Update on What Foundations Have Been Doing in Oral Health Care


January 27th, 2011

Use of fluoride is known to reduce tooth decay. Earlier this month, the federal government announced plans to lower the amount of fluoride in water because of concerns that some children were receiving too much of it.

This prompted me to revisit the subject of oral health and what some foundations around the country have been doing to help improve it. Please note that this is not a comprehensive listing.

Recent funding awarded:

Integrating Diabetes Screening in Dental Care Settings. In December 2010 the New York State Health (NYSHealth) Foundation awarded a $200,065 grant for this project, in which the grantee, Columbia University College of Dental Medicine, plans to put into place “a system-wide protocol for conducting diabetes screening” in its dental clinics; institutionalize a way to refer patients identified as having diabetes or a condition called pre-diabetes to a primary care provider; and disseminate and replicate “a protocol for routine diabetes screening in the dental care setting,” according to the NYSHealth Foundation website. The foundation explains there, “Multiple studies have shown that patients with diabetes are more likely to have periodontal disease and consequently suffer diabetes-related complications.” Please note that Improving Diabetes Prevention and Management is one of NYSHealth Foundation’s three funding priorities; dental care is not.

“W.K. Kellogg Foundation Supports Community-Led Efforts in Five States to Increase Oral Health Care Access by Adding Dental Therapists to the Dental Team,” W.K. Kellogg Foundation press release, Nov. 17. The foundation announced that it will invest more than $16 million by 2014 in the Dental Therapist Project (which includes efforts in Kansas, New Mexico, Ohio, Vermont, and Washington state) “as part of a larger effort to build awareness of oral health access issues and bring quality dental care to every community,” the release said. Community Catalyst, a nonprofit in Boston and lead grantee on Kellogg’s project, “will work with states to build coalitions and educate lawmakers on the dental therapist approach.”

Read in the December 2010 GrantWatch section of Health Affairs about an evaluation of a dental health aide therapist (DHAT) program in Alaska here (scroll down to “Oral Health”).

Results of Funding:

“Giving Voice to Oral Health in Kansas: Benefits of Long-Term Commitment,” Kim Moore, president of the United Methodist Health Ministry Fund (Hutchinson, Kansas), Aug. 23, Grantmakers In Health (GIH) “Views from the Field” series. Moore relates results of an $11 million fund initiative, which began in 1998. It launched a public awareness campaign about oral health under the Healthy Teeth for Kansas logo. “Nothing did more to make oral health a concern for Kansas policymakers, however, than the Kansas Mission of Mercy events,” which were annual, free dental clinics, Moore comments. The clinics had hundreds of people waiting in line “and dramatic stories of endured dental pain and suffering.”

The fund also provided a grant in late 2004 for “project support” for the state’s Bureau of Oral Health, which was re-established in the state health department in 2005. (Virginia Elliott, vice president for programs of the fund, told me Jan. 20 that the grant was for bureau projects, oral health materials, and staffers’ participation in state, regional and national meetings.) Moore comments that “workforce issues have dogged all our efforts.” The fund’s board, as well as those of other state and national philanthropies, “committed to support [mid-level dental] professionals to be able to deliver basic treatment and prevention services.” The decision to do this was a bit controversial, as the fund had to step out of its “neutral role”; however, that was the only “meaningful” solution to oral health access issues in Kansas, Moore states.

He cites fellow foundations’ good works on oral health, including those of the Kansas Health, Sunflower, REACH Healthcare, and Delta Dental of Kansas Foundations, as well as the Health Care Foundation of Greater Kansas City. Although the United Methodist Health Ministry Fund had a limited amount of resources to spend, it helped “produce sustainable change, in several ways, including expansion of the dental safety net” and increased use “of proven prevention techniques.”

