Report from New York State: What Is Ahead for Medicaid and Medicare?

November 30th, 2012

GrantWatch Blog invited this staffer from the Health Foundation for Western and Central New York to report on two community forums it held earlier this month in Buffalo and Syracuse.

With the presidential election over and major provisions of the Affordable Care Act (ACA) going into effect just about a year from now, what does the future hold for Medicaid and Medicare?

More than 200 health care professionals wanted to know. “The Road Ahead for New York,” events hosted by the Health Foundation for Western and Central New York on November 13 and 14, brought New York State Medicaid Director Jason A. Helgerson and Medicare Rights Center President Joe Baker to Buffalo and Syracuse to share information with both audiences on the current state of Medicaid and Medicare, upcoming changes to the two programs, and how these changes will affect  attendees at the events, their organizations, and the people they serve.

The Health Foundation has a history of hosting community speaker events to help communities plan for their future health and health care. These events are designed to provide members of the community with the most up-to-date, accurate information about what’s going on in their region, as well as to spark a discussion about new ways to think about the challenges they’re facing in health and health care in their own backyards.  Growing in popularity, these events can be used as a model by other foundations to build health capacity in their communities, we believe.  

New York’s Medicaid program spends the most in the nation—$54 billion each year to cover approximately 4.89 million people. However, state spending has not translated into high-quality care; the state’s health system ranks twenty-first overall in the nation and ranks the lowest of all states in avoidable hospital use.  

To fundamentally reshape the program, a Medicaid Redesign Team, which included Health Foundation President Ann F. Monroe, was appointed by New York State Gov. Andrew Cuomo (D). Through the team’s work, which happened in two phases, it has created a national model for health care delivery.   Read the rest of this entry »

Profiles of the Ten Robert Wood Johnson Foundation Young Leader Awardees

November 26th, 2012

This post, by my colleague Chris Fleming, originally appeared on Health Affairs Blog, which is GrantWatch Blog’s “big sister” blog here at the journal.

On November 21, Health Affairs released a series of Web First articles profiling the winners of the Robert Wood Johnson Foundation (RWJF) Young Leaders Awards, which were announced this Fall on the occasion of the Foundation’s fortieth anniversary. The RWJF Young Leader Awards highlight the important contributions that people can make early in their careers to improving health and health care for all Americans.

The awardees, all age forty or younger when they were named award-winners, have made exceptional contributions in a broad spectrum of activities that display their commitment to their communities:

Applying Data Analytics And Information Exchange To Improve Care For Patients, Ruben Amarasingham, Parkland Center for Clinical Innovation, Dallas, TX. Parkland Hospital’s Ruben Amarasingham built a model to predict patients at high risk for readmission and now leads efforts to extend the benefits of health information to the nation’s most vulnerable.

* Promoting Health And Development In Detroit Through Gardens And Urban Agriculture, Ashley Atkinson, Urban Agriculture and Openspace, the Greening of Detroit, Detroit, MI. The city’s community gardens today supply just 2 percent of the fruit and vegetables consumed locally. Ashley Atkinson aims for “food sovereignty” – the day when most of the fresh fruits and vegetables that city residents eat are also grown there.

* Employing Behavioral Economics And Decision Sciences In Crucial Choices At End Of Life, Scott Halpern, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. A program created by physician Scott Halpern employs multidisciplinary teams to help patients and family members make end-of-life decisions that track with their goals.

* Understanding The Health Impact Of Racism – And Trying To Reverse It, Naa Oyo Kwate, Rutgers University, New Brunswick, NJ. Naa Oyo Kwate not only explores the health impact of racism and inequality, but she also seeks to improve health through innovative “countermarketing” efforts against racism.

* Using Digital Communications And Social Media To Redraw The Cardiac Care Map, Raina Merchant, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA. Emergency medicine physician Raina Merchant created a cell phone program to provide CPR instructions – and now leads an effort to map every automated external defibrillator in the United States.  Read the rest of this entry »

People Post: Foundation Staff and Board News; IOM Lienhard Award to Berwick

November 21st, 2012

It’s a short holiday week. So, for some light reading, read this “people post.” You likely will recognize some of the names mentioned. Happy Thanksgiving!

