The Three Most-Read GrantWatch Blog Posts during October 2011


November 16th, 2011

Check these out in case you missed them when they first came out on GrantWatch Blog.

1. “Rural Health: Report from the Kentucky Health Policy Forum,” by Susan Zepeda and Amy Watts (September 23). Once again, this post by two staffers at the Foundation for a Healthy Kentucky, in Louisville, made the most-read list. This funder hosted a policy forum, at which Len Nichols of George Mason University and others spoke. Zepeda is president and CEO of the foundation; Watts is a senior program officer who works on the foundation’s Primary Care Initiative.

2. “Why Fund Prevention? The Rationale behind One Foundation’s Decision,” by Mary Piepenbring of the Duke Endowment (September 27). In this post, the author explains how this foundation, which funds in North and South Carolina, made the decision several years ago to fund disease prevention. Its Committee on Health Care recommended to the endowment’s board that prevention be one of the three major goals and areas of priority funding in health care because “implementing effective prevention strategies held much promise in regard to improving health status and ultimately decreasing health care costs and improving quality of life.” Piepenbring is a vice-president at this foundation in Charlotte; she is responsible for health care funding and evaluation.

3. “Health Reform: It’s about a Vision for Each State,” by Kim VanPelt of St. Luke’s Health Initiatives, a public foundation in Phoenix (October 3). VanPelt graciously agreed to report from Arizona on a forum the foundation held. The purpose of the forum was to discuss the critical issues involved in creating a health insurance exchange in the Grand Canyon State. She notes that there were varying opinions about how to set up the exchange, but few attendees stated what they “hoped the exchange would achieve.”

Note that all of these posts were written by guest bloggers. Are you a foundation staffer or grantee working on an innovative initiative or an observer of foundations with a suggestion of what foundations should be funding but are not? Guest posts welcome! Just send me an e-mail at lprina@projecthope.org. I will send you back some short guidelines for blogging.

 

Grantmakers In Health Briefing on the Safety Net: Highlights from Presenters Ku and Siegel


November 10th, 2011

Grantmakers In Health’s Fall Forum, held in Washington, DC, included a well-attended one-day issue dialogue on the health care safety net. Following are a few highlights from speakers’ remarks and the subsequent Q & A session.

To start off the day, well-known analysts Leighton Ku of the George Washington University (GWU) and Bruce Siegel of the National Association of Public Hospitals and Health Systems provided attendees with background information on the safety net landscape.

As for the federal health reform law (the Affordable Care Act of 2010), Ku predicted that the United States would go down one of two paths:

(1) Large elements of the reform law may be overturned, and effects of that would mean more uncompensated care.

(2) Alternatively, health reform may be implemented “roughly as planned”; that would mean the number of uninsured people, as well as the costs of uncompensated care, would go down. Among the issues to follow is what will happen to the newly insured.

Ku suggested what foundations should be funding related to the health care safety-net. (He clarified his comments in a follow-up e-mail to me.) He said that foundations need to fund research on the safety-net—as they have in the past at GWU, where Ku is on the faculty. For example, the Commonwealth Fund, Blue Cross Blue Shield of Massachusetts Foundation, RCHN Community Health Foundation, and Kaiser Commission on Medicaid and the Uninsured (part of the Henry J. Kaiser Family Foundation) have all funded such research at that university. He also mentioned that foundations have funded the actual operations and activities of safety-net facilities, and he hopes such funding will be awarded in the future.

Near-term issues for the safety net include whether such providers can survive governmental budget cuts, and whether providers that want to improve quality of care will have enough staff and money to do so. Ku also mentioned accountable care organizations—he noted that the final regulations were recently released (in October), but he is still in the process of reading them! (Read this Urban Institute update, by Bob Berenson and coauthor, on accountable care organizations. The Robert Wood Johnson Foundation provided funding for it.)

Long-term issues that Ku mentioned include:

• Will safety-net providers be in the health insurance exchanges that are called for in the federal health reform law?

• Will Medicaid payment rates be enough to keep safety-net providers afloat?

• Will there be enough primary care health professionals? Ku noted that there is a “big need” to expand primary care clinicians, including physicians, osteopaths, nurse practitioners, physician assistants, registered nurses, and even medical assistants.

Bruce Siegel discussed the so-called Super Committee that has been tasked with balancing the federal budget and reducing the federal deficit by later this month. He does not see much consensus thus far on that committee. If a logjam occurs, then automatic triggers to cut the budget would be put into effect. Siegel predicted that even if triggers are activated, the country won’t see much budget pain for a few years.

