How Philanthropy Is Helping with Health Reform, Part II


September 30th, 2010
by Lee-Lee Prina

In last week’s post, I marked the six-month anniversary of the enactment of the Patient Protection and Affordable Care Act. I continue here our selected sampling of what philanthropy is doing to help with health reform. Also included today are some related resources on health reform, including a tongue-in-cheek glossary of health care terms (which I have been intending to mention for a while).

Again, thanks so much to Grantmakers In Health for leads it provided.

Announcements of foundation efforts related to health reform:

“The California Endowment Launches Online Initiative to Highlight Significant Changes to Health Insurance Laws Going into Effect on September 23,” California Endowment press release, September 20. This funder states that “few consumers understand” the new health reform law “or how to benefit” from it. As part of a broader statewide education effort, the endowment has launched a web site, called GetCoveredCA.org, which is focused on young adults (under age twenty-six).

California HealthCare Foundation (CHCF) Health Reform and Public Programs Initiative. Marian Mulkey directs this initiative, which was announced May 25. Its stated goal is “to support implementation of health reform and advance the effectiveness of California’s public coverage programs.” Its specific objectives are (1) to “advance state efforts on coverage expansion,” through analysis and technical assistance; and (2) to “support the evolution of Medi-Cal [California Medicaid] and other publicly financed coverage programs.” This work will include informing key state stakeholders regarding the creation of a health insurance exchange in California, advancing streamlined enrollment in public insurance and federally subsidized private plans, and identifying ways that Medicaid can better serve both new and current enrollees. One of several approaches that the CHCF will use in this initiative is to monitor California’s progress in fulfilling the requirements of the Patient Protection and Affordable Care Act and report back to the public. Other CHCF staffers working on the initiative include Chris Perrone, Len Finocchio, and Teri Boughton, who is based in Sacramento.

The Henry J. Kaiser Family Foundation (KFF), a national operating foundation, launched the  Health Reform Source, its newest “online gateway,” on September 21. The gateway has features that explain the basics of the Affordable Care Act, “in-depth analysis of policy issues in implementation, and quick and easy access to relevant data, studies and developments,” according to a press release. For example, research and analysis by KFF staff experts will be included, “with a special area of emphasis on the 50 states as they proceed with the implementation of the law.” The Health Reform Source also contains Poll Watch, a weekly round-up of surveys related to the health reform law.

However, my favorite part of the entire KFF health reform gateway page is “Health Reform Hits Main Street,” an animated short video, which, the release says, is “designed to explain the health reform law to an American public still confused by how it works.” Narrated by news commentator Cokie Roberts, who is a member of the KFF board, the nine-minute video features animated YouToons figures playing various stakeholders ranging from Uncle Sam to insurance company representatives to average Americans. One of the funniest scenes shows an overly bronzed man coming out of a tanning salon and having to pay the new tax on tanning services, which is already being levied under the Affordable Care Act. Uncle Sam then gives the salon customer a slap on his tender back!

The Rhode Island Foundation was a member of the Healthy RI Task Force, “a community coalition of more than 150 health care leaders and business professionals,” according to a press release. Formed by Lt. Gov. Elizabeth Roberts (D), the panel released its report Healthy RI Task Force: Getting National Health Reform Right for Rhode Island at a press conference on September 23.

Owen Heleen, the foundation’s representative on the task force, was a speaker at the event in Providence. He stated, “The Rhode Island Foundation is committed to continuing our work with a wide variety of partners to work to build a stronger system of primary health care.” He specifically mentioned the funder’s “loan forgiveness program for primary care doctors, nurse practitioners, and physician assistants.” Blue Cross and Blue Shield of Rhode Island and the Rhode Island Medical Society have joined forces with the foundation on this program to increase the number of such health professionals in the state and lower health care costs. The Rhode Island Student Loan Authority administers the program. As we have learned, more primary care providers will be needed as federal health reform is implemented.

Read Heleen’s April 2010 post on GrantWatch Blog: “Bending the Cost Curve: Rhode Island Looks North.”

Commentary:

“Health Reform’s Six-Month Checkup,” Drew Altman, president and CEO of the KFF, “Pulling It Together” monthly column, September 2010. Altman says, “The politics of health reform remain as ugly as ever, but implementation of the law’s benefits and changes has been a success story so far.”