For more personnel news, watch for my January GrantWatch column (free access) in Health Affairs.

In October 2012, Don Berwick, former administrator of the Centers for Medicare and Medicaid Services, received the 2012 Gustav O. Lienhard Award from the Institute of Medicine. Berwick is perhaps best known as the former president and CEO of the Institute for Healthcare Improvement, which aims to enhance patient safety and health care quality. An endowment from the Robert Wood Johnson Foundation funds the Lienhard award.

Becky Hayes Boober has been promoted to senior program officer at the Maine Health Access Foundation, in Augusta. According to the November issue of the funder’s e-newsletter, she “has guided the foundation’s work to advance patient-centered care through [its] Integrated Care Initiative—promoting the integration of behavioral health and primary care services.” (For more on this initiative, see my September 2012 GrantWatch column in Health Affairs.)

In more news from the Maine Health Access Foundation, Charles Dwyer will join its staff on December 3 as a program officer. He has been with the Maine Center for Disease Control and Prevention (MeCDC) for a number of years. As of the writing of the foundation’s November newsletter, he was that agency’s district liaison for the four-county Midcoast area of Maine. From 2006–2011, Dwyer was director of the state Office of Rural Health and Primary Care, which is part of the Division of Local Public Health at the MeCDC; there, he worked on the statewide Health Workforce Forum and Maine Telehealth Collaborative, the newsletter says.

Shelley A. Hearne, who has been managing director of the Pew Health Group for going-on five years, will be leaving Pew at the end of 2012. As she explained in an e-mail to colleagues, “Because of some clear internal synergies, Pew’s leadership recently decided to merge the Pew Center on the States and the Pew Health Group, and the new division will be led by my colleague, Sue Urahn.” Hearne has been affiliated with Pew, on and off, for many years. Her background includes being executive director of the Pew Environmental Health Commission.

Hearne will remain in her longstanding position of a visiting professor at the Johns Hopkins Bloomberg School of Public Health. She says that she plans to continue her “efforts to strengthen the public health field and enhance its advocacy capacity.”

Read the rest of this entry »

What are Foundations Doing to Help Veterans?

November 9th, 2012

Veterans Day is Sunday, November 11, and for some of us, Monday, November 12, is a public holiday. In observation of this day honoring the many veterans in the United States—who have served in the military here in the United States and/or in another country and have protected the United States from harm—I thought I would mention some of the funders that are assisting these courageous folks. Their needs are so great from what I have read and heard.

Please note that this is not a comprehensive listing—just some examples!              .

“Green House Homes” Open for Veterans

The U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense are moving toward revolutionizing delivery of skilled-nursing care for aging veterans in three locations this autumn. How? The VA is offering vets the opportunity to live in a Green House home.

So, what is a Green House home, anyway? It houses a small number of people—up to ten—and is designed “to look and feel like a real home,” according to an October press release. Each resident in a Green House home has a private bedroom and bath in this setting, which is less institutional than a typical nursing home is. Residents dine on home-cooked meals and socialize in a common area.

Another good thing is that the Green House model meets “all state and federal regulatory and reimbursement criteria for skilled-nursing facilities,” according to the release.

A small group of trained caregivers who have been cross-trained in various roles can meet most of the needs of the veterans living in a Green House home. This care model has the potential to help not only elderly veterans (and there are many) but also younger veterans with severe disabilities who qualify for skilled-nursing care.

“By radically departing from the traditional long-term care model, Green House homes will help support the Veterans Administration’s goal to provide veterans with the greatest needs [some] new choices in their desire to lead more independent, healthier lives,” Robert Jenkens, who directs the Green House Project, commented in the press release.

The Green House Project receives major funding from the Robert Wood Johnson Foundation (RWJF) and is overseen by NCB Capital Impact.

Read the rest of this entry »

Liberia’s Landmark Commitment to Mental Health Inspires Carter Center Program

November 7th, 2012

The Carter Center, in partnership with the Liberian government and foundations, including Focusing Philanthropy and the John P. Hussman Foundation, is helping post-conflict Liberia dramatically expand mental health services with the goal of reaching 70 percent of its population.

The Carter Center is a not-for-profit organization founded by former U.S. President Jimmy Carter and his wife, Rosalynn, that works to further peace and health worldwide.