As for federal health reform, Siegel questioned whether new care models can come online fast enough to help. He suggested to this audience of foundation staffers that grantmakers should think about helping hospitals move to the accountable care organization/medical home model.

Siegel included on his list of what he called “anxieties” the question: Who is going to train the next generation of safety-net provider leaders? For example, visionary Ron Anderson is going to be retiring soon from Parkland Health and Hospital System in Dallas, Texas, Siegel mentioned. (Anderson has been a long-time champion of the idea of health care for all, regardless of ability to pay, according to the Parkland website.)

The Affordable Care Act includes a substantial Medicaid expansion, and the safety net is the largest Medicaid provider. Thus, safety-net providers need tools to help them with the influx of people, or reform will fail, Siegel said.

There was widespread audience participation in the Q & A session. Siegel forecasted that even if the health reform law is repealed, some pieces of it would be retained. For example, both value-based care and pay-for-performance to achieve high-quality care will stay alive (he noted that much of the work on these concepts was begun during the George W. Bush administration). Ku later commented that community health centers are politically popular.

The health professions workforce gap and the effects of state scope-of-practice laws were also discussed. In response to a question from a San Francisco Foundation staffer, both speakers agreed that these laws are a challenge. (Of course, these are  especially challenging in areas of the United States where there is an insufficient number of primary care clinicians.) Ku said that fixing medical schools requires time; nurse practitioners can be trained faster.

Following up on an earlier comment by Siegel that in some localities, safety-net hospitals and community health centers have no interaction, an audience member asked if the speakers knew of examples of collaboration among such centers and hospitals. Siegel gave a couple of examples, including Denver Health, and added that this area of promoting collaboration is ripe for exploration by philanthropy.

A Pew Charitable Trusts staffer inquired about dental care for the safety-net population. This question led to a lively discussion among several attendees. Siegel responded that there are “huge unmet needs” for oral health care. People have died from lack of care, and the problem is now extending into the middle class, he said. Ku called oral health care the “poor stepsister” to medical care, but there has been some progress with kids getting oral health care through Medicaid.

Tracy Garland, a senior adviser to national programs of the DentaQuest Foundation, told the audience that there is work under way to integrate oral health care into primary medical care. Under this model, there are no scope-of-practice challenges, but there is a training gap, she said. In a subsequent e-mail, Garland explained to me that the National Interprofessional Initiative on Oral Health (a consortium of funders and health professionals) is working to engage primary care clinicians in delivering preventive services for oral health. She is also program director of that initiative. Physicians in family medicine and pediatrics, nurses, physician assistants, and pharmacists are trying to get their professions involved, and “the uptake is amazing,” Garland reported. The DentaQuest, Washington Dental Service, and Connecticut Health Foundations have supported the initiative, according to its website.

Pat Mathews of the Northern Virginia Health Foundation mentioned a survey report that this grantmaker released in September. (A foundation press release noted that this is the first-ever survey conducted on oral health in Northern Virginia—that is, the suburbs of Washington, D.C. Although it was a poll of adults in general, it focused on lower-income adults because there are so few programs helping this population.) Mathews commented that a local pediatrician, after reading the report, said that there is only one pediatric oral surgeon in Northern Virginia who accepts Medicaid, and children can wait as long as a year to be treated by that provider.

Mary Vallier-Kaplan of the Endowment for Health, a foundation located in New Hampshire, commented that integration of behavioral health with primary care has caught on in that state and nationwide, but not integration of oral health. And so philanthropy could play a role by both reminding foundation colleagues about this exclusion of oral health and only awarding funding to organizations that integrate mental and dental health care with primary care, she commented.

In her remarks at the conclusion of this session, Lauren LeRoy, president and chief executive officer of Grantmakers In Health (GIH), followed up on Siegel’s earlier remark that the National Association of  Public Hospitals and Health Systems has applied to be what he called  a “hub” in the Partnership for Patients initiative of the Centers for Medicare and Medicaid Services (CMS). (Read the press release on Partnership for Patients here.) Sixty-six public  hospitals have applied to work together on quality improvement—specifically, on reducing harm to hospital patients and reducing hospital readmissions.

LeRoy asked if there were opportunities for local foundations in communities where the sixty-six hospitals are located to support this effort to improve quality of care. Siegel responded, “Absolutely.” So that is something else for funders to consider. 

