The 2010 Election: How Three Foundations Are Providing (Nonpartisan) Assistance

October 28th, 2010

Read about the nonpartisan election-related efforts of three foundations. (As you may know, 501(c)(3) private foundations are prohibited from participating in political campaigns. For details, see this Internal Revenue Service publication.)

Publication of the Views of Candidates in One Statewide Race

Bob Ross, president and chief executive officer of  the California Endowment (TCE), said in an e-mail alert this week that as part of TCE’s “ongoing effort to provide voters with information about the candidates and issues,” he invited both of the candidates for California superintendent of public instruction “to post a guest blog” on the foundation’s website. The topic? They were asked “to share their views about the role schools can play in promoting health in California.” Both of the candidates responded, and TCE published their statements on the website (not actually on a blog) “completely unedited,” Ross said.

He also made very clear in his e-alert that TCE “does not support or oppose any candidate for elective office” and urged readers to get out and vote for the candidate of their choice.

Not being familiar with this statewide race, I found out a bit more about the candidates for this office by reading an October 26 article in the Los Angeles Times. According to this article, both candidates are “espousing classically liberal positions.” One candidate, Larry Aceves, “changed his party affiliation from Democrat to Independent,” the paper reported. The other candidate, Tom Torlakson, is a Democratic member of the California Assembly. A spokesperson for the California Endowment explained to me that the superintendent’s office is nonpartisan.

In the statement Aceves sent TCE, he says he wants “to restore the 17 billion dollars of public school funding that has been cut” because of the recent state budget deficit. He also points out his accomplishments as superintendent in San Jose, California. For example, he notes: “We were able to create a free medical and dental clinic.” He describes other issues that are important to him. Among these are providing nutritious school meals and training school staffs and teaching children “about the effects of bullying and how to stop it.” Read his full statement here. Aceves has been endorsed by several newspapers, including the San Francisco Chronicle.

Torlakson, who has worked as a teacher, underlines (literally) this sentence in his statement: “We must address student health to fight the achievement gap and the drop out rate.” Nutrition and physical activity are important: The schools’ role “in addressing student health begins with a healthy meal, and exercise,” he notes. Torlakson also mentions the importance of “adequate, basic” health care and says that many kids in California are not receiving that level of care. He maintains that “county and non-profit health services must be maximized for our students and their families” and mentions the advantages of “coordinated school services.” Read his full statement here.

Flu Shots Offered on Election Day 

Have you gotten your flu shot yet? The Robert Wood Johnson Foundation (RWJF) is again helping out with a multistate immunization effort, as it did in 2004, 2006, and 2008. This year the RWJF and an additional funder, AARP, are sponsoring Vote & Vax vaccination clinics at local polling places nationwide (in forty-nine states and the District of Columbia) on Election Day, November 2. Flu shots will be offered “at or close to local polling places,” according to an October 19 e-mail alert. Even if you are not voting, or are not even registered to vote, you can still get a low-cost or free flu shot at these locations.

The clinics sponsored by the nonpartisan Vote & Vax initiative “are also a valuable exercise in emergency preparedness for public health and emergency management agencies,” the RWJF points out. Running a clinic improves agencies’ “capacity to immunize potentially large numbers of people at community venues, which can help public health providers respond effectively to future emergencies.” Agencies can still register for a free kit describing how to set up a clinic at a polling station—while supplies last—and can receive technical assistance from Vote & Vax.

The grantee for the Vote & Vax initiative is SPARC (Sickness Prevention Achieved through Regional Collaboration), which is led by Doug Shenson, a physician and an associate clinical professor at Yale University School of Public Health. Read a 2008 profile about this innovative project. 