Did the fund encounter challenges in its oral health work? Yes, it learned, for example, that “community water fluoridation is even more difficult than we envisioned.” (It did, however, achieve fluoridation of water supplies in ten communities, covering 130,000 people.) Also, Moore concedes, “an attempted replication of the successful Access to Baby and Child Dentistry [ABCD] program from Washington State floundered.”

Moore concludes that the fund’s twelve-year commitment, as well as that of other funders, to supporting oral health in the state seems to have resulted in an expanded oral health community in the Sunflower State “and a much higher recognition” on the Kansas public agenda, than there was before, that oral health is “critical to overall health,” Moore says. For more details and examples, see the GIH publication.

Elliott explained to me that “the fund is no longer funding new oral health initiatives,” but it “continues to support several key strategies as it transitions out of this area of focus.” She added, “The fund is developing a new initiative on children’s mental health.” (See GrantWatch Blog, Jan. 13.)

Publications:

Addressing Children’s Oral Health in Buffalo, New York: Final Reports and Recommendations, Kavita P. Ahluwalia of Columbia University and Diane R. Bessel of Catalyst Research, LLC, March 2010 (released August 2010). This study was commissioned by the Community Health Foundation of Western and Central New York (CHFWCNY) to help it develop a strategy for increasing the number of low-income children in Buffalo who receive “appropriate and timely oral health care,” the report says. The study aided in the development of CHFWCNY’s new children’s dental health initiative, CHOMPERS! Grantees for the initiative will be announced soon, Denise Levy at the foundation told me.

It Takes a Team: How New Dental Providers Can Benefit Patients and Practices, Pew Children’s Dental Campaign of the Pew Center on the States, released Dec. 6. The Pew Charitable Trusts (a public charity) published this report, which looks at the impact that hiring dental therapists and hygienist-therapists (new kinds of providers) “would have on the productivity and profits of a private dental practice,” according to a press release. Ninety-two percent of dentists in the United States work in that sort of practice, the report states. These new professionals are trained to provide a broader range of services than are dental hygienists, whose impact is also assessed in the report. The authors find that most private dentists who hire the new types of providers “can serve more patients, including more Medicaid enrollees, while maintaining or improving their financial bottom line,” the release notes. The authors use plenty of citations to buttress their points. The methodology includes use of a Productivity and Profit Calculator, which Pew commissioned Scott and Co., Inc., to develop. The calculator is available online; advocates, dentists, and policy makers may find it useful. Shelly Gehshan directs the Pew Children’s Dental Campaign.

Series of reports on oral health in California. Published by the California HealthCare Foundation with a “particular focus on improving access for the underserved,” according to the foundation’s website. The reports were published from March 2009–January 2011.

Related information/other entities involved in oral health:

An Electronic Compendium of Resources for Building Oral Health Coalitions, DentaQuest Foundation, released Apr. 26. Read more about this national foundation, which is located in Boston.

“HHS and EPA Announce New Scientific Assessments and Actions on Fluoride,” U.S. Department of Health and Human Services (HHS), press release, Jan. 7. HHS “is proposing that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay,” the release says. Also, the U.S. Environmental Protection Agency “is initiating review of the maximum amount of fluoride allowed in drinking water.”

The goal is to maintain fluoride’s benefit of preventing tooth decay, while preventing “excessive exposure” to fluoride. Getting too much fluoride (a mineral) may cause a condition called dental fluorosis. Young children, age eight and under, are most at risk of this type of fluorosis, which, in its “very mild or mild form” (most common in the United States), can cause tooth enamel to have markings or spots, although they are “barely visible,” HHS says.

Why is there a danger of too much fluoride now? Another question: how would it be possible to get enough fluoride with slightly lower levels of it in community water supplies? For one thing, the press release points out, there are more sources of fluoride (such as toothpastes and mouthwashes) now than there were in the 1940s when fluoridation of water started.

HHS published its recommendation about fluoride in the Federal Register on Jan. 13; the period for comments from the public and stakeholders lasts for thirty days.

