on one of the three blogs of the Health Foundation, which funds in selected areas of Ohio and Kentucky.

On the Colorado Trust’s Healthy Connections Blog, guest blogger Lorez Meinhold, senior health policy analyst, Office of Gov. Bill Ritter (D), wrote on May 12 about Implementing Health Reform in Colorado. She is Colorado’s director of health reform implementation.

Chris Langston, program director of the John A. Hartford Foundation, titles his April 29 post, I Support Health Care Reform. . . but I Worry. The Hartford Foundation’s blog is called healthAGEnda—an apropos title as the foundation is “dedicated to improving health care for older Americans.”

Leaving This Health Reform Thread, Now, by Minna Jung, is the final post of the Robert Wood Johnson Foundation’s (RWJF’s) Users’ Guide to the Health Reform Galaxy blog and is dated May 14. (Read more on this topic below.) Meanwhile, not to worry: Galaxy posts remain on the foundation’s Web site, and the RWJF has another blog called Pioneering Ideas.

A May 14 post, Local Policymakers Step Up for Colorado’s Health, on the Colorado Health Foundation’s Health Relay blog, reports that “though state lawmakers let Congress take the lead on sweeping health care reform, legislators advanced a number of important measures that are consistent with the Foundation’s goals of improving health, health care and health coverage.” Vanessa Hannemann, a public policy officer at the foundation, wrote this post.

Related item:

I also mention here Health Reform: Bye-Bye Galaxy, by Joanne Kenen. She discusses the discontinuance of the RWJF’s blog called The Users’ Guide to the Health Reform Galaxy. She mentions the Galaxy blog’s “useful” Health Reformer’s Lexicon feature. Kenan posts on The New Health Dialogue, a blog from the New America Foundation’s Health Policy Program. New America is a “nonprofit, nonpartisan public policy institute.”

Foundation News:

CEO Message to Grant Seekers: The Good and Some Ugly, a May 3 post on Bob’s Blog, by Bob Ross, president and chief executive officer of the California Endowment, has some “new guidance” for grantseekers who want to submit proposals to the endowment. Such proposals will be accepted starting on July 6, 2010. He announced that the issuance of this guidance “officially marks the implementation of [the endowment’s] 10-year, Building Healthy Communities plan for California.” Unfortunately, there is also some “tough news” that grantseekers may want to know about.

Funding Partnerships was posted on May 12 on the Reflect. Share. Blog. This is the blog of the Rasmuson Foundation, located in Anchorage, Alaska. The post mentions the value of funder collaboration and puts in a plug for the RWJF’s Local Funding Partnerships program; that national funder “is seeking out opportunities to collaborate with local funders, like Rasmuson,” the blog says.

Foundations Pull Together to Support Implementation of Connecticut Health Reform


May 20th, 2010

Group of Foundations Award a Total of $615,000 for Implementation

The Connecticut state legislature passed SustiNet, the new state health care reform law, in July 2009, when it overrode a veto by Gov. M. Jodi Rell (R). (For background on the law and the role of the Universal Health Care Foundation of Connecticut, read the GrantWatch Outcomes column in the September/October 2009 issue of Health Affairs.) An eleven-member SustiNet Board of Directors was charged with implementation of the law. However, the law did not provide enough money for sufficient staffing or for operations of the board, explained a recent press release.

That is where private philanthropy stepped in. On 18 May 2010, four foundations and the SustiNet board announced philanthropic support for the board, via an audio press briefing.

 Here is what the foundations are funding:

Universal Health Care Foundation of Connecticut: Its $150,000 in funding will support the work of Stan Dorn, a researcher at the Urban Institute, who will write what is called the “sixty-day report” on “how Connecticut can implement SustiNet within the context” of the federal health reform legislation enacted in March 2010; “the opportunities [that] federal reform offers to support SustiNet’s goals; and the ways in which the policy design of SustiNet needs to be adjusted” to mesh with federal reform, as Frances Padilla, the interim president of the foundation, explained in an e-mail following the briefing. The funding will also partially support dynamic economic modeling and analyses, as needed, by Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology (MIT). For example, he will project the cost of care under SustiNet and estimate how many people it will cover. Padilla also told me that the funding would “support communications/public information expertise for the SustiNet board.”