Poll Results

And on October 18, the Henry J. Kaiser Family Foundation (KFF) released a Poll Watch, titled “New Tracking Poll Finds Americans Divided over Health Law.” It contains results of the foundation’s own poll. The KFF states: “With the November midterm elections just weeks away, Americans remain chronically divided over the Patient Protection and Affordable Care Act, but most say that their feelings—pro and con—about the health reform law are not a dominant factor in how they will vote for Congress or whether they will go to the polls.” For more results of this tracking poll, which was conducted October 5–10 by Princeton Survey Research Associates, click here

The KFF’s latest Poll Watch, October 22, mentions a survey by the Pew Research Center for the People and the Press which “asks registered voters which [political] party they prefer to deal with [on] issues such as health care,” the KFF says. The Pew Center is an initiative of the Pew Charitable Trusts, which became a public charity several years ago.

The KFF’s regularly occurring Poll Watch feature appears on the foundation’s Health Reform Source gateway page and is a roundup of surveys from the KFF and others “assessing public attitudes and experiences over time related to the health reform law.”

Health Reform, Hospital Readmissions, Nurses, Oral Health: Foundation Blog Roundup

October 21st, 2010

Here are links to other recent blog posts from and about health philanthropy that caught my eye. The topics range from health professions to health reform to hospitals. (The blogs mentioned are all listed in our Blogroll on the right side of the GrantWatch Blog page.)

“A Boost to Better Care,” by Chris Langston, on the John A. Hartford Foundation’s Health AGEnda blog (Sep. 28). In this post, Langston highlights BOOST (Better Outcomes for Older adults through Safe Transitions), which is a “bundle” of steps suggested to improve hospital discharges and “reduce readmissions.” The Hartford Foundation has awarded a grant to the Society of Hospital Medicine (that’s the professional association for physicians called hospitalists, who just work in hospitals) to disseminate BOOST. The menu of steps uses “some of the best ideas of evidence-based practice for reducing readmission and spreads them across the health care team,” Langston, Hartford’s program director, says. Recommended practices include “assessing patient readiness for discharge, educating patient[s] and family caregivers, carefully reviewing medication, and scheduling follow-up appointments.” The foundation “is very hopeful,” Langston comments, “that the incentives of health payment reform will make the audience for this exciting program grow wildly, as it needs to do.” Eric Coleman, a professor of medicine at the University of Colorado Denver, and his Care Transitions Intervention are mentioned in this post. Read, also, the GrantWatch Blog post that Coleman coauthored with Amy Berman of the Hartford Foundation.

“A Call for Standardized Rehospitalization Measures and Information Systems,” by Anne-Marie J. Audet on the Commonwealth Fund Blog (Sep. 27). Audet, a vice president at Commonwealth, states that rehospitalizations (when patients are discharged from a hospital and then are readmitted later) “are prevalent, harmful to patients, and costly.” She points out that there are many ways to measure rehospitalization (depending on the timeframe used, the type of patients studied, and so forth), and “meaningful information” on trends in this area “may continue to elude” us because of “the lack of national standards” for measuring incidents of rehospitalization. She lays out the problems now when national reports are already being published by entities such as the Medicare Payment Advisory Commission (MedPAC) and the Centers for Medicare and Medicaid Services (CMS): “each group has adopted a different definition of rehospitalization, which makes comparisons and benchmarking across states, regions, and hospitals impossible, and most reports are based on data that are more than two years old.” Among Audet’s recommendations are to use measures that apply to all patients and use timely data. The United States “must invest in [health] information systems that can provide the timely data,” she maintains. Even six-month-old data are not recent enough, Audet says. Also, Medicare, states, and other commercial payers should all use the same standardized measurement methods. Audet mentions how preventable rehospitalizations are going to be addressed under the Patient Protection and Affordable Care Act. She then points out that “improving care transitions and reducing rehospitalizations are among the priorities” of a Commonwealth Fund program. She specifically mentions that Commonwealth awarded a grant to the Institute for Healthcare Improvement (founded by Don Berwick and others) for the State Action on Avoidable Rehospitalizations (STAAR) initiative, which is working in Massachusetts, Michigan, and the state of Washington. Some comments with interesting observations follow Audet’s blog post.

