Fostering Productive Dialogue on Health Reform Implementation


May 19th, 2011

Catherine Hess of the National Academy for State Health Policy (NASHP) reports on how foundations are supporting efforts to foster dialogue between states and stakeholders during implementation of health reform. Facts, not ideology, should ground discussions was among the lessons learned at a meeting of state officials and advocates in southern states.

Even in political climates where health care reform can be polarizing, shared goals in improving health care and health can bring officials and advocates together in productive dialogue about how each can carry out complementary roles to achieve those goals, a March meeting of advocates and state officials in southern states, sponsored by the Public Welfare Foundation, showed.

Subsequently, on May 11, the National Academy for State Health Policy (NASHP) convened a webinar based on that meeting and titled “Building Partnerships: State Officials and Advocates Working Side by Side on Health Care Reform.” Sponsored by the Public Welfare Foundation, this webinar and a forthcoming brief share some of the lessons learned in complementary projects conducted by NASHP (a national policy analysis and assistance organization focused on states) and the national consumer advocacy organization Community Catalyst.

For several years, Public Welfare invested in building consumer advocacy capacity in eleven southern states, through grants to Community Catalyst. In the past year, the foundation supported NASHP to help engage southern state officials with those advocates on implementation of health reform—that is, to reach out to the officials and invite them to talk with and work with advocates on common-ground issues. While this most recent project was short-term, the need remains for support (financial and otherwise) to bring together policy makers, advocates, and other stakeholders to build or strengthen working relationships to tackle the daunting challenges of health care reform.

At the May 11 webinar, Rebecca Mendoza of the Virginia Department of Medical Assistance Services shared some lessons learned from Maximizing Enrollment, a Robert Wood Johnson Foundation (RWJF) initiative (for which NASHP serves as national program office). (These lessons had sparked active discussion, at the previously held March meeting, among the nine states attending about the roles that advocates and states each can play in improving enrollment systems, which will be so critical to the success of health reform.) Mendoza also talked about plans to convene a variety of stakeholders for a health care reform summit focused on children, with support from Virginia’s Maximizing Enrollment grant.

Moriba Karamoko, director of the Louisiana Consumer Healthcare Coalition, talked frankly at the meeting and during the webinar about how his organization and the state had developed an effective working relationship in planning for the movement of Medicaid recipients into managed care. Karamoko emphasized to webinar participants that both agency officials and advocates need to come prepared for productive exchange. Advocates, for example, need to be ready with potential solutions and not just dwell on problems, and state officials need to respect advocates’ cultures; both need to be okay with, as they say, “agreeing to disagree.” At the meeting, and on the webinar, we summed up some of the key lessons learned in improving working relationships—build trust through direct communication (do not blindside each other); create formal (for example, advisory committees) or informal (for example, monthly phone calls) ways to communicate; and aim to ground the discussions in facts, not ideologies.

NASHP will be applying these lessons in Children in the Vanguard, a collaborative network of ten states focusing on maintaining and increasing the number of children with health insurance coverage in the context of health care reform. Supported by the Atlantic Philanthropies as part of its campaign to protect and expand children’s coverage, this network is made up of Medicaid and Children’s Health Insurance Program (CHIP) officials from states across the country who want to work toward this goal. One of the objectives here is to strengthen states’ relationships with advocates, and NASHP will be convening state officials and advocates to focus on improving enrollment of children and youth now and as states prepare new systems for 2014, when the expanded eligibility for Medicaid and new insurance exchange provisions of the Affordable Care Act kick in.

While my and NASHP’s experience suggests that nothing is as effective as face-to-face interaction for promoting exchange of information, learning, and collaborative problem solving, other less costly means such as calls and webinars can be effective in sustaining and nurturing such relationships. The May 11 webinar shared ideas with a diverse audience of state officials, advocates, and others, such as policy researchers, and tried to stimulate interest in such collaboration. However, newer technologies and modes of communication also can be tapped to foster exchange of ideas and information.

NASHP’s recently launched State Refor(u)m, a Web-based platform for exchanging information on state implementation of health care reform, already has more than 600 registered users and many more visitors, including a variety of stakeholders beyond the core audience of state officials. With funding from the RWJF, NASHP developed and is maintaining this website, which offers real-time opportunities to share materials and converse about milestones toward implementation of eleven key indicators of state success in health reform implementation. The slides for the May 11 webinar can be found here, posted under the indicator called “Engage the Public in Policy Development and Implementation.” Other indicators address such areas as simplification and integration of eligibility systems and being strategic in implementing insurance exchanges.

The foundations mentioned in this blog post have invested in supporting information exchange and building relationships between state officials, advocates, and other key stakeholders. Supporting neutral convening of key parties to come up with solutions for implementing health reform is one of the most important roles that foundations can play. If we are to reach 2014 ready to enroll millions of uninsured people in coverage that will offer access to high-quality care, we will need funders to play a continued and even stronger role.

Click here to listen to the webinar.