 ●Connecticut Health Foundation: $300,000 over one year (renewable)—one of its largest grants ever—to be used for a project management team affiliated with the University of Massachusetts Medical School’s Center for Health Law and Economics (in Charlestown, Massachusetts).

Jessie B. Cox Charitable Trust (which is based in Boston and funds throughout New England): $90,000 over one year for the partial costs of Gruber’s work, mentioned above. Through modeling, Gruber will be able “to examine the impact of different scenarios” to help the SustiNet board arrive at its recommendations for implementation, the trust’s Amy Segal Shorey explained in an e-mail.

Robert Wood Johnson Foundation (RWJF), through its State Coverage Initiatives national program: $75,000, to support the work of Stan Dorn. With these funds, he will provide technical assistance to the SustiNet board and will oversee and coordinate the policy work of SustiNet’s various task forces and committees.

In her opening remarks during the briefing, Padilla of the Universal Health Care Foundation commented that SustiNet “works hand-in-glove with federal reform.” Pat Baker, president of the Connecticut Health Foundation, said that the mission of that foundation is to improve the health status of people in Connecticut. She stated that philanthropy must partner effectively with government, other philanthropic groups, and the community. “No one can do it all,” she added.

Shorey of the Cox Trust noted that it had recently narrowed the scope of its health funding area—it now focuses on access to high-quality, affordable care—so the grant aiding SustiNet implementation is a good fit for that foundation. (See the trust’s new guidelines.) Enrique Martinez-Vidal, who directs the RWJF’s State Coverage Initiatives program, said that SustiNet was an “extraordinary accomplishment,” given the fiscal situation in which most states find themselves. However, some modifications will clearly have to be made to coordinate it with federal health reform, he commented.

Kevin Lembo, who is the official “healthcare advocate” for Connecticut (this is a state job) and serves as cochair of the SustiNet board, commented that the foundations’ funding was “timely and innovative” and will help the board to meet its statutory deadlines.

Nancy Wyman, the state comptroller and the other SustiNet board cochair, also made some opening remarks. She stated that because of state “fiscal conditions,” Connecticut could not move forward with implementation of the SustiNet law without this philanthropic support. She also mentioned that some 160 volunteers who are experts in such subjects as health information technology (IT), disease prevention, and quality of care, had worked on SustiNet committees over the past several months. Also, the SustiNet board has three task forces at work on obesity prevention among children and adults, tobacco and smoking cessation, and health care workforce concerns. As Connecticut implements state health reform, Wyman commented, the idea is to “capitalize on the features” of federal reform.

A Q & A session followed. In response to a reporter’s question, Lembo said that the SustiNet board is making an effort to collaborate with the three health reform–related boards that Governor Rell has established; those three panels, though, will expire when Rell’s term ends in January 2011. (She is nearing the end of her second term and will not run again; the general election for governor is in November 2010.) Padilla pointed out that “foundations stand the test of time” and go “beyond political interests.” They can ensure that the Connecticut SustiNet law is implemented.

In response to a question on the challenges of integrating SustiNet with the federal health reform legislation, Martinez-Vidal mentioned that the insurance exchange is included in the federal legislation, but not in SustiNet. In general, he sees opportunities for SustiNet and the federal legislation to fit together nicely; he does not foresee that any major changes to SustiNet will be required.

Padilla later commented that Connecticut can demonstrate to the United States how a state-offered health plan can be part of the insurance exchange, required under the federal legislation. Baker stated that Stan Dorn, the Urban Institute researcher, has said that there is nothing in SustiNet that has to be redesigned in order to comply with requirements of the new federal legislation; “just technical issues” will need to be fixed.

A discussion followed on when various reports and documents are due.

Here is the timeline:

Late May 2010: The “sixty-day report” to be written by Stan Dorn is delivered to the Connecticut General Assembly. The report will be posted at http://www.ct.gov/sustinet.

1 July 2010: SustiNet committees and task forces “issue specific recommendations for SustiNet, based on their specific charges” in the Connecticut SustiNet legislation, Victoria Veltri, general counsel in Lembo’s office, explained in an e-mail.

January 2011: The SustiNet board submits a report to the state legislature with recommendations and/or draft legislation on implementing the SustiNet law, Veltri said. Gruber’s economic analysis will be part of the submission.

The above information comes from an audio press briefing held 18 May 2010 and from responses to follow-up questions addressed to some of the briefing participants.

