Health Affairs

The author is program director of the John A. Hartford Foundation, a national funder based in New York City. He is editor and contributor for its blog, Health AGEnda.

For more than twenty years, the John A. Hartford Foundation has worked to improve the health of older Americans. And over that time, institutionally, we have shifted from deep skepticism about publicity and communications to what we hope is a balanced sense of how communicating to, and hearing from, the public can improve our work. This year, we extended our efforts to educate the public through two national public polls, through which we asked people older than age sixty-five about their experiences with, and views about, health care.

Given our size (endowment of $500 million) and average grant of almost $1 million over three years, the total cash cost of these polls feels reasonable ($20,000 to $30,000) and is comparable to some of the other “non-grant” ways we have tried to advance our mission (for example, publishing reports, convening grantees and policy audiences, and providing training in capacity building). Of course, it also requires an enormous effort from foundation staff and our outsourced communications colleagues from Strategic Communications and Planning.

Why are we doing this?

In considering any tactic, one should start at the beginning: the definition of the problem and our operating theory of change. Our fundamental thesis has long been that the health care system and the general public are unprepared for our aging society and don’t know what they don’t know. Basically, a lack of demand for expertise in the care of older adults on the part of consumers of care has translated into inattention in the health professions and a lack of serious preparation in the delivery system.

While everyone who faces cancer knows that they should at least consult with an oncologist, how many older Americans and their families facing increasingly complex chronic health and social care issues “know” that they should see an expert in geriatric care? How many people even believe that there is a relevant body of expertise? Read the rest of this entry »

The author previously led national quality and patient safety initiatives at the Robert Wood Johnson Foundation, including its twelve-year program to bring palliative care into the nation’s hospitals. She is the principal author of The Treatment Trap, The Battle Over Health Care: What Obama’s Reform Means for America’s Future, and the forthcoming book, Medicare Meltdown (Rowman & Littlefield, March 2013). She has previously written for Health Affairs journal and for GrantWatch Blog.

Raise the Medicare eligibility age? Increase Medicare premiums?

As winter arrives in Washington, these proposals have surfaced in the fiscal cliff debate that is reaching a boiling point.

Is there a better way to control spending that doesn’t require shifting cost burdens to patients and taxpayers? The answer is a resounding yes, according to the documentary film, Money & Medicine, which aired this fall on PBS.

The film shines a light on uncontrolled health care spending, much of it occurring because of overdiagnosis and overuse of health care services. It hints at the following conundrum: pressure within health care organizations for constantly growing revenue is diametrically opposed to the need for affordable health care for patients and families, employers, and federal and state governments. Read the rest of this entry »

The author is a former Connecticut state legislator and the former president of a foundation in South Florida.

In the aftermath of the unspeakable tragedy at Sandy Hook Elementary School, what we all seek most are the answers to two questions—why did this happen, and what could have been done to prevent it?

As a former resident and elected official of Connecticut, I have thought about these questions while watching the faces of so many friends and former colleagues. Those leaders are attempting to answer these two questions while somehow reassuring us all that something like this won’t happen again.

And I feel for Connecticut’s Governor Dannel Malloy (D), who said in its immediate aftermath that “the sad truth is, there are no answers. No good ones, anyway.”

We may never know for sure what led to this particular tragedy, or whether it specifically could have been avoided. But there are things we can do to prevent tragedies like this from happening in the future.

And funders who do not want to wait to do something relevant in the wake of the Sandy Hook tragedy have several good options to explore. Read the rest of this entry »

It has been a long time since I have done a round-up of posts on other philanthropy blogs that have caught my eye, so today is the day! Other topics covered below include social determinants of health (specifically, housing), “tasksharing” in global health, and charities’ use of data.

I love having the opportunity to peruse the GrantWatch Blogroll (list of blogs) to see what others are writing about.

Do you work for a foundation that has a blog that covers health and is missing from our list? Let us know!

Health Reform

“Affordable Care Act Offers Funders Opportunities for Impact,” by Peter Long, president and CEO of the Blue Shield of California Foundation, on that foundation’s blog, December 10. Long is a foundation leader who is very comfortable with using social media to communicate. Hats off to him! Here, he writes about the principal components of the health reform law. He comments, “Regardless of what a state decides [to do about its health insurance exchange or expanding Medicaid], health foundations are primed to work with federal and state agencies to make major investments to maximize enrollment” in health insurance. He reminds funders that they “are uniquely positioned to rise above political posturing and [to] promote progress on implementing the ACA [Affordable Care Act].” Doing so “will undoubtedly improve the lives” of many Americans, he maintains.