Events:

“Affordable Care Act: Impacts and Opportunities for Disparities Research,” AcademyHealth and the Aetna Foundation, webinar focused on policy making, Tuesday, October 5, 1:00 p.m.-2:30 p.m. This webinar is part of their free Disparities Research Webinar Series. (A second policy webinar is scheduled for November 18.) Read more about both events here. Click here to register by Friday, October 1.

“Paying for Health Reform: The Imperative of Cost Containment,” New York State Health (NYSHealth) Foundation conference, in New York City, Tuesday, November 2, 9 a.m.-12:30 p.m. The keynote speaker will be Glenn Steele, president and CEO of Geisinger Health System. The event is free, but those who wish to attend should register here; space is limited. This event is for consumers, insurers, policy makers, providers, and researchers, the foundation says.

NYSHealth commented in an e-alert: “After decades of rapid growth in health care costs, ballooning Federal deficits and State budget shortfalls make cost containment more urgent than ever.” It added, “Without thoughtful approaches to lowering the actual costs of providing quality care, policymakers and providers will be tempted to adopt blunt, across-the-board cuts that could impair quality of care or reduce access.”

Read a July 2010 GrantWatch article in Health Affairs, by David Sandman of NYSHealth and Anthony Kovner of New York University, about the foundation’s program on health care cost containment at the state level.

Recently released reports:

Health Insurance Exchanges and the Affordable Care Act: Eight Difficult Issues, by Timothy (“Tim”) Stoltzfus Jost of Washington and Lee University School of Law, released September 30. Funded by the Commonwealth Fund. Jost makes recommendations to state and federal policy makers.

Implementing Health Reform: Funders and Advocates Respond to the Challenge, Grantmakers In Health, August 2010. Funded by the Nathan Cummings Foundation and the Public Welfare Foundation, with additional support from the California Endowment. Barbara Masters of MastersPolicyConsulting and Amanda Rounsaville (both formerly of the endowment) conducted the interviews for the report and wrote it.

State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals, by Stan Dorn of the Urban Institute, July 2010 (updated September 2010). Dorn prepared this report for State Coverage Initiatives, a Robert Wood Johnson Foundation national program administered by AcademyHealth. Among the chapters is “Fundamental Questions about Health Insurance Exchanges.”

Recently awarded grants:

“MeHAF Grants Help Nonprofits Inform Maine People about Health Reform,” Maine Health Access Foundation (MeHAF) press release, July 23. This funder awarded a total of $344,492 to ten grantees; among them are the Maine Primary Care Association, in Augusta, and Eastern Agency on Aging, in Bangor.

“Northwest Health Foundation Provides Health Grants to Uncommon Partnerships,” Northwest Health Foundation press release, August 25. This funder, located in Portland, Oregon, awarded a total of $500,000 to eleven partnership grantees. The grants target those most affected by a lack of health insurance. Each project awarded funding “focuses on advocacy during the 2011 Oregon legislative session,” the release points out. Here is an example of one partnership that received a grant: Cascadia Behavioral HealthCare, the Oregon Health Action Campaign, and NAMI (National Alliance on Mental Illness) Multnomah County. The groups are partnering to engage “consumers of mental health services” in the health reform process.

Related resources to read:

“Americans Still Confused, Divided about Health Law,” Lexie Verdon, Kaiser Health News, September 27. This article mentions both a KFF Tracking Poll and an Associated Press poll. Kaiser Health News is affiliated with the KFF.

“Dr. Contrarian’s Glossary of Health Care Terms,” Roger Hughes, “The Drift” column, St. Luke’s Health Initiatives (SLHI). The contents for this column, published this spring, purportedly came from Dr. Contrarian, “purveyor of all things wild and wacky.” The good doctor explains things so that “even the not-so-smart can understand”! SLHI is a public foundation in Phoenix, Arizona. Add some humor to your day!

“Six Things to Know about Health Care Coverage: A Study of the Media and the Health Care Debate,” Pew Research Center’s Project for Excellence in Journalism, June 21. The Pew Charitable Trusts, based in Philadelphia, funds the project. To clarify: this report is about media coverage, not insurance coverage.

“Study: Health Reform Law Will Hike Premiums Between 1 and 2 Percent,” Mike Lillis, Healthwatch blog of The Hill, September 27. The title of this post refers to results of a Hewitt Associates report; according to Lillis, the report said that the “reform law will have only a modest impact on the insurance premium hikes projected to hit employers next year.”