“The Hartford Foundation: Yes . . .The Hartford: NO!” also by Langston, who writes on the Hartford Foundation’s Health AGEnda blog (Sep. 23). I am briefly mentioning this post, as I thought it was fun to read and shows how similar names of organizations can confuse people. Langston says that the John A. Hartford Foundation (a national funder located in New York City) is from time to time confused with the Hartford Foundation for Public Giving, a community foundation in Hartford, Connecticut, and with The Hartford, an insurance company. (Did you know that the money for the John A. Hartford Foundation, founded in 1929, comes from two brothers who were both CEOs of the Great Atlantic and Pacific Tea Co. [otherwise known as the A&P grocery store chain])? Here in Health Affairs’ GrantWatch section, we have published peer-reviewed articles on efforts of both the John A. Hartford Foundation (the most recent being “Helping Nursing Homes Prepare for Disasters”) and, back in 1999, the Hartford Foundation for Public Giving (“The Children’s Health Council: A Community Foundation/State Government Partnership” ).

“Health Care Reform Forum—Twitter Summary,” by Jayson Smart, on the Rasmuson Foundation’s Reflect. Share. Blog. Smart, a program officer at this foundation which is based in Anchorage, Alaska, and awards grants statewide, writes about a September 2010 Health Care Providers’ Forum sponsored by Rasmuson and Providence Health and Services. Some 170 people, including several state legislators, attended the event at the University of Alaska Anchorage. The forum aimed to provide an overview of federal reform and perspectives on how various sectors of health should “best respond to and plan for provisions in the new law,” Smart says. He used the funder’s Twitter feed to delineate some key points made by the five panelists at the event. The Tweets (verbatim) included:

  • For insurance reform to work, consumers can’t be in [high-risk] pool/insurance only when there is a health issue. . . otherwise it will collapse the system—not sustainable.
  • [The] legislation expands behavioral health options for Native health care system.
  • [Alaska] is one of 20 states with legal challenge of new law.
  • [Alaska is] not planning [a] health insurance exchange—leaving that responsibility to the feds.

“Not for Nurses Only!” by Patricia Flatley Brennan, on the Robert Wood Johnson Foundation’s (RWJF’s) Pioneering Ideas blog (Oct. 6). Brennan, who is national program director of the RWJF’s Project HealthDesign, discusses a 620-page, October 2010 Institute of Medicine (IOM) report on the future of nursing. Prepared by the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, the report has four recommendations, which Brennan lists briefly. She also notes that nurses must actively engage “with other clinicians, the business community and health policy makers” to achieve the “bold vision” put forth by the IOM committee. Former U.S. Department of Health and Human Services Secretary Donna Shalala chaired the panel, which included a number of well-known health policy people, including Jennie Chin Hansen, Bill Novelli, Yolanda Partida, Bob Reischauer, John Rowe, and Bruce Vladeck. Sue Hassmiller, an RWJF staffer and a past GrantWatch author, served as study codirector of the initiative.

“Welcome Dental Funders,” by Cassandra Stalzer, on the Rasmuson Foundation’s Reflect. Share. Blog (Oct. 11). Stalzer, who is the funder’s communications manager, tells us that foundation staffers and others from around the United States were in Alaska then to hear about the Dental Health Aide Therapist (DHAT) program, which originated in Alaska and aimed “to improve oral [health] care in very rural communities.” These mid-level providers “have been providing preventive and basic dental care” in that state since 2003. Rasmuson was among the early supporters of this interesting workforce model and has continued to support it. Stalzer told me that an evaluation of the DHAT initiative will be released in late October. GrantWatch will be interested in hearing the results of it. Read more about the DHAT project and which foundations have funded it in this press release, the contents of which were originally published as an op-ed in the Anchorage Daily News.

Roundup: What’s New on the Philanthropy Blogs

October 19th, 2010

Here are links to some recent blog posts from and about health philanthropy that caught my eye. They cover a variety of topics—from political contributions to water and sanitation to social media to the flu. All blogs mentioned are listed on our Blogroll on the right side of the page.

“Healthcare Reform and Mental Health,” by Janice Bogner, in The Health Foundation blog of the Health Foundation of Greater Cincinnati (Oct. 11). Bogner, a foundation staffer, comments, “Finally, mental health is recognized as a health condition and is to be included in basic healthcare benefit packages.” She recommends online resources that provide “excellent information” on what health reform means for mental health.