Related Resource:

“Quick Question: What’s the Right Relationship between Philanthropy and Government?” GrantCraft released this four-page document on 19 May 2010; GrantCraft is funded by the Ford Foundation. This document begins: “It’s practically a given these days that philanthropy and government ought to work together.” In it, GrantCraft reports results from its online survey of more than 1,500 respondents. They responded to quotations from foundation leaders including Karen Davis of the Commonwealth Fund, Gara LaMarche of Atlantic Philanthropies, and Luis Ubiñas of the Ford Foundation.

What Philanthropy Is Doing to Promote Oral Health Care


May 17th, 2010

Here is a sampling of what foundations and others are doing in the important area of oral health care.

Recent reports:

The Cost of Delay: State Dental Policies Fail One in Five Children was released 23 February 2010 by the Pew Center on the States (part of the Pew Charitable Trusts). The report was funded by Pew, the DentaQuest Foundation, and the W.K. Kellogg Foundation. Pew graded the fifty states and the District of Columbia on eight “key performance indicators” (policy solutions), such as providing dental sealant programs in high-risk schools, “fluoridating community water supplies,” improving reimbursement rates for dentists under Medicaid, and “authorizing new primary care dental providers.” The results of this study? “Two-thirds of states are doing a poor job,” Pew says. However, six states were graded A: Connecticut, Iowa, Maryland, New Mexico, Rhode Island, and South Carolina. Want to find out how your own state did? Fact sheets are available for each state and D.C. See the report’s methodology section for data limitations that the researchers encountered.

The report points out that “most low-income children nationwide do not receive basic dental care that can prevent the need for higher-cost treatment [such as fillings and root canals] later.” It also mentions that “the consequences of poor dental health among children are far worse—and longer lasting—than most policy makers and the public realize.” For example, there are economic consequences, such as the fact that “42 percent of incoming [U.S.] Army recruits had at least one dental condition that needed to be treated before they could be deployed,” according to a 2000 study of the U.S. armed forces. And, of course, oral health affects overall health: The report cites a growing amount of research that gum disease “is linked to cardiovascular disease, diabetes and stroke.”

Pew suggests that four solutions to the crisis are “within states’ reach.” These are school-based sealant programs; water fluoridation; improvements to Medicaid; and innovative workforce models. In its discussion of workforce innovation, the report mentions the Dental Health Aide Therapist (DHAT) training program in Alaska (see p. 34 of the report); the DHAT program’s funders include Kellogg, the Rasmuson Foundation (a funder based in Anchorage, Alaska), Bethel Community Services Foundation, and Murdock Charitable Trusts.

In its conclusion, the report emphasizes that poor oral health among low-income kids “is not an intractable problem.” A variety of solutions already exist, “they can be achieved at relatively little cost, and the return on investment for children and taxpayers” would be great.

I asked Shelly Gehshan, who heads the Pew Children’s Dental Campaign and worked on the report, whether she was optimistic that the passage of the federal health reform legislation will help improve the oral health picture. She told me on 17 May 2010 that the “legislation indeed gives us room for optimism.”

She explained, 

Pew worked hard with leaders in Congress and the whole oral health community to win some important oral health provisions. Most important to Pew is the guarantee of dental benefits within new plans offered by insurance exchanges, sealant programs for all fifty states, and a program to evaluate new types of dental providers.

Going forward, she said that “Pew is now working in coalition with other groups to ensure that Congress provides funding for these new provisions.”

Denti-Cal Facts and Figures (second edition), released 11 May 2010 by the California HealthCare Foundation, discusses Denti-Cal (the fee-for-service dental program of Medi-Cal, which is California’s Medicaid program). Many of the data in the report have to do with the financing and organization of services in 2007; in July 2009, most adult dental benefits were eliminated in California because of the state’s budget problems. “Children’s services, as required by federal law, continue to be delivered” now, the foundation noted in an e-alert.

The report culls information from many sources. Among its key findings are that Denti-Cal reimbursement was “typically lower than reimbursement rates in other states” as of 2008. Another interesting statistic, in this case from the University of California, Los Angeles, is that in that same year, 73 percent of adults in California did “not know that cavities are infectious and can be spread from one person to another.”