Read much more about fluoridation and fluorosis on the Centers for Disease Control and Prevention’s web site.

My thanks to Jennifer Buschick in the Office of the Assistant Secretary for Health at HHS for clarifying some information.

“Racial and Ethnic Disparities in Dental Care for Publicly Insured Children,” Nadereh Pourat of the University of California, Los Angeles, and Len Finocchio of the CHCF, July 2010, Health Affairs. (This article is available full-text on the CHCF web site.)

The mission of the Sadie and Harry Davis Foundation, which is located in Portland, Maine, “is to advance the health of Maine’s children,” according to its website. The funder focuses most of its grant making on very young children’s oral health through a preventive care program it developed and piloted called From the First Tooth. (The program is modeled after one in North Carolina.) With Davis Foundation funding, MaineHealth, a health system, operates From the First Tooth in partnership with others. The program’s goal is to get primary care physicians to integrate preventive oral health care into well-child visits for kids ages six months through 3½. The statewide program, which has three components, aims to help all children, but there is an emphasis on the underserved, Sharon Rosen, executive director, told me in a telephone interview. The components are the following: (1) oral examination, (2) education of parents about care of their child’s mouth, and (3) application of fluoride varnish. Please note that the Davis Foundation only funds in Maine, and it does not accept unsolicited grants for the From the First Tooth program. (Read here, after Mar. 15, about how to apply for its Small Grants Program, focused on children’s health.)

West Virginia Partners for Oral Health is funded by the Claude Worthington Benedum Foundation through a grant, awarded in 2010, to the West Virginia Council of Churches, in Charleston. According to the partnership’s website, its mission includes compiling research results and other information on oral health in the state and publishing that on its website; educating policy makers and the public about the importance of good oral health, particularly for pregnant women; and addressing provider payment issues regarding oral health with the state’s Medicaid program, the West Virginia Children’s Health Insurance Program, and West Virginia Public Employees Insurance Agency. The Benedum Foundation focuses its funding on West Virginia and southwestern Pennsylvania only.

“What Philanthropy Is Doing to Promote Oral Health Care,” Health Affairs GrantWatch Blog, May 17. This post contains examples of foundations’ funding in that area.

The Robert Wood Johnson Foundation and Its Mastery of Social Media


January 25th, 2011

As Web administrator of ScanGrants, a free online database of funding opportunities in the health sciences, I spend hours trying to find grants, fellowships, science prizes, and scholarships in the health sciences to list on the site. I am doing this so that students, physicians, scientists, nurse researchers, public health experts, and health services researchers can find the funding they need to advance science and medicine. The database is provided as a public service by Samaritan Health Services’ Center for Health Research and Quality, in Corvallis, Oregon.

All those hours entering data about such funding opportunities have endowed me with affection and admiration for a certain pool of grantors, and I want to give one of them, the Robert Wood Johnson Foundation (RWJF), a big public hug.

What do I particularly love about the RWJF? For one thing, I like that it funds fascinating forays into the frontiers of health technologies, such as the use of computer gaming in health education.

 What can other grantors in the health sciences learn from the RWJF? How about the ability to generate excitement among groups we don’t traditionally associate with public and community health, such as Web developers and start-ups? Also, the foundation partners with other grantors (for example, the Markle Foundation) to sponsor competitions such as the Blue Button Challenge

Sponsoring contests and competitions in the tech world offers several advantages. It demonstrates that a grantor is innovative and fosters those who are. It engenders interest in health affairs among new groups such as undergraduates in science and engineering, tech bloggers, and science journalists. It also gets the name of the grantor into the blogosphere and on Twitter and results in product showcases that lead to further innovation and to products and services that eventually actually advance the grantor’s mission. There is nothing wrong with looking cool and cutting edge, and the RWJF is totally cool. 

