May 8th, 2013
I covered the Grantmakers In Health annual meeting in San Francisco in March. This meeting is always a wonderful occasion for me to meet or reacquaint myself with foundation staffers from around the United States.
In this round-up post, I mention some interesting points made by various speakers at the event, which had some 550 attendees this year. These quick thoughts come from what I jotted down in my “reporter’s notebook,” as Katie Couric used to say. I think that even two months later, a few points made at this meeting are still useful to blog about!
After the Boston Marathon bombing, Nicole Lurie’s work remains particularly important.
Nicole Lurie, assistant secretary for preparedness and response at the Department of Health and Human Services (HHS), was the opening plenary speaker on March 13 at the Grantmakers In Health meeting. Her topic was “Community Resilience and Disaster Response.” Disasters here would include hurricanes, oil spills, tornadoes, earthquakes, and more.
Her office is the federal government’s lead agency for national policy on public health emergencies, with additional responsibility for the advanced development and procurement of drugs for use during disasters, for federal medical response assistance to states during disasters, as well as for hospitals’ and community health systems’ preparedness. And Lurie pointed out that there are many types of “resilience” needed in a disaster: (1) physical resilience (of buildings, for example); (2) economic resilience—during a recession, for example; and (3) psychological resilience of workers and area residents—this type is often overlooked after a disaster.
Planning for chronic care needs is also important, Lurie pointed out. Obese patients, for example, are hard to move, so special equipment to help would need to be in place. Local officials also need to figure out where patients with chronic illness who need oxygen would go during a power outage.
Health care facilities have many challenges during a disaster: lack of electrical power, evacuation of patients, and the psychological effects of the disaster on their workforce. Most hospitals are in “pretty good shape,” Lurie commented. But many nursing homes and dialysis centers are not so well prepared.
Lurie said that Joplin, Missouri, fared a bit better after the devastating tornado in 2011 because the hospital had started using electronic health records some three weeks earlier. And they had done “remote back-up” of medical records.
Use of social media as a means of communication can also be important during disasters, she added.
Lurie suggested that foundations can encourage organizational resilience among their grantees, as well as support development of an “evidence base” on resilience.
There were a couple of good questions during the Q & A. A staffer from a foundation in California asked about first responders. Lurie said that bystanders are actually the first responders in a disaster.
Len McNally of the New York Community Trust inquired about how one can prepare to help older adults before a disaster hits. Lurie said that many elderly people are socially isolated; it is important that agencies such as those providing home care and durable medical equipment are functioning after a disaster. Thus, such agencies need to have disaster plans for doing this in place, and they should have plans for the clients they serve. In answer to my follow-up question a few weeks after her speech, she said that public and private payors could require such plans as a condition of participation.
Health Reform Session
The next day, Grantmakers In Health held a well-attended session titled “Without a Net: Leveraging the Affordable Care Act.” Speakers were Heather Howard of Princeton University, Bob Hughes of the Missouri Foundation for Health, Andy Hyman of the Robert Wood Johnson Foundation (RWJF), and Jim Knickman of the New York State Health Foundation. The session aimed to “explore the work of several foundations that have engaged in conceptualizing, operating and monitoring state-based initiatives aimed at advancing the goals of the ACA [Affordable Care Act].” I got to the session a bit late, but here are a few things I learned in the time I was there.
Hughes mentioned that the Missouri Foundation for Health’s focus in this area is on the uninsured. Its roles are research and education, including Cover Missouri (a project to promote high-quality, affordable health care for every Missourian); general support for advocacy groups; cultivation of relationships with state legislators from both political parties who are interested in health—the funder offers them scholarships to attend the National Academy for State Health Policy (NASHP) conference in October; and its MOCap program, in which the foundation helps local organizations identify opportunities for federal funding.
Ryan Barker, the foundation’s vice president of health policy, later explained that NASHP is seen as politically neutral. And the foundation also offers those scholarships to staff leaders in health-related state agencies.
Knickman mentioned the New York State Health Foundation’s “to-do list” of questions that need researching. The list included what the New York health insurance exchange should look like, should the state adopt the Basic Health Plan, and what happens to populations left out of health reform.
There were a number of questions from the audience during the Q & A.
In response to a question about Pennsylvania, Hyman of the RWJF pointed out that the research demonstrates the economic benefits to states that decide to expand Medicaid, as allowed for in the ACA.
Charles Dwyer from the Maine Health Access Foundation said that it will have a new policy research initiative focused on identifying which state residents will be uninsured after federal health reform. (He later explained to me in an e-mail that this initiative also will focus on what the coverage expansion options related to the ACA might mean for Maine’s insurance market, small businesses, and individuals. The foundation will invite proposals for this initiative.)
At the GIH session, Dwyer also raised the question: What is the role of foundations in helping to explain the complexity of health reform to businesses? Maine has many small businesses, he commented.
Hyman suggested working with Small Business Majority, which can communicate information and do analysis. The RWJF staffer said that the foundation is funding a program with Community Catalyst regarding the impact of health reform on business. Through this program, Massachusetts business leaders are meeting with business leaders from other states to describe their experiences following health reform in the Bay State. (This week, Kathy Melley, director of communications at Community Catalyst, directed me to this short publication about the project.)
Jim Knickman noted that local chambers of commerce often are good potential grantees for initiatives to help small businesses navigate insurance reform. (Many chambers have good information about small business needs and good connections with business owners who will be making decisions about participation in health insurance exchanges, he explained to me.)
Frances Padilla of the Universal Health Care Foundation of Connecticut noted that Connecticut will have a state-based exchange. She asked the panelists what state-based foundations can do if they want to collaborate across states regarding the ACA. Heather Howard pointed out that the National Governors Association’s Center for Best Practices, with the support of the RWJF, had convened states that have exchanges. States are hungry for information, she commented.
A staffer from the Sisters of Charity Foundation of Cleveland (Ohio) said that Ohio’s governor has approved Medicaid expansion for that state but asked about the workforce and infrastructure to meet Medicaid’s needs. Howard said that states are starting to discuss scope of practice for health professionals. Maryland seems to be more out front on this issue than others.
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