A Guide to Improving Children’s Oral Health Care: Tools for the Head Start Community, a February 2010 “toolkit,” was published by the Center for Health Care Strategies (CHCS) and funded by the Robert Wood Johnson Foundation (RWJF). Written by Sheree Neese-Todd, Bonnie Stanley, and Lauren Marino, this guide was written “to help New Jersey Head Start staff establish dental homes and improve oral health for low-income children ages 0–3.” The publication contains a section called “What Is a Dental Home?” as well as a glossary of oral health terms. It is part of an RWJF initiative called New Jersey Smiles: A Medicaid Quality Collaborative to Improve Oral Health in Young Kids. Funding for the initial grant period (eighteen months) has ended; however, “the Collaborative is exploring additional funding to sustain and build upon the effort,” a CHCS spokesperson told me on 17 May 2010.

Reimbursing Medical Providers for Preventive Oral Health Services: State Policy Options, by Carrie Hanlon, was published by the National Academy for State Health Policy (NASHP) in February 2010. The Pew Charitable Trusts funded the publication. The NASHP Web site states that “many state Medicaid agencies are working to increase children’s access to preventive oral health services by reimbursing primary care medical providers for fluoride varnish application, an oral examination or screening, and/or caregiver education about establishing good oral health habits.” This publication focuses on five states’ experiences “to help states considering adopting similar policies.”

Recent grant making:

The Caring for Colorado Foundation, in Denver, announced in fall 2009 that it had awarded approximately $100,000 to each of five grantees in Colorado. These grants are part of its ten-year, $10-million Oral Health Improvement Project, which aims “to increase access to oral health services for the underserved statewide,” according to a press release. Specifically, the grants “help increase the long-term capacity of the oral-health safety net and target oral disease prevention in children.” Click here for details of the foundation’s newest oral health RFP—the deadline is 25 June 2010.

The DentaQuest Foundation, a national funder located in Boston, announced that it had made “a major investment to improve oral health literacy and close the disparities gap among children and youth in Maryland,” according to a January 2010 press release. One grant, for $331,343, went to the University of Maryland for a statewide oral health literacy and awareness campaign. The university will conduct a survey of parents and health care providers, including physicians and dentists. The other grant, for $202,886, for the development of the Maryland Dental Action Coalition, was awarded to the Maryland State Dental Association Charitable and Educational Foundation (as a fiscal agent). This coalition will implement an oral health literacy plan throughout Maryland. Both grants fund a strategy for raising awareness about oral health, particularly within low-income groups and communities of color.

In addition, the DentaQuest Foundation awarded a grant to the Deamonte Driver Dental Project. Deamonte was a twelve-year-old boy in Maryland who became widely known after he died in 2007 as a result of an abscessed tooth; bacteria from the infection had spread into his brain. Read a Washington Post article about Deamonte and the problems that many children covered by Medicaid have in gaining access to oral health care.

A February 2010 press release discusses the DentaQuest Foundation’s funding of work in Florida. The foundation’s eligibility requirements for receiving funding are described here.

Interested in what the DentaQuest Foundation has learned over a number of years, so you can avoid “reinventing the wheel”? Read its Lessons Learned from Eight Years of Oral Health Grantmaking (May 2009).

The United Hospital Fund recently awarded a $53,000 grant to New York University College of Dentistry “to develop and evaluate a community-clinic referral model that aims to increase” prevention and treatment of oral disease among older adults, according to an April 2010 press release. “Older adults have the lowest rate of dental visits of all adults over [age] 18 and face barriers to oral health care services—such as Medicare’s lack of dental care coverage, inadequate transportation, and a perception that the services are not needed by the older population,” the release explains. Read about the grantee here. The United Hospital Fund “is a health services research and philanthropic organization whose mission is to shape positive change in health care for the people of New York.” More information is also available here, on NYU’s Web site.

Related resources:

“Delivering Preventive Oral Health Services in Pediatric Primary Care: A Case Study,” by Dianne Riter, Russell Maier, and David C. Grossman, GrantWatch Special Report in Health Affairs, Nov/Dec 2008. This article is about a partnership of the Washington Dental Service Foundation, Group Health Cooperative, and other providers in Washington State.

Establishing, Funding, and Sustaining a University Outreach Program in Oral Health,” by Jim Lalumandier and Kay Molkentin, GrantWatch Special Report in Health Affairs, Nov/Dec 2004. This article is about a foundation-funded, Case Western Reserve University program in the Cleveland public schools.