How Philanthropy Is Helping with Health Reform, Part I


September 23rd, 2010
by Lee-Lee Prina

On the six-month anniversary of the enactment of the Patient Protection and Affordable Care Act, we present a selected sampling of what some foundations are doing to help out as reform is being implemented. Next week on GrantWatch Blog, watch for more about foundation efforts on health reform!

Thanks much to Lauren LeRoy and her staff at Grantmakers In Health for the leads they provided.

Recently Awarded Grants:

“Blue Shield of California Foundation to Help Counties Plan for Health Coverage Expansions: New Grants Will Help Counties Build a Bridge to Reform,” Blue Shield of California Foundation (BSCF) press release, September 21. The foundation is investing a total of $1.9 million to help a dozen California counties (including Fresno, Sacramento, San Francisco, and Santa Barbara) “plan for expansions in public health coverage,” according to the release. Nine of the twelve grantee counties will plan how (and also whether) they can create a new Health Care Coverage Initiative, and three counties will plan how to expand their existing one, all under the requirements of California’s proposed Section 1115 Medicaid Waiver. If approved, the waiver will generate federal matching funds to help cover certain low-income, still uninsured, legal residents. By covering this population as early as 2011, these county-based efforts thus will serve as a “bridge” to the coverage expansions under federal health reform that are slated to take effect in 2014. For more information, contact Richard Thomason, program officer, at the foundation.

In May 2010 the BSCF awarded a $400,000 grant to the Small Business Majority Foundation, Inc., to help “California’s small businesses navigate the landscape after health reform,” according to a June 2010 press release. The funding will help this stakeholder group to “understand how the new law will make it easier to get coverage for their employees.” Brenda Solórzano of the foundation noted in the release that more than half of uninsured Californians work for small businesses.

Announcement/Commentary:

The California Endowment’s Patient Protection and Affordable Care Act Education Effort. Read a description of the statewide effort by the endowment and its partners “to educate people about how they can benefit” under the federal health reform law. The foundation’s plans include outreach to Latinos, businesses, and youth. (The endowment announced this multimillion-dollar effort on health reform at a September 2 press conference. California’s lieutenant governor attended. Watch the video of the event here.) Also check out the foundation’s Web page called “The New Health Law and You” with links to numerous resources; the page is also available in Spanish.

Read “Groups to Educate Californians on National Healthcare Reform,” by Molly Hennessy-Fiske, September 2, on the L.A. Now blog. Bob Ross and Daniel Zingale of the California Endowment are quoted. The blog is a joint effort of the Los Angeles Times and two Southern California TV stations.

“The Health Care Safety Net and Health Reform,” Gary L. Yates of the California Wellness Foundation (TCWF), President’s Message, released August 18, 2010. TCWF’s president and CEO talks about how foundations can help safety-net providers during these especially tough economic times in California. Yates also mentions what foundations can do to “assist with implementation of health reform.” He says that TCWF will continue providing core (general) operating support (a hallmark of this funder) for safety-net providers and for groups advocating for the underserved in California and will continue its “efforts to increase the health workforce and ensure it has the cultural competence and language proficiency to provide sufficient access to and quality of health care for the increasingly diverse population of California.”

Web resources:

On September 21, the Commonwealth Fund launched a web page called Health Reform Resource Center; the subtitle for the page is “What’s in the Affordable Care Act?” Here you will find a timeline of when provisions of the Affordable Care Act take effect and a searchable “Find Health Reform Provisions” feature. You can search the provisions by year, category (Coverage, Revenue, or System and Delivery Reform), and/or stakeholder group (such as older adults or small businesses). The summaries “include estimates of health system savings [from reform] where applicable,” according to a Commonwealth e-alert. For instance, the indoor tanning services tax provision is listed on the web page under “Revenue.” This provision, which has made such services that use at least one ultraviolet lamp “subject to a 10 percent excise tax on amounts paid,” is expected “to raise $2.7 billion over 2010-19,” Commonwealth reports! (That provision of the law has already kicked in.)