The third class of twenty-four locally trained and credentialed mental health clinicians in Liberia takes the country’s new Mental Health Clinician Oath during graduation ceremonies held in Bong County, Liberia, in August 2012. Photo Credit: The Carter Center/J. Cooper.

Anthony experienced one of the most dangerous things possible in the small West African country of Liberia—he had a seizure. (Anthony, not a real person, is an amalgamation of several people with epilepsy whom graduates of the Carter Center’s training program have seen.)

Anthony, age sixteen, has had regular seizures since he was a small child. In Liberia, epilepsy, a neurobiological disease, is not only considered a mental illness, it is thought to be contagious—not to mention a punishment for past misdeeds.

Anthony’s father is embarrassed by his son’s disease and the shame it has brought to the family. Anthony has no friends and is even taunted by his siblings. He regularly is injured while seizing—falling off his motor bike, for instance—since few are willing to assist him for fear that the illness is contagious. School is no sanctuary—Anthony is shunned when he goes there.

Anthony feels he is a burden to his family despite being smart, strong, and capable of holding a job.

The sad truth is that Liberians like Anthony historically have had few options for controlling their epilepsy. Traditional healers’ herbs have little effect, and health workers at local clinics have little knowledge of this condition. Few Liberian health professionals in this nation of 3.8 million people are trained in neurobiological diseases or mental illnesses. Until recently, citizens with these disorders had literally nowhere to turn for treatment.

And epilepsy isn’t the only mental health issue plaguing Liberia. Approximately 6 percent of the disease burden in Liberia is mental illness, like many other countries around the world. However, unlike many other countries, Liberia also has a high level of trauma resulting from the civil war, which ended in 2003. One study estimates that as much as 40 percent of the population suffers from post-traumatic stress disorder caused by war atrocities like gender-based violence.

Read the rest of this entry »

Foundations Focusing on Oil and Gas Fracking and Its Effects on Health

November 1st, 2012

This post is partially adapted from an October 1, 2012, post on the Health and Environmental Funders Network’s blog, Giving InSight.

Public health concerns are a major part of escalating philanthropic attention to oil and gas extraction through hydraulic fracturing, or “fracking,” explained below.  In just fourteen months, more than forty foundations have joined a working group of funders concerned about the public health, environmental, and community impacts of fracking. The Funder Working Group on Hydrofracking is part of the Health and Environmental Funders Network (HEFN).  

A recent report produced for the working group by HEFN, and authored by consultant Michael Passoff, responds to this growing funder interest. The September 2012 Drilling Deeper: Impacts of Hydraulic Fracturing and Related Grantmaking Strategies provides funders with an introduction to various philanthropic concerns related to fracking, as well as an outline of funding strategies being considered or implemented.

Hydraulic fracturing techniques have made it possible to reach previously inaccessible deposits of oil and gas trapped deep underground in shale rock. Fracking involves injecting a mixture of water, sand, and toxic chemicals under high pressure into deep wells, to crack shale rock and allow natural gas or oil trapped there to flow to the surface.  Fracking and the intensive industrial activities—including well construction, waste management, and gas transport and processing—related to it pose risks to public health, according to a September 2012 Government Accountability Office report. The report also states that the “extent of these risks is unknown, in part, because the studies GAO reviewed do not generally take into account the potential long-term, cumulative effects.”

Funders are concerned about people being exposed to health hazards, as well as environmental contamination, from the full range of activities involved in shale gas development. Many of the chemicals in fracking fluid include known and suspected carcinogens. A study of chemicals used in fracking operations found that at least 75 percent could negatively affect the skin, eyes, and other sensory organs, along with the respiratory and gastrointestinal systems. Air pollution caused by venting gases and diesel exhaust from trucks moving to and from drill sites all release substantial amounts of volatile organic compounds that have been linked to asthma and other respiratory diseases. Each fracking event uses millions of gallons of water. Shale gas development also produces millions of gallons of wastewater annually. Research on fracking wastewater has found toxicity levels above allowable thresholds, as well as radioactive materials picked up underground; such radioactive materials have been shown to cause liver, bone, and breast cancers. Read the rest of this entry »

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