By March 2012, GIH will release an issue brief on the health care safety net. For more information on the November 2011 GIH meeting on the safety net, send e-mail to Anna Spencer, aspencer@gih.org.

New Health Affairs Issue Includes Article on Oral Health Care of Children


November 9th, 2011

More and more foundations, it seems, are interested in oral health these days. The topic generated some buzz at a Grantmakers In Health meeting earlier this month, I noticed. The November issue of Health Affairs, just released this week, has a peer-reviewed GrantWatch paper on oral health care for children. Its abstract is free to all.

In “Strengthening Children’s Oral Health: Views from the Field,” authors Donna Behrens and Julia Graham Lear, who are both affiliated with the Center for Health and Health Care in Schools at the George Washington University, look at why proposals for improving the oral health status of low-income and minority children have failed to gain traction over the past decade.

With support from the Robert Wood Johnson Foundation, the center conducted interviews in late 2010 and early 2011 with key informants. The goal, the authors say, “was to learn the experts’ views on barriers to preventive services, treatment, and workforce development and to listen for ‘bright spots’ or successful models for service delivery.” Interestingly, most all of the interviewees agreed to be publicly identified.

The center learned that to improve kids’ oral health status, one has to address factors related to consumer demand for access to care and to the supply of oral health providers. Behrens and Lear discuss why consumers do not demand better access to care and suggest why policy makers and the federal government are not putting this issue on a front burner. State dental practice laws (especially scope-of-practice laws) affect the supply of dental professionals, as does the cost of professional education and the effects of that school debt on where dentists set up a practice, they say.

Most people interviewed for this study suggested either expanding the role of registered dental hygienists or training additional mid-level providers, such as dental therapists (“an emerging class of dental professionals with an expanded scope of independent practice beyond that of dental hygienists”) as a way to meet the unmet needs of both children and adults.

Of course, the center was interested to know informants’ views on school-connected oral health care. Those interviewed were in favor of having oral health services provided in schools but did not agree on what the services should be. (For example, some said screenings and limited preventive services [such as applications of fluoride varnish]. Some others wanted a comprehensive set of services—ranging from oral health education to fillings and extractions—to be provided in schools.)

As for financing of care, the majority of interviewees commented that the low level of payment from public payers continues to be an issue for many dental practices.

The article includes quotes from staffers at the Greater Cincinnati Health Care Foundation, Connecticut Health Foundation, and the Robert Wood Johnson Foundation.

Also, the authors cite this other GrantWatch article, “Delivering Preventive Oral Health Services in Pediatric Primary Care: A Case Study,” by Dianne Riter of the Washington Dental Service Foundation and coauthors. It was published in 2008.

Philanthropy Blogs Round-Up: Cancer, Global Health, Health Reform


November 4th, 2011

It is time for another round-up of interesting content that I spotted when scrolling through some of the blogs established by foundations and others that follow philanthropy. Another topic in today’s potpourri is “Philanthropy Insights.” I recently found out that the Maine Health Access Foundation has started a blog! So, the GrantWatch Blogroll is still growing.

Global Health

“Introducing WASHfunders.org,” October 19, Foundation Center’s PhilanTopic blog. The Foundation Center launched the WASHfunders.org website, funded by the Conrad N. Hilton Foundation, to give funders and other interested parties information needed to improve access to water and improve sanitation and hygiene around the world. The interactive funding map has plenty of information (but it requires a little time to figure it out, I found). You can click on a country to find out the dollar amount of foundation grants awarded for water, sanitation, and hygiene projects, by year. You then can click on “Grants” for a list of grants, by foundation, for projects in that country. Also, there is a useful list of funders in these topic areas that links to more detailed profiles of them.

The WASHfunders.org site links to an interesting and concise report on advocacy that was commissioned by the Howard G. Buffet Foundation, Bill & Melinda Gates Foundation, and the Hilton Foundation. Written by FSG Social Impact Consultants, a nonprofit firm, the report notes, “While the U.S. Government will not likely drive an increase in WASH funding, there are rich opportunities to increase WASH funding and focus from non-governmental sources.” So stakeholders should advocate for assistance from foundations, corporations, and others, the report says. By the way, I read in the report that “WASH” stands for water/sanitation/hygiene!