“Navigating the Politics of Philanthropy,” by Suzanne Perry, in the Chronicle of Philanthropy’s Government and Politics Watch blog (Sep. 30). Perry tells us about a Huffington Post tool that may tell you “about the political leanings of your favorite philanthropist” (and anyone else!). Perry experimented with this search engine and found out that Bill Gates, for example, “donated to both Democratic and Republican members of Congress in 2009 and 2010.” Also, you can search by employer—that is, you can pull up all recent personal donations by contributors who listed a specific employer (for example, a foundation).

“Official Data Underestimate Global Water and Sanitation Crisis, Showing Need for Improved Monitoring,” by Frank Rijsberman on the Official Blog (Sep. 9). is Google’s philanthropic arm. (Rijsberman recently left google org to join the Bill and Melinda Gates Foundation—see the GrantWatch “Outcomes” column in Health Affairs’ November 2010 issue, to be released November 2, for more on this.) Rijsberman says that the data released by the Joint Water Monitoring Program of the World Health Organization (WHO) and UNICEF “on the number of people still lacking access to adequate water and sanitation services prove that the situation is simply unacceptable.” He maintains that “a realistic assessment” of this crisis “requires continuous monitoring at local levels.” Read about the H2.0 partners and what they are doing to help obtain more accurate data.

“Preparing for the 2010–2011Flu Season with the Flu Vaccine Finder,” by Roni Zeiger, on the Official Blog (Sep. 28). Zeiger says that “Google is again collaborating” with the U.S. Department of Health and Human Services (HHS), its collaborators, and the American Lung Association on a feature that “allows people to more easily find nearby locations for getting the flu vaccine.” She notes that this year’s vaccine “protects against the three viruses that research suggests will be most common, including the H1N1 [‘swine flu’] virus.” Also, check out Google Flu Trends, previously described in GrantWatch.

“Social Media Insights, Tactics for Nonprofits and Foundation Support,” Sabine Kortals, in the Colorado Trust’s Community Connections blog (Aug. 25). Kortals, who recently resigned from the trust’s communications staff to accept another position elsewhere, describes “an intensive master class and workshops” attended by some 300 members of the nonprofit community in Colorado. (The Colorado Trust, Gill Foundation, Gay and Lesbian Fund for Colorado, and the Colorado Health Foundation funded the meeting, which was hosted by the Colorado Nonprofit Association and the Colorado Association of Funders.) The blogging workshop, conducted by Beth Kanter of Zoetica and Jen Caltrider and Alan Franklin of ProgressNow Colorado had some helpful hints for bloggers, such as asking readers questions to elicit comments and “being willing to tackle controversial topics” on a blog. Links to other helpful resources are included.

“Why Health Costs Hurt U.S. Competitiveness,” by Annette Quintana, on the Health Relay blog of the Colorado Health Foundation (Aug. 26). Quintana is chief executive officer (CEO) of Istonish Inc., which is an information technology services firm based in Denver. What is her connection to the foundation? She chairs the business engagement group of the Center for Improving Value in Health Care, which is a grantee of the foundation. Quintana maintains, “What we don’t talk about is how the cost of health care is embedded in goods and services made or delivered in this country.” She adds, “Because most U.S. employers cover the cost of health care benefits—on behalf of their American workforce—insurance premium costs must flow through nearly every product or service.” Read her views from the business side.

“Why Neglected Tropical Diseases Need a Renewed Focus,” by Peter Hotez, president of the Sabin Vaccine Institute and director of Sabin Vaccine Development, on the Foundation Blog of the Bill and Melinda Gates Foundation (Oct. 14). Hotez discusses these neglected diseases. On the list of those causing “the greatest health damage,” he says, are schistosomiasis, lymphatic filariasis (elephantiaisis), and several others. Major vaccine manufacturers are not developing vaccines for these diseases—with the exception of dengue fever, he states. Hotez also mentions a new WHO report on neglected tropical diseases. I would add: Don’t forget the section on “fighting neglected diseases” in Health Affairs’ November/December 2009 issue; Hotez wrote one of the articles.