What else do I like about it? Well, in my opinion, the RWJF is one of the few major grantors that really “gets” social media and social marketing. It uses Twitter very effectively, for example. Say you are a policy wonk interested in public/community health and health policy in general. Then you could subscribe to the RWJF’s main Twitter account

But say you are more of a tools-oriented geek (that’d be me). Then you would want to sign up for the Twitter account of the foundation’s Pioneer program. 

Unlike some funders that create Twitter accounts but then tweet infrequently and boringly, primarily about their own programs, the tweets of the RWJF are intellectually engaging, and they excel at outreach to those in the health field. 

Case in point: I recently looked at the Twitter account of the RWJF’s Pioneer program and saw this tweet, “@RACfunding Could you update your Web site? RWJF accepts unsolicited proposals for the Pioneer Portfolio (@pioneerrwjf).” 

So what is RAC? Its full name is the Rural Assistance Center. On its Web site, I read, “RAC is a collaboration of the University of North Dakota Center for Rural Health (UND-CRH), the Rural Policy Research Institute (RUPRI), and the federal Office of Rural Health Policy (ORHP) at the U.S. Department of Health and Human Services, and is located at the University of North Dakota.” 

RAC saw the message from the RWJF, updated its site as requested, and tweeted about the RWJF accepting unsolicited proposals for the Pioneer (program’s) Portfolio. I retweeted both of those tweets, and maybe someone will retweet my tweets, and so on. My point is that here we have a funder that is taking the time to encourage technological innovation in the hinterlands and that is using simple, inexpensive social marketing tools like Twitter to do so (save for the fact that it does have to pay the staffers that do the tweeting). 

Another lesson that other grantors could draw from the RWJF’s use of Twitter is to encourage their staffers to maintain their own Twitter accounts. That gives a public face to the funder and personalizes its programs. Let’s say a young technologist has an idea for the Blue Button Challenge or just wants to get a feel for the people at an organization and to be able to communicate with them via the friendly, nonthreatening free-for-all that is Twitter. Isn’t it nice for that person to be able to note that he can direct message or openly tweet someone like Paul Tarini, who is team director and senior program officer, Pioneer Portfolio, at the RWJF? 

Take a look at what Tarini tweets about. I just read, for example, his tweet about an article in Nature; the tweet led me directly to the article, “Peer Review: Trial by Twitter.” 

Lesson for grantors? You can use social media to publicize your own programs, to create alliances with new players, to provide substantive services to the scholarly and philanthropic communities (such as providing links in tweets to serious bits of journalism, think pieces, or white papers of your own, or to ones written by others that you find otherwise noteworthy), and to both talk about social media and use it for the benefit of your own organization. Lee Aase, director of social media at the Mayo Clinic, is a master at this, for instance. I just retweeted his tweet about his use of Quora. (Keep your eye on Quora, in general, as a new social media tool.) 

Take-away for grantors: Innovation in programs and their marketing pays.

Patient-Centered Care: A Grantmaker Relates An “Eye-Opening” Personal Experience


January 18th, 2011

Today I want to tell you about a blog post published recently on the John A. Hartford Foundation’s health AGEnda blog. Its focus is patient-centered care. This post does not contain theoretical or hypothetical musings about that topic, and it is not a dry recitation of facts. Instead, the information presented here is very real, and the post makes one sad in a couple of ways. Amy Berman, senior program officer at the Hartford Foundation, wrote this post from her own personal experience after being recently diagnosed with Stage IV inflammatory breast cancer. Her blog post has “gone viral,” so to speak—with fifty-seven comments at last count. The comments were instructive to me also. Berman’s post has definitely resonated with many readers.

Some of you may know Amy Berman. A nurse by training, she is the coauthor of two peer-reviewed GrantWatch papers about a Hartford initiative on disaster preparedness for long-term care facilities. She also has coauthored, with Eric Coleman, a GrantWatch Blog post on care transitions. In addition, she is GrantWatch’s greatest champion and a friend!

I wish her well.

