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Helping to Define Health Philanthropy’s Role in the Implementation of Health Reform



August 12th, 2010

Two weeks ago, Grantmakers In Health (GIH) joined with the Jewish Healthcare Foundation, California HealthCare Foundation, and Commonwealth Fund to sponsor a discussion among funders about the roles that state and local health foundations can play in advancing health reform.

The night before the meeting, surgeon and writer Atul Gawande set the stage for the funders’ discussion by laying out the overall goal of health reform—which he framed as getting better results at a lower cost without harming a single person—and reminding the audience of grantmakers that we can make considerable progress if we just systematically apply what we already know. Using anecdotes and insights from his experiences at Brigham and Women’s Hospital, the Dana-Farber Cancer Institute, and the New Yorker magazine, he encouraged philanthropy to provide the platform for stakeholders to set priorities, to help obtain data, and to start working on scalable system innovations.

The next day, Brandeis faculty kicked off a set of conversations about the safety net, delivery system redesign, payment reform, workforce efficiency, and consumer education. Stuart Altman and others were faculty discussants. (For an agenda, click here.) What struck us was that the law will only truly take shape as regulations are issued. Implementation will take place in an extremely contentious political climate. The law’s potential benefits and complexities will need to be communicated to diverse allies, confused consumers, and determined opponents. And the Affordable Care Act is not a cure-all; it has strengths and weaknesses and is silent on several of the issues and populations—such as health care for undocumented immigrants—that funders care most about.

We clearly had the right people in the room and the right topics on the agenda: for eight hours, more than seventy people from nearly sixty foundations across the country discussed their challenges and concerns, asked one another’s advice, and identified potential areas of investment and coordination. Together, the group created an ambitious list of funding opportunities to use in their own states and communities. They also gained a network of potential funding partners with whom they can collaborate—within a state, in neighboring states, or at the national level—to achieve the greatest impact.

Foundations are facing important decisions regarding how their limited resources can best leverage the opportunities created by national reform legislation while continuing to advance broader changes not fully addressed by the Affordable Care Act. The law’s ambitious timeline adds to the field’s sense of urgency. For the funders in the room, the priorities included:

–tackling the enrollment challenge;

–weighing in on the relationship between Medicaid and health insurance exchanges;

–helping state officials access the technical assistance they’ll need;

–supporting convening of diverse stakeholders to develop common goals;

–rethinking ways to provide care to those who will remain uninsured;

–helping to develop the safety net into a coordinated system of care that includes public hospitals, community health centers, free clinics, and community health workers; and

–making sure that state decisions made within the regulatory process are made with public input.

We at GIH have spent years working to connect health grantmakers with each other as well as with those in other fields whose work has important implications for health. What excited us about this discussion was how action-oriented it was. When funders enter into conversations with the explicit intent to share strategies and coordinate, the potential for collaboration is great.

This discussion was part of GIH’s targeted work to advise funders about implementation of health reform and keep them informed about the work of their colleagues as implementation unfolds. Up next will be the release of a report on plans of health funders and advocacy organizations in the wake of the health reform law’s passage. Stay tuned!

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1 Response to “Helping to Define Health Philanthropy’s Role in the Implementation of Health Reform”

  1. Carl Rush Says:

    On behalf of the Community Health Worker Section of APHA, thank you for including CHWs in your expression of priorities. We invite your attention to our paper in the July 2010 Health Affairs on the challenges of shaping policy to encourage greater inclusion of CHWs in healthcare (http://content.healthaffairs.org/cgi/content/abstract/29/7/1338). We note that a number of federal agencies are publicly touting inclusion of CHWs in implementation of PPACA, notably HRSA and CMS, and it would seem logical to link private investments to federal initiatives where appropriate. Leaders of the APHA CHW Section would be happy to assist interested funders in responding to this challenge.

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