New Article: What Foundations Are Funding in Environmental Health


May 12th, 2011

“Philanthropy at the Intersection of Health and the Environment,” by Karla Fortunato and Kathy Sessions of the Health and Environmental Funders Network (HEFN), was released earlier this month in the May issue of Health Affairs, a thematic issue on “environmental challenges for health.” The Kresge Foundation provided funding for the journal issue on this important topic. Below I mention just a few highlights from this informative GrantWatch article.

Foundations are increasingly viewing protection of the environment as a way to improve human health outcomes, the authors say. Foundations’ grant awards demonstrate that growing belief. Based on what they learned from a 2007 HEFN analysis, Fortunato and Sessions estimate that foundations are now investing at least $70 million a year for environmental health projects. Examples include helping disaster-stricken communities in the Gulf Coast area of the United States after the British Petroleum (BP) oil spill, supporting a national movement to reform federal policy on chemicals, defending clean air and water standards, and funding “environmental justice work in low-income communities and communities of color.”

In their well-organized article, Fortunato and Sessions discuss (1) what types of foundations fund environmental health (that is, “who” is funding in this area)—and it is not just health foundations; (2) why foundations invest in environmental health—they do so to prevent disease and protect health, reduce inequities and health disparities, and broaden support for clean and healthy environments; (3) what types of projects foundations are supporting—grants are being used to improve scientific understanding, clean up communities, strengthen community organizations, promote systemic change (that can be policy change or economic change), and to respond to disasters (such as September 11, Hurricanes Katrina and Rita, and the BP oil spill).

Health Affairs readers will be particularly interested in the policy change section of the article. The authors note that “comprehensive national chemicals policy reform is the main interest of US funders in this area.” For example, they point out that many environmental health funders would like to see the Toxic Substances Control Act of 1976 overhauled. Fortunato and Sessions later note that opportunities exist to translate foundations’ investments “into stronger policies to protect public health.”

Fortunato and Sessions also mention “funding gaps”—that is, needs that foundations are not funding. In the area of environmental justice, they note that “the largest remaining gap. . . is probably in work related to Native American communities and groups.” However, they say that “the biggest funding challenge. . . is one of scale.” There are simply not enough dollars being put into environmental health and justice compared with what is needed.

The authors mention numerous foundations in the article, such as the California Wellness Foundation, W.K. Kellogg Foundation, Kresge Foundation, and the New York Community Trust. I would guess that this may be the first time you have heard of some of the other funders cited, though. For example, do you know of the Passport Foundation, “recently created by a group of hedge fund partners”?

This is just the basic outline of the article—much more is in the full-text version. If you are not a subscriber, click here to order a copy.

Don’t miss the rest of the Health Affairs issue on environmental health. That link goes to the Table of Contents, where abstracts of articles are free to all.

For more information on the Health and Environmental Funders Network, popularly known as “HEFN,” visit its website: http://www.hefn.org. Fortunato and Sessions codirect this group of funders.

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For more information on environmental health funders, see these past GrantWatch Blog posts:

“Roundup of Recent Blog Posts: Environmental Health, Medicaid, Global Health, & More” (April 14, 2011)

“Round-Up of Foundation News—Bioethics, Environmental Health” (May 11, 2010)

“Focus on Foundations’ Funding in Environmental Health” (April 22, 2010)

The Three Most-Read GrantWatch Blog Posts during April 2011


May 11th, 2011

We list below the three most-read posts during the month. Take a look in case you missed one of these when the original tweet or e-alert went out.

1. “Foundation Blogs Round-up: Community Clinics, Health Reform, Health IT, & More,” by Lee-Lee Prina (March 31).

First on the most-read list during April was a selected sampling of posts from several other philanthropy-related blogs that I wanted to bring to your attention.

Here, I mention and link to a post on community clinics (Blue Shield of California Foundation funding mentioned in the California Health Report blog); a post on health information technology by Carol Diamond of the Markle Foundation; and posts on health reform by Karen Davis of the Commonwealth Fund, James Squires of the Endowment for Health (Concord, New Hampshire), and Joan Henneberry, project director for the Colorado Health Insurance Exchange (who wrote on the Colorado Health Foundation’s blog). Other posts mentioned are on the topics of health care for the elderly (two posts on the academic geriatrics workforce, by Chris Langston of the John A. Hartford Foundation) and health promotion and disease prevention in Ukraine (by Kathleen Kingsbury of the Open Society Foundations).

And as a lagniappe (a term from Louisiana, where I lived as a student long ago), I mention some “Foundation News You Can Use”: a post by Bradford Smith of the Foundation Center about foundations that do not accept unsolicited proposals and one by Ann Barnum of the Health Foundation of Greater Cincinnati about Grantmakers In Health’s recent annual meeting in Los Angeles.

Unless otherwise noted, posts highlighted above were published on a blog at the foundation or organization where the author is employed.

Does the foundation you work for have a blog that includes posts on health care? Is it listed on the “GrantWatch Blogroll” (list of other blogs)? If not, please let me know.