Would you like to add to something one of the bloggers said? Do you disagree with any of the points made? Please use the Comment feature on GrantWatch Blog to respond!

There are too many good philanthropy blog posts to mention today. More later this week!

Does your foundation have a blog that we have not listed on our Blogroll? Please let me know about it.

Why Foundations Need to Shape Payment Reform

October 14th, 2010

One of the most important unanswered questions about the Patient Protection and Affordable Care Act of 2010 is whether it will deliver on its promise to bend the cost curve. The law includes an array of provisions to rein in spiraling costs. These include eliminating cost barriers to effective prevention and screening measures in health insurance plans to promoting the development of new payment arrangements called accountable care organizations (ACOs).

At a recent meeting of health professionals, someone asked what an ACO is, and how ACOs will work. Just like ten blind men describing an elephant, the understanding of ACOs and how they serve as the platform for payment reform is largely reflective of which organization or group is driving the conversation.

A virtual stampede of hospitals, health systems, and provider networks are now claiming they are “becoming an ACO.” At the same time, a horde of consultants is in a rush to offer their “ACO expertise.” Implementing an ACO model is complex work that shouldn’t be left to corps of consultants. Health funders can play an important role in making sure that we get this payment reform model right so health reform can survive and thrive.

Since 2008 the Maine Health Access Foundation (MeHAF), based in Augusta, has advanced a broad, statewide initiative on payment reform and cost containment. This two-year grant program supported a diverse group of grantees representing business and private payers, safety-net providers, consumer advocates, public health professionals, and Maine’s Medicaid program. Grantees met quarterly so alliances and strategic partnerships could be identified and leveraged across projects. One grantee, the Maine Health Management Coalition, has emerged as the lead organization representing employers, providers, health plans, and hospitals across the state in laying the groundwork for ACO development.

MeHAF just fielded a follow-up request for proposals (RFP) designed to build on the work of these grantees yet push a more defined focus on advancing payment reform strategies in support of the Accountable Care Act. The proposals, and our experience with the first cadre of grantees, highlight some important steps that health funders can take as we encourage and advance this work.

First, health funders are one of the few neutral organizations that can convene leaders from diverse and competing systems in forums to learn about key concepts, structural components, and trial models for ACOs. Three years ago, we tapped into the goals spelled out in the “Triple Aim” and advanced these as key components of our view of payment reform, so applicants would have a better understanding of how national thought leaders were proposing substantial changes to care delivery and payment.

We’ve also shared the work of our national health philanthropy colleagues on payment reform models. They have done an excellent job setting the table for reform efforts through convening, research, and demonstration projects. Yet many organizations considering ACOs are unaware of these important resources. The Commonwealth Fund’s Commission on a High Performance Health System has been a key leader in defining the core principles and system changes that must occur to get better value for our health care spending. Its publications provide a sound guide to the values, attributes, and key components that should drive ACO planning and development.

Similarly, the Robert Wood Johnson Foundation (RWJF) has convened national experts to chart a path for health care payment reform. The RWJF has just released a new RFP to translate the concepts of payment reform into models that provide high-value care.

Having national philanthropic resources to guide this work is important, yet aside from Medicare, most decisions about payment reform and ACOs will be framed at the local level. This is where local health funders can use their convening, grant-making, and technical assistance capacity to advance payment reform in ways that meet the Accountable Care Act’s goals and our respective missions.

Local funders can help ensure that safety-net providers and those who provide specialty services, such as mental and behavioral health care and oral health care, are part of ACO conversations. For the past five years, MeHAF has led a major initiative to promote patient- and family-centered care by focusing on the integration of primary care and mental/behavioral health. It is clear that as health systems and provider networks consider providing care for broad populations of patients, having the capacity to address physical and behavioral health needs in cost-efficient ways becomes a key factor in controlling financial risk under any ACO structure. In Maine, ACO development now largely includes the expectation that mental health care would no longer be carved out but would be “carved in” for an ACO to fully function.