Webcast:

Full Steam Ahead—Implementation Opportunities and Challenges for Employers and Consumers, September 8, Alliance for Health Reform briefing, held in Washington, DC. This event on implementation of health reform was cosponsored by the Robert Wood Johnson Foundation (RWJF). The Henry J. Kaiser Family Foundation produced the webcast and podcast. A written transcript is also included on this page. Brian Quinn of the RWJF moderated. Speakers included Steve Wojcik of the National Business Group on Health.

Report:

Starting on the Path to a High Performance Health System: Analysis of the Payment and System Reform Provisions in the Patient Protection and Affordable Care Act of 2010, by Karen Davis, Stuart Guterman, Sara R. Collins, Kristof Stremikis, Sheila Rustgi, and Rachel Nuzum, released September 23, 41 pages. Funded by the Commonwealth Fund. This report analyzes how the Affordable Care Act “will affect providers’ financial incentives, the organization and delivery of health care services, investment in prevention and population health, and the capacity to achieve the best health care and outcomes for all,” the authors say. All authors are with Commonwealth; Rustgi, formerly with the fund, is now a medical student. This publication revises a Commonwealth report published in December 2009.

Luncheon Event:

The BIG Picture of Health Reform, October 14, in Meriden, CT. Speakers will be Stuart Butler of the Heritage Foundation (a member of Health Affairs’ editorial board) and Len Nichols of George Mason University. These two people “might not seem to have much in common, but they both believe in fiscal sustainability, accuracy and honesty, the health of our nation and in civil discourse,” according to a September 23 e-alert. The Universal Health Care Foundation of Connecticut’s parent organization, the Connecticut Health Advancement and Research Trust, is sponsoring the event. Patricia (“Pat”) Baker, president and CEO of the Connecticut Health Foundation, will be moderating it.  Click on the first link above to find out how to buy tickets, which are $50 or $100 each (sponsorships available).

Foundations’ Use of Social Media; What Your Local Blues Foundation Has Been Working On


September 17th, 2010
by Lee-Lee Prina

The Foundation Center has just released a short publication on grantmakers’ use of social media, including blogs. (I include here some examples of posts by foundation presidents that have appeared in recent months on the GrantWatch Blog. Subjects range from health reform to HIV/AIDS to smoking prevention.) Also recently released is a report on what Blue Cross and Blue Shield foundations and corporate-giving programs have been funding all over the United States. Read more below.

Foundation Center Publication:

“Are Foundations Using Social Media?” Foundation Center, released September 16, 2010. Funded by the Wallace Foundation. This document, containing results of a September 2010 survey of seventy-three members of the center’s Grantmaker Leadership Panel, says that 30 percent of foundation chief executive officers (CEOs) regularly read blogs, but only 6 percent regularly use Twitter.

Sixty-five percent of CEOs use e-newsletters (which are characterized as “relatively ‘old fashioned”), though.

However, 44 percent “have [ever] personally contributed or responded to a blog post.” The most-read blog (meaning at least once during the past six months) among the foundation leaders polled was the Huffington Post. The next most-read was the Philanthropy 2173 blog.

Interestingly, most of the examples given of foundation leaders who said that social networking/Web 2.0 services “have been ‘very useful’ in furthering the work” of their foundation are people from community foundations. The Rasmuson Foundation, in Anchorage, was an exception among the examples.

Foundation CEOs Who Have Been Recent Guest Bloggers on GrantWatch Blog:

We now encourage you to read the following recent GrantWatch Blog posts by foundation CEOs—in case you missed them earlier:

“Health Reform at the Retail Level: Community by Community, State by State,” by Karen Feinstein, president and CEO of the Jewish Healthcare Foundation, in Pittsburgh (August 19, 2010).

“How Foundations Can Help States Implement Health Reform,” by James Knickman, president and CEO of the New York State Health Foundation, based in New York City (August 13, 2010).

“Lessons Learned from the Pfizer Foundation’s ConnectHIV Initiative,” by Atiyah Ali and Caroline Roan (July 29, 2010). Roan is president of that corporate foundation, which is based in New York City.

“Right Pills, Wrong Pills—It Makes All the Difference,” by Karen Feinstein of the Jewish Healthcare Foundation (July 13, 2010).

“A Foundation’s Win at Public Health Policy on Smoking,” by Billie Hall, president and CEO of the Sunflower Foundation: Health Care for Kansans, based in Topeka (June 15, 2010).

Also:

Follow Health Affairs journal on Twitter and receive a Tweet every time a new GrantWatch Blog post is published, as well as Tweets about other journal content.