“Can Good Care Produce Bad Health?” Amy Berman on health AGEnda (the John A. Hartford Foundation’s blog), Jan. 11. Berman states, “I am writing here because in the time I have left [to live], I hope my story and my journey can help illustrate why some of the reforms that my colleagues and I at the John A. Hartford Foundation, as well as many others, have championed are so important.” Berman, a nurse and well-informed staffer at a health philanthropy, understood her disease and her health care options “well enough to make an informed decision” about treatment. However, “What about the millions of older Americans facing a terminal illness or chronic disease?” she asks. Read this beautifully written post, as well as the many comments that it elicited.

Related resources:

“Developing Physician Communication Skills for Patient-Centered Care,” Wendy Levinson of the University of Toronto, Cara S. Lesser of the ABIM Foundation, and Ronald M. Epstein of the University of Rochester Medical Center, Health Affairs, July 2010.

“If You Build It, Will They Come? Designing Truly Patient-Centered Health Care,” Christine Bechtel and Debra L. Ness of the National Partnership for Women and Families, Health Affairs, May 2010. This article is on what patients want from primary care.

“In Focus: Health Care Institutions Are Slowly Learning to Listen to Customers,” Vida Foubister, Quality Matters (a Commonwealth Fund e-newsletter), Feb/Mar 2010.

“Informed Patient Choice: Patient-Centered Valuing of Surgical Risks and Benefits,” James N. Weinstein, Kate Clay, and Tamara S. Morgan, of Dartmouth Medical School, Perspective, Health Affairs, May-June 2007.

“Opportunities to Improve the Quality of Care for Advanced Illness,” Randall Krakauer, Claire M. Spettell, Lonny Reisman, and Marcia J. Wade of Aetna, Perspective, Health Affairs, Sep/Oct 2009.

“The Relief of Suffering from Serious Illness: How Foundations Can Lessen the Pain,” Rosemary Gibson (independent consultant), Health Affairs GrantWatch Blog, Aug. 6.

“Why the Nation Needs a Policy Push on Patient-Centered Health Care,” Ronald M. Epstein, Kevin Fiscella of the University of Rochester, Cara S. Lesser, and Kurt C. Stange (editor of Annals of Family Medicine, American Cancer Society Clinical Research Professor, and professor at Case Western Reserve University), Analysis and Commentary, Health Affairs, August 2010.

Note: Affiliations current at time of publication.

Mental Health Care: What Have Foundations Been Funding in This Area?


January 13th, 2011

Mental illness has been on the minds of many people this week, after the shootings in Tucson, Arizona, on Saturday. A University of Virginia forensic clinical psychologist and professor says in a CNN.com opinion piece this week, “The rampage shooting in Arizona is another anguishing reminder that mental health is the weakest link in our ailing health care system.”

See some examples of what foundations around the country have funded in the area of mental health.

In memory of a victim of the tragedy in Tucson

This first item is not related to mental health care. However, I wanted to report that the family of little Christina Taylor Green, age nine, who died in the shootings on Jan. 8, has created a memorial fund for her at the Community Foundation for Southern Arizona, in Tucson. According to news reports, Christina had just been elected to the student council of her school and was interested in politics. A foundation spokesperson told me earlier this week that the family had not yet decided what the proceeds of the fund will be used for.

Mental Health Care

Grant Outcomes:

“The New Orleans Metropolitan Area Family Resiliency Project Helps with Mental Health Problems after Katrina,” Robert Wood Johnson Foundation (RWJF) Grant Results summary, September 16, 2010. The foundation awarded a two-year grant, ending in 2009, to Louisiana State University Health Sciences Center (LSUHSC). The grantee provided training about handling trauma and mental and emotional problems to clinicians, parents, and teachers and also provided behavioral and mental health services to children and first responders and their respective families in three Louisiana parishes “hard hit by Hurricane Katrina.” Among the results of this project are that it developed evidence-based prevention and intervention strategies to prepare for future disasters and inform policy decisions, the foundation said. The project also received funding from the National Child Traumatic Stress Network and the American Red Cross. Read the full report here.