One of the most important roles for health funders is to constantly ask—and help answer—the accountability question. To whom is the ACO accountable? Ultimately, ACOs have to meet community health needs and be accountable to patients for delivering higher-value care. Health philanthropy can take an active role to ensure that the voices and opinions of patients and families are at the ACO planning table—this means not only involving consumer advocacy organizations, but also getting input directly from patients.

To many, inclusion of the “customer” seems obvious. But in practice, ensuring substantive patient input on payment reform and delivery system reform is still largely an unnatural act for many provider and health care organizations. This is a point where health funders can help. For example, as part of MeHAF’s recent payment reform RFP, we required grantees to describe how they will actively involve consumers in planning, implementation, and providing feedback as care delivery and payment are restructured.  

But it’s not enough to merely have their voices at the table. Payment reform has to drive tangible changes in how care is actually delivered on the ground in ways that reflect what patients say they need to get better value and better health. MeHAF reached out to Mainers to solicit this type of on-the-ground advice. We have challenged our payment-reform grantees to specify how they will incorporate and respond to this information in their planning.

Many of these changes, such as having extended office hours for physicians and providing better explanations of preventive screenings, medication therapies, and lifestyle changes, do not need ACOs to come about. But if ACO development and implementation doesn’t include steps that deliver on these simple, straightforward requests, patients won’t feel that there’s any substance to reform.

At a recent national health reform meeting for health philanthropy, held by Grantmakers In Health at Brandeis University, funders from the New England states got together ahead of time to share strategies and explore how we can work together to achieve regional impact. Coming together on payment reform ranked high on the list for a few of us.

Ensuring the success of payment reform is a challenge that requires all of our best collective efforts. National funders have set the stage. Local funders are working with the actors in their geographic areas. It’s time for us to come together to leverage the intellectual and fiscal power of national and local funders to ensure that there’s a successful curtain call.

Most-Read GrantWatch Blog Posts for September 2010

October 7th, 2010

Below we list the three most-read GrantWatch Blog posts during the month of September. (GrantWatch Blog launched in March 2010.) If you missed the original posts, here’s a second chance.

“Stem Cell Research: How Foundations Have Weighed In”

by our regular GrantWatch blogger, Lee-Lee Prina. (Posted Sept. 15.)

“Recent Foundation Funding in Global Health: Helping Haitians after the Earthquake; HIV/AIDS” This one is by Lee-Lee as well. (Posted Aug. 27. FYI, In the blogosphere, a post can first appear in one month but still be one of the most-read in the following month.)

“Can Funders Quell a ‘Perfect Storm of Overutilization’?” by Rosemary Gibson, an independent consultant. (Posted Aug. 25.)

Lee-Lee’s first post concerned the always touchy subject of stem cell research. Her peg for the post was the 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. The report, funded by the Ellison Medical Foundation, was released in May and is available as a free PDF download and in paperback—ordered online—for $18.90. It updates the National Academies’ research guidelines by noting the expanded role of the National Institutes of Health in overseeing human embryonic stem cell research. One of the report’s great values, Lee-Lee noted, is its untangling of the complicated series of events in the past few years pertaining to stem cell research.

Lee-Lee’s second post mentioned the work of two foundations related to the earthquake that devastated Haiti in January. In the RAND Corporation’s “Building a More Resilient Haitian State,” Keith Crane and his coauthors address the issue of bolstering institutions and services in a way that will make them effective even in the face of catastrophe. The authors argue that the Haitian government should work to effectively monitor and regulate health services (as well as education) but not try to provide those services itself. The report states that “consideration should be given to shifting the operation of all health centers and hospitals to NGOs [nongovernmental organizations] and other private institutions, allowing the MSPP [Ministère de la Santé Publique et de la Population, or Ministry of Public Health and Population] to concentrate on setting policy and planning for, overseeing, monitoring, and evaluating the operation of Haiti’s public health service–delivery network.”

