September 26th, 2012
GrantWatch Blog invited the author, vice president of research and evaluation at the Robert Wood Johnson Foundation, to report on a webinar that the funder held this month.
The fortieth anniversary of the Robert Wood Johnson Foundation (RWJF), a national funder, is a time for reflection on how we at the foundation have done, what we could do better, and how we should do our work in the future. This past week, in a webinar, Bob Blendon, one of the early staff members at the foundation, noted that when the RWJF began, it wanted to bring an evidence revolution to health problems and solutions.
Early leaders of the RWJF funded evaluations both as a way of holding the foundation accountable for its work and as a way of providing information—disseminating innovations that worked. Blendon (who worked at the RWJF from 1972–1987) discussed the foundation’s first great success—the Emergency Medical Services (EMS) Program, which started in 1972 with forty-four sites. The evaluation of the EMS program found that people were getting emergency care faster than before, but people weren’t being taken to the closest, most appropriate hospital. Part of the EMS program’s goal was realized; the other part would take the next decade to fix.
More recently the RWJF also used evaluation to support the development of health policy. At the webinar, Jim Knickman (who worked at the RWJF from 1992–2006) described the Cash and Counseling Demonstration and Evaluation, in which elderly and disabled Medicaid recipients were allowed to purchase services from whomever they wanted, including family members, and buy equipment that would assist them, rather than receiving services from a Medicaid-approved agency. In the late 1990s, this was very controversial: policy makers were worried that costs would skyrocket, that family caregivers weren’t trained to do this, and that there would be fraud.
The evaluation conducted by Mathematica and jointly funded by the federal government and the RWJF found that consumers in Cash and Counseling programs were more satisfied and had better outcomes and that there was no fraud. The evaluation assuaged policy makers, and the program was adopted as a Medicaid option in the Deficit Reduction Act of 2005. Today, fifty states have some form of the program, and the Veterans Administration has it available in seventeen states. The key to its success was strong evidence and a partnership with the federal government—thus, improving the likelihood of acceptance. Read the rest of this entry »