2. “One Foundation’s Path to Expanding Palliative Care in California’s Public Hospitals,” by Kate O’Malley of the California HealthCare Foundation (CHCF) and Ruth Brousseau, an independent consultant (March 30). In this second most-read post (which was also popular on Twitter), the authors remind us that palliative care “is the medical specialty focused on improving the overall quality of life for people facing serious and life-threatening illness,” according to the Center to Advance Palliative Care, up in New York City. O’Malley and Brousseau then reference an interim evaluation report on the CHCF’s grants to start a palliative care consultation service at eight hospitals and expand it at four. They then share with readers a nine-ingredient “recipe” for building palliative care capacity at public hospitals. Final results are not in, they concede, but “there is reason for optimism” that this approach is effective, they say.

3. “It Is National Public Health Week: A Sampling of Foundation Funding in Public Health,” by Lee-Lee Prina (April 6). In the third most-read post during April, you will find a selected sampling of public health efforts; these were funded by the Robert Wood Johnson Foundation, Burroughs Wellcome Fund, Merck Company Foundation, Pew Charitable Trusts, Open Society Foundations, Richard M. Fairbanks Foundation, United Health Foundation, and the California Endowment. Among the topics included are U.S. county health rankings, antibiotic resistance, H1N1 flu (so-called swine influenza), and more.

Southern Foundations Discuss PACE: Comprehensive Care to Help Elderly Age in Place


May 6th, 2011

GrantWatch Blog asked Tina Markanda, a program officer at the Duke Endowment, to write about a recent webinar.

The massive growth of the age sixty-five-plus population in the United States will bring new challenges and opportunities as that “silver tsunami” fast approaches. This topic—and programs to meet needs for this population—were recently discussed by a group of Southeastern Council on Foundations colleagues participating in the EngAGEment Initiative, a project funded by Grantmakers In Aging and the Atlantic Philanthropies to increase knowledge about grant making for elders.

The discussion included the perspective of Marianne Ratcliffe, executive director of the Program of All-Inclusive Care for the Elderly (PACE) site in Burlington, North Carolina, regarding that program’s experiences. Also, as a program officer in health care at the Duke Endowment, I spoke about the endowment’s experiences with PACE, an evidence-based model of care for the frail elderly.

First, a bit of background: PACE is based on a system of care developed more than three decades ago by On Lok Senior Services, in San Francisco. The Health Care Financing Administration (now Centers for Medicare and Medicaid Services) tested the PACE model through demonstration projects that began in the mid-1980s. Funders including the Robert Wood Johnson Foundation and the John A. Hartford Foundation played important roles in refining the model and assisting in its expansion nationally. PACE is still relatively new to North Carolina and South Carolina, the two states in which the Duke Endowment funds.

PACE is a community-based program that serves as an alternative to traditional institutional care. It has consistently demonstrated positive clinical outcomes and increased client and family satisfaction at reduced costs. Research studies have documented the impact of PACE.

Most importantly, the program allows people to remain in the community and receive all of the benefits needed to “age in place.” PACE is a capitated program, which provides people with multidisciplinary medical and support services to meet their specific needs. Given the current supply and demand issues for existing resources to serve elders, community-based programs will be increasingly important.

To date, the Duke Endowment has funded three PACE sites (in North Carolina and South Carolina)—one in an urban area and two in rural communities. The sites are still in early stages of implementation and are achieving important outcomes. For example, at the Burlington PACE site, in its first two years of operation, out of a total seventy-six participants, there have been only twenty-three emergency department visits, twenty-four hospitalizations, and no hospital readmissions. Given the frailty of PACE participants, these results are impressive. (According to the New England Journal of Medicine, approximately 20 percent of Medicare beneficiaries are readmitted to the hospital within thirty days.) With the assistance of the National PACE Association, to which all sites submit operational and cost data, the endowment will continue to monitor the experiences of the three currently funded sites as well as any sites funded in the future. The Kate B. Reynolds Charitable Trust has been a funding partner for the two North Carolina PACE sites.

During the Southeastern Council on Foundations webinar in late April, participants discussed the unique needs and challenges of operating PACE in rural communities. Issues such as transportation and the value of developing contracts with specialty providers have proven to be especially important for rural communities in serving elders comprehensively. A Centers for Medicare and Medicaid Services report on the expansion of PACE into rural areas was presented to Congress in early 2011.

In addition, the webinar participants reinforced the importance of community-based programs, particularly in light of the growing population of elders and the increasing desire of elders to remain at home.

PACE contains numerous elements that make this model worthy of consideration for foundation support: it is evidence based, comprehensive and multidisciplinary, financially sustainable (only one PACE program in the nation has ever closed), and community based. PACE emulates key tenets of health care reform and operates essentially as a mini-accountable care organization because it manages revenues and expenses to care for a specific population.

Resources to learn more about PACE are available at the National PACE Association. Conversations such as this one, which the Southeastern Council planned, are important to help grantmakers develop effective strategies and programs. I hope that it will trigger further discussions on this important issue.

To listen to the webinar, go to http://www.dukeendowment.org/prevention/providing-innovative-services-for-seniors-resources.

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