“Foundations’ Role in Improving Oral Health: Nothing to Smile About,” by Shelly Gehshan, GrantWatch Essay in Health Affairs, Jan/Feb 2008. Gehshan was working for NASHP when she wrote the article; she is now with the Pew Center on the States.

Funders’ Group on Oral Health Policy. Foundation staff who are interested in participating in this group may contact Ralph Fuccillo at Ralph.Fuccillo@dentaquestfoundation.org or Tracy Garland at tracygarland@comcast.net.

Grantmakers In Health’s Web site content on oral health.

Institute of Medicine’s (IOM)’s An Oral Health Initiative, supported by the U.S. Health Resources and Services Administration (HRSA) http://www.iom.edu/Activities/HealthServices/OralHealthInitiative.aspx.

Dr. Samuel D. Harris National Museum of Dentistry, University of Maryland, Baltimore. Affiliated with the Smithsonian Institution, this museum has on exhibit George Washington’s (ivory, not wood) lower dentures, among other things. I have been there and encourage you to visit.

Training New Dental Health Providers in the U.S., by Burt Edelstein of Columbia University and the Children’s Dental Health Project (which is located in Washington, D.C.), was funded by the W.K. Kellogg Foundation. The full report was released 27 January 2010.

Round-Up of Foundation News—Bioethics, Environmental Health


May 11th, 2010

In today’s post I have pulled together a few items showing some foundation efforts in two areas: bioethics and environmental health.

Bioethics

The Arizona Bioethics Network is being relaunched. Saint Luke’s Health Initiatives (SLHI), a public foundation in Phoenix, is providing core funding. The network is “being reconfigured as a community of practice focused on ethical issues in health care related to practice, policy and education,” SLHI said in April 2010. The network’s Web site points out, “With a small but growing core group of bioethicists and bioethics programs in Arizona, an expanding health care industry, and ever more contentious ethical issues of resource allocation and cost-benefit, there is a clear need to collaborate across institutional settings and professional roles and create a true learning network to develop and support an ethics healthcare agenda in the state.”

Initially, the network will focus on supporting hospital ethics committee members and reaching out to long-term care facilities with education and information on such topics as hospice and palliative care. This will include “end-of-life decision making, individual autonomy and the role of surrogates.” Carol Lockhart has been named project director. A consultant with C. Lockhart Associates, “a health systems relations and policy-consulting firm,” she also is a professor at the University of Tennessee Health Science Center, College of Nursing, in Memphis.

I asked Carol Lockhart if she were aware of similar networks in other states, and she said that she believed the Arizona one is somewhat unusual in that it is “independent and foundation-based”; most of the others she has heard of are in a university setting, where they are part of a medical or bioethics program. She emphasized, though, that she has not done extensive research on systems in other states.

Related resources:

Bioethics Forum, a blog that is a free service of the Hastings Center Report, “publishes thoughtful commentary, from a range of perspectives, on issues in bioethics.” Recent authors include Carol Levine of the United Hospital Fund.

“Financial Penalties for the Unhealthy? Ethical Guidelines for Holding Employees Responsible for Their Health,” Steven D. Pearson and Sarah R. Lieber, Health Affairs, May/June 2009.

The Greenwall Foundation, a national foundation located in New York City, has bioethics as one of its two funding priorities.

Environmental Health

Blog post; conference:

“CleanMed Conference Takes on Health Care’s Environmental Impact,” Robert Wood Johnson Foundation’s (RWJF’s) Pioneering Ideas blog, 22 April 2010. The RWJF Blog team notes “a disturbing irony: The hospitals and clinics we rely upon to keep us healthy may be contributing to poor health in the first place.” The post mentions Health Care Without Harm (HCWH), as well as the 2010 CleanMed conference going on 11-13 May, in Baltimore. See the list of HCWH’s funders.

Recent reports:

Health Problems Heat Up: Climate Change and the Public’s Health, a Trust for America’s Health (TFAH) report, was released 26 October 2009. It looks at “U.S. planning for changing health threats posed by climate change, such as heat-related sickness, respiratory infections, natural disasters, changes to the food supply, and infectious diseases carried by insects.” TFAH notes that only five states—California, Maryland, New Hampshire, Virginia, and Washington—had “plans to address the health impact of climate change” as of the report’s writing. The report was funded by the Pew Environment Group. The group is part of the Pew Charitable Trusts, which was formerly a foundation and became a public charity in 2004.