Report on How Blues Plans Are Helping to Improve Health in Their Communities:

Investing in America’s Health: 2009 Report, BlueCross BlueShield Association, formally released September 2010. According to an introduction by Scott Serota, president and CEO of the association, the thirty-nine Blue Cross and Blue Shield companies “collaborate with organizations large and small on innovative initiatives to raise healthcare quality and safety, increase access [to care], maintain affordability and improve consumer health through healthier lifestyles and healthier communities.” The companies collectively “contributed more than $208 million to support these important initiatives” in 2009.

This readable report spotlights Blue Cross and Blue Shield foundation and corporate-giving programs around the nation.

GrantWatch Blog narrows the focus by mentioning briefly just a few of the foundation efforts in 2009 (not every Blues plan has a foundation) that are mentioned in the report.

(1)   The Blue Foundation for a Healthy Florida, which is based in Jacksonville. Its Embrace A Healthy Florida program, which aims to prevent childhood obesity, had awarded some forty grants, as of the report’s publication. The report mentions a couple of grantees, including the nonprofit Education Fund’s Plant a Thousand Gardens Collaborative Nutrition Initiative, which “addresses the alarming rate of childhood obesity, diabetes and other harmful medical conditions due to poor nutritional choices.” The initiative’s aim is “to change eating patterns in elementary school children and their families” by using hands-on nutrition literacy, and to engage teachers and school leaders in collaborative research “that empowers them to become advocates” for nutritional literacy. Read about the initial results of the Plant a Thousand Gardens Initiative on page 15 of the report.

(2)   Anthem Blue Cross and Blue Shield Foundation (Maine). It has provided funding for the Healthy Community Coalition’s Franklin Health Access—Rx Program. This program is for people in rural Greater Franklin County, Maine—which the report describes as an area of “widespread lower literacy levels.” The coalition aims to improve (1) access to prescription medications, (2) medication safety through education, and (3) “medication compliance through the implementation of a community-wide electronic prescribing system.” The program also strives to increase participation in prescription assistance programs and increase providers’ and patients’ knowledge about “the value of cost-of-medication discussions.” On page 17 of the report, read about the outcomes of the Anthem Foundation’s funding thus far.

(3)   The Blue Cross Blue Shield of Massachusetts Foundation, based in Boston. Its Innovation Fund for the Uninsured has been providing grants (lasting up to three years) to help community health centers and other provider organizations in Massachusetts to “improve the organization, continuity and completeness of care for the uninsured or those at risk of losing their coverage.” (Read about the grants awarded in 2009 here on the foundation’s web site.) As the report notes, on page 33, there are still state residents “who continue to lack health insurance or experience gaps in coverage,” despite the “remarkably effective” efforts of Massachusetts health reform. The Innovation Fund’s “ultimate goal is improved health outcomes and more cost-effective care through outreach and education, prevention and medical management.” The foundation has just embarked on a strategic planning phase, Phillip González, director of grant making at the foundation, told me yesterday. For more information about the Innovation Fund going forward, send him an e-mail.

Stem Cell Research: How Foundations Have Weighed In


September 15th, 2010
by Lee-Lee Prina

A bill was introduced this week in the U.S. Senate to legalize the federal government’s funding of embryonic stem cell research. If passed, according to news reports, the legislation would codify President Obama’s 2009 executive order advancing such research. The Ellison Medical Foundation funded a recent report and updated guidelines about this research. Other foundations have awarded grants on various implications of stem cell research.  

Final Report of the National Academies’ Human Embryonic Stem Cell Research Advisory Committee and 2010 Amendments to the National Academies’ Guidelines for Human Embryonic Stem Cell Research, National Research Council and Institute of Medicine of the National Academies, released May 26, 2010. A free PDF is available for download. A paperback copy is available for $18.90 when ordered online. The publication was funded by the Ellison Medical Foundation, which is based in Bethesda, Maryland. Larry Ellison, chief executive officer and founder of Oracle Corporation, is chairman and president of the foundation.

This 2010 National Academies publication updates the National Academies’ research guidelines by taking “into account the new, expanded role” of the National Institutes of Health (NIH), as of 2009, in overseeing human embryonic stem cell research. The document “also identifies those avenues of continuing National Academies’ involvement deemed most valuable by the research community and other significant stakeholders.”