HIV/AIDS

“Up for Debate: Turning the Tide on AIDS,” by Stefano Bertozzi of the Bill & Melinda Gates Foundation, on its Impatient Optimists blog, December 3. (This post is part of a series produced by the Skoll World Forum and the Gates blog.) Citing UNAIDS data, the author states that “the world has made huge progress against HIV,” especially in reducing the rates of new infections in Africa. Also, good and measurable progress has been made in expanding access to antiretroviral treatment, “while reducing the cost of HIV medicines by more than 99 percent.” But “the epidemic continues to outpace efforts to control it,” Bertozzi states. New ways to prevent HIV have been demonstrated and are gaining approvals. There have been “promising advancements in vaccine research.” Read the post for more details and for suggestions of what advocates should tell funders. Read the rest of this entry »

On December 4, this funder, based in Basking Ridge, New Jersey, announced its intent to invest nearly $13 million in health care funding to four national nonprofits and more than a dozen other locally and regionally focused organizations. Support will include not only cash grants but donations of health information technology.

The Verizon Foundation aims to reduce disparities for children, women, and seniors with chronic health conditions who live in underserved communities around the United States, through improving access to care, quality of care, and patient self-management of their conditions and overall health. This is a new funding strategy for the Verizon Foundation’s health focus area, because now, grantees will receive access to in-kind donations of health information technology (IT), which the funder calls “solutions,” as well as money.

The grants to the four national nonprofits have been awarded, but the technology will be donated to them in early 2013, according to the foundation’s website.

Treatment of chronic diseases is costly, and such diseases often are preventable, the foundation notes in explaining why it is focusing on these conditions. In addition, underserved children, women, and seniors are most at risk for chronic conditions attributable to socioeconomic, genetic, and environmental factors. The Verizon Foundation is focusing on heart disease, diabetes, and lung diseases. Read the rest of this entry »

GrantWatch Blog invited the author, who is director of the Center for Disease Dynamics, Economics, and Policy, to write this post focused on the center’s telebriefing, which was held in November. He most recently wrote for Health Affairs in 2011 as lead author of an article on India’s vaccine deficit.

On November 13 the Center for Disease Dynamics, Economics, and Policy (CDDEP) and a group of twenty-six leading national health care organizations released an unprecedented statement to preserve antibiotic effectiveness and combat drug resistance. In a telebriefing that kicked off the Centers for Disease Control and Prevention’s (CDC’s) Get Smart about Antibiotics Week, representatives from the CDC, CDDEP, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the Society of Infectious Disease Pharmacists, the Pew Charitable Trusts, and the Robert Wood Johnson Foundation (RWJF) came together to express their agreement on critical steps that must be taken to protect our diminishing supply of working antibiotics.

The joint statement (available here) emphasizes a number of issues that have been core areas of focus for Extending the Cure, a research and consultative effort led by CDDEP and funded in part by the RWJF’s Pioneer Portfolio. As Portfolio director Brian Quinn mentioned in the telebriefing, Pioneer grantees’ goals lie in developing “innovative approaches to some of the biggest problems faced in health and health care.” Through Extending the Cure, CDDEP has been producing independent research since 2007 to identify and evaluate potential policy solutions to incentivize the judicious use of existing antibiotics and the timely development of new ones.

Since their introduction in the 1940s, antibiotics have saved millions of lives and become a cornerstone of modern medicine. Unfortunately, the more we expose disease-causing bacteria to antibiotics, the quicker they evolve mechanisms to resist them. The issue grows more urgent each year, as the spread of resistant organisms is outpacing our ability to invent new drugs. Unless collaborative policy action is taken, we are facing the real danger of returning to an era in which simple bacterial infections are deadly or very costly to treat.

“We must remind ourselves that antibiotics are a shared resource and every individual should consider how each prescription or use of antibiotics impacts the overall effectiveness of the antibiotic arsenal,” said the CDC’s Arjun Srinivasan during the briefing. “How we use and protect these precious drugs must fundamentally change.”

The urgency of this problem is further highlighted by new CDDEP research that was released concurrently with the joint consensus statement. With the latest iteration of our online tool ResistanceMap, which visualizes trends in antibiotic use and resistance, CDDEP has revealed new and concerning patterns of antibiotic use and resistance in the United States. Read the rest of this entry »