Promising Practices from the Healthy Returns Initiative: Building Connections to Health, Mental Health, and Family Support Services in Juvenile Justice, released May 27, 2010. Published by the California Endowment (TCE). This report contains results of the endowment’s four-year initiative to strengthen the ability of county juvenile justice systems to provide mental health and other services that are needed for youth while they are in custody and in the community, according to a press release. The report looks at strategies used by five California counties, including Los Angeles County. Government agencies, community partners, and private providers collaborated on the initiative. About half the youth detained at the county level in California “have a suspected or diagnosed mental illness,” and three-quarters have a substance abuse disorder, the release states. By putting in place some promising practices, this initiative “accomplished a range of positive outcomes for youth and their families,” TCE maintains. The practices that have been used to identify youth with mental health and other problems and make sure they “receive appropriate services” are actually “simple” and “commonsense,” Barbara Raymond of TCE notes in the release.

New Initiative

Ready for Life and Learning: Healthy Social and Emotional Development in Early Childhood is a new 2010–2012 strategic focus area for the United Methodist Health Ministry Fund, located in Hutchinson, Kansas. The fund explains, “Early toxic stress—such as that caused by stressed families, violence, or the loss of a parent—may short-circuit the development of important skills and abilities for relating positively to others and dealing with adversity.” Too often, the result is behavioral problems in childcare and preschool. The objectives of the fund’s new focus area include screenings for mothers and young children; improving access to early interventions; enhancing health and child services professionals’ readiness for working with young kids; and increasing everyone’s awareness of early prevention and intervention that can head off problems.

The fund has authorized $600,000 for the new initiative. Fund staff are reviewing submissions in response to a request for proposals. (The deadline was Jan. 10.) The grantmaker expects to award funding to two or three programs serving Kansans; the grantees selected will be announced by Mar. 11.

Publications:

Addressing the Mental Health Needs of Young Children in the Child Welfare System: What Every Policymaker Should Know, Janice L. Cooper and colleagues of the National Center for Children in Poverty (NCCP) at Columbia University’s Mailman School of Public Health, September 2010. Funded by the Annie E. Casey Foundation, in Baltimore, and the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration (HRSA). This publication looks over “what we currently know about the prevalence of young children [ages birth to 5] in the child welfare system,” how maltreatment or neglect affects their development, and the services that are currently offered to this population compared with those that are needed, a summary states. The publication is based on a June 2009 NCCP roundtable. Citing others’ research, the authors note that kids younger than age three “are the most likely of all children to be involved with child welfare services.” They say that young children who have been abused are later at risk for developmental delays. They conclude by offering several recommendations for federal and state officials and others.

Maine Children’s Mental Health: 2010, Maine Children’s Alliance, 61 pp., released September 21, 2010. Funded by the Maine Health Access Foundation. In this broad overview of children’s mental health status in the state, the alliance points out the “lack of integrated data to effectively measure and evaluate children’s mental health outcomes across systems of care” (such as departments of education and child welfare) in Maine and looks forward to more integrated data resulting from provisions of a new state law. The report highlights the importance of children being screened for mental and behavioral health problems before they start kindergarten; emotional and behavioral issues are often detected then. The report’s recommendations include having data systems track “toxic stress” (including extreme poverty) in children, “so that a child’s well-being” is more broadly understood. “Intensive interventions” early in life can reverse effects of such stress, and “nurturing, protective relationships and appropriate learning experiences” sooner, rather than later, are less expensive and produce better outcomes than later interventions such as remedial education and clinical treatment, the report says.