I found the introduction helpful in explaining the complicated events of the past few years and in describing the NIH Guidelines on Human Stem Cell Research (yet another set of guidelines!), which were released in July 2009. The introduction, for example, explains the Dickey-Wicker amendment, which President Obama left intact in his executive order, the report notes. (I was curious enough to look up Dickey-Wicker and found a page describing the amendment on the American Association for the Advancement of Science’s Web site. The amendment was part of a 1996 appropriations bill. In case you were wondering, Dickey and Wicker were two congressmen.) Dickey-Wicker “can only be changed by Congress,” and it “effectively prohibits the use of federal funds to derive” new human embryonic stem cell lines, the National Academies publication states.

Background. In 2005 the National Academies released a book containing guidelines, “which offered a common set of ethical standards” for embryonic stem cell research. Because of “the absence of comprehensive federal funding” at the time, the field “was lacking national standards for research,” the web site of National Academies Press explains. The National Academies released amendments to the guidelines in 2007 and 2008, as well as the most recent update mentioned above.

In 2006 the Human Embryonic Stem Cell Research Advisory Committee was established at the National Academies; the Ellison Medical Foundation, the Greenwall Foundation, and the Howard Hughes Medical Institute supported this panel. R. Alta Charo of the University of Wisconsin-Madison and Linda B. Miller of the Volunteer Trustees Foundation were among those who served on the committee, which has now concluded its work.

Read more about stem cells on the National Academies’ web site.

Related resources:

“Senator Pushes Bill Legalizing Stem Cell Research,” by Jim Abrams of the Associated Press (AP) on WTOP Radio Network’s web site, September 13, 2010. This article discusses a bill introduced by U.S. Sen. Arlen Specter (D-PA). The story says that U.S. Rep. Diana DeGette (D-CO) and U.S. Rep. Mike Castle (R-DE) “have introduced similar legislation” in the House of Representatives. “It’s unclear whether lawmakers will have the time, or the political will, to undertake the controversial subject in the few weeks remaining” before Congress goes on recess for the fall 2010 election campaign. (And I just heard on the news yesterday night that Castle, who was running for a U.S. Senate seat, lost in the Republican primary, in an unexpected upset.) This AP story contains a good summary of recent “conflicting court decisions,” as well as executive orders and legislation on stem cell research over the years. Here is a news release from Specter’s office issued shortly before he spoke about the bill on the Senate floor.

“After Court-Imposed Halt, Specter Seeks to Make Stem-Cell Funding Permanent,” by J. Taylor Rushing, post on Healthwatch (The Hill’s blog on health care), September 13, 2010. This article points out that Specter lost in the Democratic primary earlier this year and is a two-time cancer survivor; both points provide interesting context for his introduction of the bill. (One also wonders how the fact that Castle and Specter will be leaving Congress will affect the stem cell bills that they are championing. As a colleague commented, their influence may now be gone, or, alternatively, there could be a new sense of urgency because of expected Republican gains in the November elections.)

“Stem-Cell Research Pushed to Top of Congress’ Agenda,” by Michael Riley, Denver Post, September 15, 2010. Riley reports that “quashing a recent court ruling that bans federal funding for embryonic stem-cell research has suddenly risen to the top of Congress’ pre-election to-do list.” He says that, in addition to the court ruling, there is another reason why some members of Congress are “poised to act”; read why that is.

Stem Cell Policy and Ethics (SCOPE) program at the Berman Institute of Bioethics at Johns Hopkins University. I asked Alan Regenburg, who is the bioethics research manager at the Berman Institute, if the SCOPE program receives any foundation funding. He responded in an e-mail that, “although it does not have its own separate budget,” faculty members affiliated with the program “have completed a series of grant-funded projects.” In addition, SCOPE members have “collaborated with bioethicists and stem cell researchers” based in California and the United Kingdom (UK) “to form ‘the Hinxton Group’ (www.hinxtongroup.org).” He added, “We’re currently working on a Hinxton Group project that will gather a group of experts/key stakeholders in early November [2010] to work on proprietary challenges in stem cell research.” (Examples of this would be challenges in the areas of intellectual property, data sharing, and materials sharing.) A group of funders including the Greenwall Foundation, the Wellcome Trust (a funder based in the UK, which focuses on low- and middle-income countries), and others supports this project.