The Impact of Air Quality on Hospital Spending, a 2010 technical report by John A. Romley, Andrew Hackbarth, and Dana P. Goldman, was published by RAND Health and funded by the William and Flora Hewlett Foundation. This interesting study ”determined how much failing to meet federal air quality standards cost various purchasers/payers of hospital care in California over 2005–2007.” Air pollution is known to be harmful to human health, but “little is known about the financing of such pollution-related medical care,” according to a March 2010 press release. RAND Health picked California for the study, as it is “known for its high levels of particulates and ozone.”

The cost to public health care purchasers (such as Medicare and Medicaid) and private health insurers was “more than $193 million for hospital care alone from 2005 to 2007,” said that press release, which was issued by the Kresge Foundation. Kresge wants to get the word out because it “has underwritten a communication strategy targeted at the healthcare industry, including payers and providers, to raise their awareness of the public-health dimensions of pollution-related respiratory illness,” the release explained. David Fukuzawa, who directs Kresge’s health program, said in the release that the foundation “is interested in helping to advance the case that environment quality has [to] be considered when we discuss how to improve the health of the nation’s children and adults.” He added that this RAND Health report “goes a long way in confirming that link.”

The full report is available for $20.70 if purchased on the Web; a research brief is available online.

Related resource:

“Asthma Prevalence Subject of Study,” Jody Weigand, Pittsburgh Tribune-Review, 6 May 2010,  http://www.pittsburghlive.com/x/pittsburghtrib/news/pittsburgh/s_679444.html#.  A large  Heinz Endowments grant for the Pediatric Environmental Medicine Center at Children’s Hospital of Pittsburgh of UPMC has funded programming and operations at the center, including the asthma study, a spokesman from the endowments explained to Health Affairs.

Highlights: “What Health Care Reform Means for Philanthropy” Teleconference


May 6th, 2010

Arabella Philanthropic Investment Advisors, which describes itself as “one of the leading philanthropy services firms supporting the efforts of individual, family, institutional and corporate philanthropists,” held a teleconference this week (on 4 May 2010) on “What Health Care Reform Means for Philanthropy.” Grantmakers In Health and CCM Family Advisors cosponsored the event. Listen to a recording of the hour-long call here.

Panelists for the teleconference were Shannon Brownlee of the think tank New America Foundation (New America) and author of the book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer; Andy Hyman of the Robert Wood Johnson Foundation (RWJF) and coauthor of a 2009 Health Affairs GrantWatch Essay on mental health funding by foundations; Peter Long of the Henry J. Kaiser Family Foundation (Kaiser); and Wendy J. Wolf of the Maine Health Access Foundation (MeHAF). Arabella Advisors’ Fawzia Ahmed moderated the call.

The goals of the teleconference, Arabella Advisors said, were to answer the following questions.

●What does health reform mean for funders?

●How will it affect health care providers that funders currently help?

●What effect will reform have on funders’ communities and the “needs of populations” that funders support?

●What does health reform “miss”—that is, whom and what is it not expected to help?

●“What new opportunities for strategic philanthropy does it create?”

Here are a few of the thoughts from this teleconference. Click on the link in the first paragraph for more details.

Fawzia Ahmed (Arabella) asked Peter Long (Kaiser) to provide an overview of the congressional health reform bills that passed, as they are “controversial and complex.” He mentioned the goals of the reform legislation, including “affordable, accessible health insurance coverage [for] nearly all Americans”; health insurance market reforms; health systems reform (such as improvements in the health care workforce, “linkages between health care providers at different levels,” and improvements in quality of care); and improvements in health promotion and disease prevention. He noted that, although there are some cost containment provisions in the legislation, it “remains to be seen” if the legislation will reduce or contain costs. Reform will be an “evolving process” taking place over the next decade.

Shannon Brownlee (New America) focused her remarks on delivery system reform. She said there is “widespread agreement” that we need to improve quality of care (that is, obtain better health outcomes for what we are spending). This can be done by reducing unnecessary care, increasing effective care, and making sure that patients with the option of elective care are fully informed.

Andy Hyman (RWJF) said that health reform is in effect a “dramatic test for federalism” in America—a “test for finding a workable balance” for the federal and state governments to work together. Many reforms will be a “shared responsibility.” The executive branch will issue regulations, and the states, in almost all cases, will have a role in administering and implementing reforms.