In “Responding to Haitian Devastation, at Home,” on Smart Assets: The Philanthropy New York Blog, Jim Knickman of the New York State Health (NYSHealth) Foundation reported on NYSHealth’s provision of health care and social services to Haitians who found their way to New York in the wake of the earthquake.

The third most-read post—by Gibson, formerly a senior program officer at the Robert Wood Johnson Foundation and principal author of the recently published The Treatment Trap—addresses the overuse of medical services. Gibson sees a role for foundations to play in preventing the overutilization, which is, of course, a primary cause of runaway health care costs. “Foundations,” she writes, “can fund the development of new payment models as well as new delivery models that help organizations learn how to reduce waste in care delivery processes and curb overuse of tests and treatments that don’t benefit a patient.” They can also fund research into patients’ experience of overtreatment.

Helping Nursing Homes Prepare for Disasters

October 7th, 2010

Summer is over, but hurricane season doesn’t end ’til Nov. 30. We recently marked the 5-year anniversary of Hurricane Katrina. During that catastrophe, many elderly nursing home residents died because the facilities they lived in lacked emergency resources. In this month’s GrantWatch, you can read about an initiative funded by the John A. Hartford Foundation to help nursing homes be better prepared for future disasters, & make sure govt emergency officials include these homes in their planning & response efforts.

What Foundations Can Do to Reduce Medical Malpractice Lawsuits and Improve Patient Safety

October 6th, 2010

The costs of the medical liability system have received attention in Health Affairs recently, and the dialogue presents an opportunity for foundations to make a difference in the medical liability system in a new way. Best practices are emerging that offer a patient-centered approach to reduce medical malpractice lawsuits while also improving patient safety.

The ethics of medicine require health care providers to tell patients about adverse events that cause harm, yet these conversations occur infrequently. The University of Michigan Health System (UMHS) was one of the first health care organizations to establish and implement a policy and practice of informing patients and families when preventable harm occurs.

The principles underlying the UMHS policy are patient-centered. When harm occurs through unreasonable care, the organization must make it right. When the care that staff members provides is reasonable under the circumstances, they need to be supported even when something goes wrong. A commitment to learning from medical errors helps the organization continually improve its quality.

With funding from the Blue Cross Blue Shield of Michigan Foundation, UMHS reported its experience in the Annals of Internal Medicine. The study documents a decline in the average monthly rate of lawsuits from 2.13 to 0.75 per 100,000 patient encounters and a commensurate reduction in legal costs and patient compensation costs. While the study design does not establish causality between the disclosure practices and a reduction in lawsuits or costs, similar approaches adopted in other health care organizations suggest that transparency in the aftermath of medical harm results in multiple benefits.

The University of Illinois Medical Center at Chicago (UIC) has adopted a comprehensive, patient-centered system to respond to adverse events. UIC staff meet with the patient, apologize, and provide a remedy, whether patients want to file a claim or not. They waive fees for hospital and physician services and prescription drugs. The hospital puts a hold on bills that would otherwise be mailed to the patient’s home.

In the first two years, the policy of open and honest communication resulted in more than 4,000 incident reports annually, prompted more than 200 investigations to analyze the cause of the incidents, and led to nearly 200 system improvements. Nearly 300 conversations have taken place with patients and families, and fifty more in-depth disclosures occurred where inappropriate or unreasonable care caused harm to patients. A substantial decline in lawsuits and associated legal costs occurred, according to physician Timothy McDonald, UIC’s chief safety and risk officer.

Patient safety and medical malpractice are intertwined. The Agency for Health Care Research and Quality (AHRQ) has made this important link in its work on patient safety and medical malpractice liability. Foundations can support the establishment and growth of comprehensive systems of patient-centered disclosure in hospitals. Grant funding would be well spent to support the study and publication of research on well-developed systems of disclosure and their impact on patient safety and on liability costs. Grantmakers can multitask and strive to improve patient safety and reduce medical liability costs simultaneously.

A patient-centered approach to dealing with the aftermath of adverse events is good for patients, good for health care providers, and good for reducing health care costs.

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