“Mobile Mental Health Unit Takes to Road,” Renee Dudley, October 24, 2010, Charleston (South Carolina) Post and Courier. This news article describes the South Carolina Department of Mental Health’s mobile clinic called Highway to Hope, which receives funding from the Duke Endowment. The unit, a specially outfitted recreational vehicle (RV), is operated by the Charleston Dorchester Mental Health Center. It will serve patients in areas of the state’s Low Country region, such as Edisto Island, that have been impacted by budget cuts that caused the state to close some clinics over the past several years. Debbie Blaylock, executive director of the center, notes in the article that the mobile clinic is a “cost saver” because it provides preventive care that could keep patients out of high-cost hospital emergency departments. The clinic, which began rolling in November 2010, expects to eventually link patients, via satellite, to an off-site psychiatrist. As of now, either an advanced practice nurse (APN) or a masters-level mental health clinician will be on board the mobile clinic, Matt Dorman of the center explained to me. Sometimes a psychiatrist is on board.

Read more about this three-year, $635,121 Duke Endowment grant, which helps to fund the mobile clinic and funds extended hours at a weekend psychiatric urgent care clinic in Charleston (which opened in 2009). An article in the endowment’s August 2010 e-newsletter explains that these two enhancements to mental health resources in the Low Country are “designed to divert patients from overcrowded emergency departments and psychiatric inpatient facilities.” Today, Dorman confirmed the estimated cost savings (mentioned in the newsletter) from fewer clients visiting such facilities: $279,000 per year. (That is the figure if all grant goals are met.) The S.C. Department of Mental Health also provides funding for both clinics. Grant details: The Duke Endowment’s grant was actually awarded to Roper St. Francis Foundation, in Charleston. This fund-raising arm of Roper St. Francis Healthcare received the grant as fiscal agent for the Charleston Dorchester Mental Health Center, Anne Weston Sass, grants development officer, explained to me.

“New System of Community Health Clinics in New Orleans called a “Model for the Entire Country,” Oct. 20, 2010, an article on the RWJF’s website. Read about the work of Karen DeSalvo, who was an RWJF Generalist Physician Faculty Scholar from 2002–2007. (The $46.8 million RWJF Generalist Physician Faculty Scholars Program, a national program, ran from 1992 to 2008.) DeSalvo, who is at Tulane University School of Medicine, is among the health leaders who hurried to help set up a new system of clinics in the Crescent City area after Hurricane Katrina. Many clinics include mental health services and specialized care, the article says.

Citing a Columbia University study reported on in the New Orleans Times-Picayune, Kaiser Health News (KHN) reported here (in its Daily Report, August 26, 2010) about continuing mental health needs in New Orleans. KHN is a program of the Henry J. Kaiser Family Foundation,

Related resources and commentary:

“Could the System Have Prevented Rampage?” Dewey Cornell, CNN opinion piece, Jan. 10.

“Elephant in the Room,” author Pete Earley on his blog, Jan. 11.

“Law Prompts Some Health Plans to Cut Mental-Health Benefits,” Russell Adams and Avery Johnson, Wall Street Journal online, December 23, 2010. The law mentioned here is the mental health parity legislation enacted in 2008.

“Some Mental Health Lessons from the Tucson Tragedy,” David Shern, Health Affairs blog, Jan. 11

“Violence Is a Public Health, Not a Mental Health, Problem,” Paul Gionfriddo (former president of the Quantum Foundation and a former state legislator and mayor), Our Health Policy Matters blog, Jan. 11.

“What Do We Really Know about Foundations’ Funding of Mental Health?” Ruth Tebbets Brousseau (independent consultant) and Andrew D. Hyman of the RWJF, GrantWatch Essay, Health Affairs, Jul/Aug 2009.

Health-y Public-Philanthropic Partnerships: A Prescription for Greater Opportunities


January 6th, 2011

René Cabral-Daniels is the former director of the Public-Philanthropic Partnership Initiative at the Council on Foundations. She recently became chief of staff at the National Patient Advocate Foundation.