Wendy Wolf (MeHAF) noted that philanthropy can be a “vital partner” in reform—funders can help state governments “optimize” opportunities to get the most out of the new legislation. She mentioned that MeHAF had provided information, in a nonpartisan way, to Maine’s congressional delegation during the national health reform debate. MeHAF told the delegation about lessons learned during Maine’s health care reform effort, which resulted in the state’s Dirigo Health.

Moderator Ahmad asked how donors can support local governments in implementing reform. Wolf (MeHAF) suggested to funders, “Look at your mission.” They should try to view reform through the lens of “What are the opportunities to promote work you care about?” She cited as examples that the legislation provides opportunities to improve oral health and public health (such as obesity prevention), so those could be funding niches if they are among a funder’s priorities.

Long (Kaiser) said that surveys by Kaiser and others have found that the public finished the health reform debate “confused.” Funders can play a role by making sure that members of the public have an active role in implementing reform.

Brownlee (New America) noted that funders have often thought of expanding hospital capacity (such as building a hospital wing), but she maintained there is enough capacity already in the vast majority of the United States. Funders should think more, for example, about funding a project to meet the need for more organized and accountable primary care and funding grantees to come up with “new ideas on how to change the delivery system.”

Later, Wolf (MeHAF) commented that philanthropy is very good at “transformational thinking.”

When asked if there will still be gaps in coverage after health reform, Long (Kaiser) said yes and suggested, for example, that philanthropy can provide subsidized care for those who do not have access to care, such as people who are undocumented. It can also fund advocacy for universal care if that falls under a funder’s mission.

As for foundations’ role in communications with the public, Wolf (MeHAF) suggested that foundations could help educate people about quality of care. Funders should “be honest about what [they] know and don’t know” and “share objective information.” She suggested getting feedback from people on where problems with health reform are cropping up; “tweaks” will be needed, she added.

When asked what regional funders can do to “drive the issue of quality,” Hyman (RWJF) suggested that local funders can convene stakeholders, allowing them to participate in health reform and apply for pilot programs that are part of reform, such as accountable care organizations (ACOs).

He later said that consumer advocates need to be at the table along with the bigger players. Consumers can do advocacy work, be watchdogs to ensure compliance with laws, and make sure the public is informed—so that the public “understands any new benefits available to them.”

Acknowledging that consumers need to be at the table, Brownlee (New America) pointed out that often “consumers have argued for more” (research, care, and so forth), but they need to be educated that “more is not necessarily better.”

Wolf (MeHAF) reminded listeners that funders should do what they are comfortable doing. If a funder’s mission is to quietly help the vulnerable, it could still help those who remain uninsured after health reform by simply playing a charitable role to help address those needs.

The speakers also addressed the question of whether community health centers still need support and discussed what philanthropy can do to connect successful pilot projects to policy at the national level.

Thanks to Health Affairs deputy publisher, Ann Link, who listened to the teleconference and provided insights.

Foundation-Funded Efforts Related to Primary Care


May 4th, 2010

Today, the May 2010 issue of Health Affairs, including a new GrantWatch Outcomes column, was released. This issue, which is chockfull of information at more than 300 pages, has the theme “Reinventing Primary Care.”

GrantWatch Outcomes also focuses on primary care; it discusses results of projects funded by foundations around the United States. For example, see how the Colorado Trust’s funding is helping to inform policy in that state.

The column also contains a section on foundation staffers’ comings and goings. Read about the new president and CEO of the Annie E. Casey Foundation, in Baltimore; the retirement of well-known grantmaker Beverly Railey Robinson, from the Claude Worthington Benedum Foundation; and more.

Among the foundation-supported content in this issue is “Primary Care and Why It Matters for U.S. Health System Reform,” by Robert L. Phillips Jr. and Andrew W. Bazemore; the Josiah Macy Jr. Foundation commissioned an early version of this paper. Another example  is “Structuring Payment for Medical Homes,” by Katie Merrell and Bob Berenson; the Commonwealth Fund supported this work.

Also in this issue, Len Finocchio of the California HealthCare Foundation (CHCF) has written a review of a book on oral health.

The United Health Foundation, CHCF, CVS Caremark, the ABIM Foundation, and the American Academy of Physician Assistants supported the May 2010 issue of Health Affairs.

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