Stem Cells 101. This New York Stem Cell Foundation (NYSCF) web page answers questions such as “What are embryonic stem cells?” and “What are adult stem cells?” A glossary is included. The NYSCF also has a Stem Cell News page. The NYSCF, a nonprofit organization, solicits donations and award grants.

Research on Medical Malpractice Reform: Examples of What Foundations Have Funded


September 9th, 2010
by Lee-Lee Prina

The just-released September 2010 issue of Health Affairs contains a section on malpractice and medical errors. Today, the GrantWatch Blog looks at examples of foundation funding of research on malpractice reform and suggests related resources for further reading on this controversial topic.

New Issue Brief:

“Will the Patient Protection and Affordable Care Act Address the Problems Associated with Medical Malpractice?” Randall R. Bovbjerg, August 2010, Urban Institute paper. Funded by the Robert Wood Johnson Foundation. This document is one of a series of briefs that look at the question, “How will [health] reform affect health care costs?”

“Malpractice reforms could help curb health care spending and promote safety,” but the Patient Protection and Affordable Care Act “only offers small steps,” according to the paper’s pull-quote.

After mentioning the politics of malpractice reform, Bovbjerg comments, “Conventional tort reform is a zero-sum game, much as lawsuits are—every gain for one side is a loss for the other.” He adds that “the traditional liability regime” helps neither patients nor caregivers.

The Affordable Care Act, however, “did nothing to change this political dynamic or the underlying problems,” the author maintains. In fact, he explains that there are only “two small liability-related provisions” in the law. These provisions (1) authorize limited demonstration projects by states on the topic of malpractice and (2) extend “federal malpractice protections to free clinics’ nonmedical personnel.”

Bovbjerg indicates that, unfortunately, the savings that would accrue from reducing the practice of defensive medicine would be small. But he also says that “omitting defensive services almost by definition would not harm patients.” Defensive medicine is practiced “more for legal defense than for patient benefit,” he explains.

He then examines various promising liability and safety reforms (such as early disclosure of “adverse events” by physicians, with subsequent “reasonable compensation” to the patient “where mistakes have occurred”) to see whether they would qualify for the Affordable Care Act’s demonstration grants. He finds that it is unlikely that any of these approaches would get the thumbs-up from the federal government.

Bovbjerg recommends shifting “any available” funding for demonstrations under the Affordable Care Act to the Agency for Healthcare Research and Quality (AHRQ), which recently awarded grants through its Medical Liability Reform and Patient Safety Initiative. (The author notes that the money for medical liability reform demonstration grants in the Affordable Care Act has been authorized but not yet appropriated. This point was confirmed by an AHRQ spokesperson.)

Bovbjerg also suggests that a trade-off of sorts be made with physicians: medical liability reform could be extended to them so as “to promote [their] full participation in Medicaid or to reduce resistance to evidence-based medicine, case management, or other health insurance initiatives that reduce cost or enhance value.” That would be similar to the free-clinic liability provision in the Affordable Care Act.

In a summary of the paper, the author states, “Patients as a whole could benefit if conventional tort limits were traded for better-value care as health reform is implemented or if broader reforms of  liability could be demonstrated [to be] successful.”

Grant Awarded:

The New York State Health (NYSHealth) Foundation awarded a $151,980 grant in August 2009 to the Common Good Institute, in Brooklyn, New York, to design “an arbitration-based medical injury dispute resolution system for New York health systems.” The aim of the nonpartisan, nonprofit Common Good is to develop a program based on arbitration (not litigation) that would “resolve medical liability cases openly, quickly, and at a significantly reduced cost for all parties involved.” The grantee planned to collaborate with health providers in New York. Read more about this interesting project here.

This grant is one of six grants awarded under NYSHealth’s Strategies to Contain Health Care Costs in New York State program. For background, read the (now-closed) request for proposals.

Related reading:

“A Philanthropy Tackles Growth in Health Costs at the State Level,” David Sandman of NYSHealth Foundation and Anthony Kovner of New York University’s Robert F. Wagner Graduate School of Public Service, Health Affairs, GrantWatch section, July 2010. The grant to Common Good is described there also.

The Robert Wood Johnson Foundation (RWJF) awarded several grants to Common Good over the years; all have now concluded. From the RWJF’s website, it appears that the most recent grant was for a forum that was held in December 2009 “on viable, state-based medical liability reform.” Read more here about the forum, held at the National Press Club, in Washington, D.C.