Health Reform

“White Coats in the Room: The Overlooked Ingredient in Health Reform,” Wendy J. Wolf, October 18, Maine Health Access Foundation’s (MeHAF’s) Blog. Wolf, president of MeHAF and a physician, maintains that “too often the people developing rules and regulations that guide—and judge—what constitutes the ‘standard’ of care are largely divorced from the practical world” of health care professionals. She points out that if the goal is a different system of care, providers cannot “abdicate or ignore the leadership role they must play in shaping it.” But this problem isn’t new, Wolf says—she notes that a decade ago, when she worked for the federal government, most of the folks at a meeting to draft standards-of-care regulations for the State Children’s Health Insurance Program were excellent drafters but were not boots-on-the-ground health professionals. Most of them had not cared for patients. Unfortunately, the current situation is similar: the push to create patient-centered medical homes, an old idea that has received new life under federal health reform, “seems largely led by health system administrators whose first-hand knowledge of primary care practice is cursory at best,” Wolf comments.

Patient-Centered Care: Cancer

“Think Silver—Not Pink—for Breast Cancer Awareness Month,” Amy Berman, October 27, John A. Hartford Foundation’s health AGEnda blog. Berman, a senior program officer at the Hartford Foundation and a popular blogger, has Stage IV breast cancer. She notes, however, that the past year, since her diagnosis, “has been the best year of my life, both personally and professionally.” She is treating the cancer nonagressively and has less pain than a year ago. Berman acknowledges that her “experience is atypical” and not just because she chose palliative treatment; it is also because she is younger than many cancer patients. She then explains that older patients often are coping with other chronic conditions simultaneously. Particularly for that population, care in which the patient is informed and “able to fully participate” in treatment decisions (as Berman has been) is so important. Older people also need patient-centered care tailored to their circumstances and needs, she says.

Philanthropy Insights

“The Insider: Robert K. Ross, M.D., President and CEO of the California Endowment,” B. Denise Hawkins Guest, October 3, BlackGivesBack.com blog (which describes itself as “the premier online destination for African American philanthropy”). Guest, a journalist, interviews Bob Ross, whose past jobs include commissioner of public health for Philadelphia. Read his response to the question of how he happened to get the opportunity to lead the endowment, one of the top-fifty foundations in the United States, by total giving, 2009, according to the Foundation Center.

Guest mentions the California Endowment’s $4.05 million grant to the D5 coalition. The grantee, she says, will use the funding to “help track progress on diversity [in philanthropy], spawn greater diversity and inclusivity in foundation leadership, support the work of diverse donors and population-focused funds, and develop relevant policies and practices for foundations.” (The coalition receives funding from other foundations including the W.K. Kellogg Foundation and the Robert Wood Johnson Foundation, Guest says.) How did the endowment decide to award such a big grant? Ross comments, “Too often, America has stereotyped African Americans, folks of color, and low-income communities as supplicants for services and supports.” These people have good ideas to put forth, he comments, and if philanthropy were more diverse and inclusive, their ideas could “be welcomed, nurtured, and explored—and even funded!”

Check out Bob Ross’s blog, called Bob’s Blog.

Read more about the D5 coalition in the October 2011 GrantWatch section of Health Affairs—in a peer-reviewed article titled “Philanthropy and Disparities: Progress, Challenges, and Unfinished Business,” by Faith Mitchell and Kathy Sessions. (free abstract)

“A Number Every Grantmaker Should Memorize: 0.1%,” Sean Dobson, September 26, National Committee for Responsive Philanthropy’s (NCRP’s) Keeping a Close Eye blog. Dobson cautions foundation staffers not to feel too comfortable and powerful, because the dollars that foundations invest to “ameliorate” huge social problems “amount to a mere drop in the bucket.” The percentage in the post’s title is relevant for GrantWatch readers: Dobson derives that percentage by comparing the total investment in health by U.S. foundations in the years 2007–2009 with total health care spending in this country in 2009, Dobson states. Foundations contributed “an infinitesimal 0.1 percent of the U.S. health care sector,” he then concludes.

So, what should foundations do to be more effective in health (and other funding areas)? Fund more advocacy, Dobson says, and he explains why. Citing a recent NCRP report, Towards Transformative Change in Health Care: High Impact Strategies for Philanthropy, by consultant Terri Langston (formerly of the Public Welfare Foundation), Dobson says that just 11 percent of the biggest health grantmakers’ domestic grant dollars went for advocacy (social justice efforts). Most of the rest went for direct services or research. Read why Dobson thinks that common grant-making strategy is “worse than futile.” The NCRP receives funding from more than sixty foundations.

Many thanks to PhilanTopic blog for alerting me to the above two blog posts!

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