If you define philanthropy as Council on Foundations President and CEO Steve Gunderson does—as “a strategic investment in social change,” it is clear that initiating and sustaining that social change, often requires some level of public-sector involvement. When the public-sector (that is, government) is directly involved in a public-philanthropic partnership, the potential for sustaining the social change becomes more likely.

A review of the publication, For The Greater Good: Moments in the History of Philanthropy and the Council on Foundations reveals historic examples of successful public-philanthropic partnerships that have yielded sustainable social change outcomes related to health. They include major efforts in eradicating yellow fever around the globe and the creation of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003.

Upcoming health reform implementation efforts offer the philanthropic sector many opportunities to consider its impact on existing social change investments. Grantmakers In Health (GIH) has already catalogued a number of philanthropic efforts related to health reform implementation that are already under way in its August 2010 report entitled, Implementing Health Care Reform: Funders and Advocates Respond to the Challenge. Examples of these efforts include educating the public on the content of the Affordable Care Act, convening members of the community to discuss specific sections of the law, and engaging in relevant public policy research. A number of the efforts have involved public-philanthropic partnerships. GIH and the Council on Foundations partnered to host an educational webinar tailored specifically for community foundations, so that those funders might become leaders in assessing the impact of health reform implementation on their communities.

While these examples provide insights regarding health-related public-philanthropic partnerships that are already under way, there are three programs identified in the Affordable Care Act that offer great promise for using such partnerships as a framework for investment in sustainable social change. These three public-philanthropic partnership opportunities all will be administered by the Center for Strategic Planning, which is located within the Centers for Medicare and Medicaid Services (CMS).

The first is the Community-based Care Transitions Program (CCTP), which provides funding to test models for improving care transitions for high-risk Medicare beneficiaries. The CCTP seeks to assure the appropriateness of the care for these patients by (1) improving transitions of Medicare beneficiaries from the hospital to other care settings, (2) improving the quality of care received in those settings, (3) reducing the number of hospital readmissions for high-risk beneficiaries, and (4) quantifying the savings for Medicare.

The second program that has great health-related public-philanthropic partnership potential strives to put into place strong disease prevention incentives so as to decrease chronic disease prevalence in the Medicaid population. It authorizes grants to states to provide incentives to Medicaid enrollees who participate in prevention programs and who, upon completion, demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors. These programs must be comprehensive, evidence based, widely available, and easily accessible. They must be designed and uniquely suited to address the needs of Medicaid enrollees in controlling or reducing weight, eliminating the use of tobacco, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or improving the management of that condition.

The third program is limited in its geographic eligibility but holds promise for bringing about a great social change. The Affordable Care Act establishes a program for early detection of certain medical conditions related to environmental health hazards. The program provides innovative approaches to furnishing comprehensive, coordinated, and cost-effective care for people with asbestos-related illness who reside in the Libby, Montana, area. (A vermiculite mine spewed airborne pollutants that created a hazardous health condition for residents of the area.) In addition, area residents with asbestos-related disease will be deemed to be entitled to Medicare.

One of the most promising aspects of the CMS’s identification of these programs as having public-philanthropic partnership potential is that it reflects an understanding of the breadth as well as depth of philanthropic resources. CMS leaders welcome and appreciate the philanthropic community’s intellectual capital, as well as its ability to convene community residents in furthering social change. The CMS will continue its communication with the Council on Foundations and with Grantmakers In Health to identify a range of roles that grantmakers may want to take on in implementing these three programs.

Given the great interest by government and the philanthropic sector in public-philanthropic partnerships, it is clear that the future will hold additional opportunities, particularly in the health delivery arena. The Council of Foundations has a website where all such opportunities are highlighted and catalogued. This website is expected to be used more as funders become aware of the value of appropriate public-philanthropic partnerships. After all, if philanthropy is truly to become a “strategic investment in social change,” it will be essential to identify important partners, such as the public sector, that can help make the investment sustainable.

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