Related resources on medical malpractice reform:

Health Affairs, September 2010 issue, which has a section on Medical Malpractice and Errors. Articles include:

 “Low Costs of Defensive Medicine, Small Savings from Tort Reform,” by J. William Thomas, Erika C. Ziller, and Deborah A. Thayer, all of the Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine. The RWJF’s Health Care Financing and Organization (HCFO) national program supported the research for this article.

“Physicians’ Fears of Malpractice Lawsuits Are Not Assuaged by Tort Reforms,” by Emily R. Carrier, James D. Reschovsky, Michelle M. Mello, Ralph C. Mayrell, and David Katz. Carrier, Reschovsky, and Mayrell are with the Center for Studying Health System Change; Mello is at the Harvard School of Public Health; and Katz is with the University of Iowa’s Department of Internal Medicine. The RWJF funded this work.

Common Good Institute’s website, http://www.commongood.org. This site has useful links to recent news articles on medical malpractice.

“Even with Malpractice Insurance, Doctors Opt for Expensive, Defensive Medicine,” Manoj Jain, Washington Post, Health Section, August 31, 2010. Jain writes about his own experience. He is an infectious-disease specialist in Memphis, Tennessee, and an adjunct assistant professor at Emory University’s Rollins School of Public Health.

Medical Liability Reform and Patient Safety Initiative, AHRQ (an agency of the US Department of Health and Human Services [HHS]), http://www.ahrq.gov/qual/liability. President Obama announced this initiative September 9, 2009. This web page has links to descriptions of the demonstration grants and planning grants that were awarded in June 2010. HHS allocated $25 million for this initiative, and all of the money has been awarded, according to the AHRQ spokesperson I contacted. Existing AHRQ funding will pay for a review of what works and for overall program evaluation, according to an initiative fact sheet.

Read more about the AHRQ demonstration grants in “Averting Medical Malpractice Lawsuits: Effective Medicine—or Inadequate Cure?” by Stephen Langel, September 2010, Health Affairs. Langel is a senior editor at the journal.

“Young Doctors Getting Defensive Medicine Lessons Early On: But Less Than a Third of Physicians Older Than Fifty-five Learned These Tactics When They Were in Medical School,” Amy Lynn Sorrel, American Medical News, May 19, 2010. Reporting on a survey that was conducted by Jackson Healthcare, Sorrel says, “eighty-seven percent of doctors who described themselves. . . as current residents or fellows reported being taught to practice defensive medicine while in medical school or residency.”

Three Most-Read GrantWatch Blog Posts during August 2010


September 7th, 2010
by Lee-Lee Prina

Below, we have tabulated a list of the three most-read GrantWatch Blog posts in August 2010. (GrantWatch Blog launched in March 2010.) Here is a chance to take a gander at these posts if you missed them when the original Tweet or e-alert came out.

  1. “The Relief of Suffering from Serious Illness: How Foundations Can Lessen the Pain,” by Rosemary Gibson, independent consultant (date of post: August 6, 2010).
  2. “Foundation Underscores the Merits of Healthy Food Choices,” by Lee-Lee Prina (date of post: July 28, 2010).
  3. “Reducing Health Care Disparities Affecting People with Diabetes,” by Lee-Lee Prina (date of post: July 17, 2010).

Heading the list was a post by Gibson, whom many of you may remember from her years at the Robert Wood Johnson Foundation.  She writes here about palliative care, which “seeks to relieve symptoms and suffering for patients with serious illness regardless of prognosis.” She describes the good things about palliative care and mentions how foundations’ funding could help increase its availability.  

Next on the list was a post highlighting an issue of the Heinz Endowments’ magazine called h, which focused on eating healthy food. The GrantWatch Blog post also points out a few foundations that are funding obesity prevention efforts, and it directs readers to the Table of Contents of the March 2010 issue of Health Affairs, whose theme was “Child Obesity: The Way Forward.”

Coming in at third place was a post highlighting the Merck Company Foundation’s Alliance to Reduce Disparities in Diabetes. Merck’s foundation has committed $15 million through 2013 to this effort on diabetes and disparities. The post also includes a list of related resources on one of the following topics: diabetes, health disparities, and chronic diseases in general.

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