My experience with collaboration among foundations to achieve a particular goal has varied widely in my dozen years at the REACH Healthcare Foundation. While some collaborations have just resulted in stronger personal relationships with funder colleagues, other collaborative endeavors have reminded me of childhood experiences at camp where we would be urged to run through the woods on a “snipe hunt” in search of an elusive, and imaginary, bird, only to come up empty-handed and a little wiser.
A recent collaboration in which I was involved, however, set the bar in terms of exceeding expectations and resulting in a lasting contribution to the field of health philanthropy.
Nearly four years ago, a group of health grantmakers with shared interest in improving access to preventive oral health care began meeting to strategize how to engage primary care providers in promoting the relationship of good oral health to overall health, and to gain their support for an efficient and effective delivery framework. The DentaQuest Foundation, REACH Healthcare Foundation, and Washington Dental Service Foundation drew on the expertise of Qualis Health to design the Oral Health Delivery Framework, a conceptual model developed in partnership with a Technical Expert Panel made up of primary care and dental care providers, medical and dental associations, payers and policy makers, a patient and family partnership expert, and oral health and public health educators and advocates. The framework was published in 2015 in the white paper Oral Health: An Essential Component of Primary Care.
The framework presents five actions that primary care teams can take to protect and promote their patients’ oral health. This work was highlighted in a June 2015 post in the GrantWatch section of Health Affairs Blog. The framework proposes that oral health integration in the primary care setting presents a prime opportunity to improve clinical outcomes, address population health, and deliver whole-person care.
At the time of the publication’s release, the three foundations provided financial support to cover twenty months of field-testing in nineteen primary care practices that included federally qualified health centers (FQHCs), community-based clinics, private practices, and large group practices in Massachusetts, Washington, Kansas, and Missouri. The field tests involved eighty clinician care teams and touched nearly 14,000 patients, providing data that validated the framework as a feasible model for addressing oral health issues in primary care.
Results of Field-Testing
In October 2016, Qualis published the results of the field-testing and a set of operational tools in an Oral Health Integration Implementation Guide. This resource guide provides step-by-step guidance on clinical change processes, leadership and team readiness, staffing models, workflow optimization, patient screening protocols, treatment referrals, health information technology (IT), financial sustainability, and more. The publication is now part of the Safety Net Medical Home Initiative’s resource library and is available to download and share broadly.
As a regional health foundation with a defined six-county service area that encompasses parts of Kansas and Missouri, the REACH Foundation’s interest in the project was in developing new models for addressing oral health service gaps in our region. Because of the foundation’s longstanding partnerships with FQHCs and other community health clinics, we wanted to find ways to involve primary care providers in improving this health access issue. Furthermore, just as the patient-centered medical home (PCMH) model took hold in other parts of the country before gaining traction in our Midwest region, we saw an opportunity to tie the integration work to other PCMH efforts nationally to advance the standard of care in our region.
This project produced increased exploration of the concept both among primary care providers nationally, as well as in our own service area. The intersection between developing a new way for providers to approach their work and the realities of implementation is often where well-intentioned efforts fail to result in significant uptake in practice. With more than two dozen national health-related organizations endorsing the guide and toolkit, this investment has produced a sustainable work product that can be adapted to practice environments that are in the early stages of exploring oral health integration as well as those that have been providing this type of preventive care and want to evaluate their efforts.
When funders decide to partner on a multiyear, complex effort such as this one, it is valuable to take stock of what was learned and gained through the collaboration. Following are a few of the lessons we mined from this experience.
When your foundation has set its sights on a game-changing effort that will involve collaboration with many other groups working around the country, you will need a skilled consultant with content and project management expertise to weather leadership transitions at the funder and partner level. Producing a meaningful project out of a large-group effort requires technical expertise and diplomacy skills to produce a work product that can satisfy all partners and add value to the field. For this project, the funders invested time up front defining their expectations for the project, identifying the right project consultant, and establishing the overall scope of work.
This particular funder collaboration included a mix of national, state, and regional foundations. The national foundation partner brought larger financial capacity and connections to national oral health groups. The state-level and regional funders were able to provide a check point for what works at state and local levels. While REACH has funded in oral health since 2005, our investments in implementation of PCMH models of care allowed us to provide an on-the-ground perspective of what might work within the PCMH framework. In the end, the foundations were able to capitalize on our networks in a way that increased the commitment from prospective endorsers.
Timing also worked in our favor. Development of the oral health integration implementation guide benefited from increased federal attention to oral health as a substantial unmet need and from wider interest in patient-centered care.
However, slow adoption of health care payment reforms and lack of agreement around quality standards in the oral health field made it difficult for the funding partners to resolve some challenges. For example, some users of our toolkit wanted more information on payment sources and financial models, but in the end, we had to accept that we did not yet have the answers and should move forward with testing the framework and tools while staying open to exploring potential payment models in the future.
Lastly, the importance of transparency and trust among the partners on this oral health project cannot be overstated. We were able to establish goals upfront, be honest about the limitations within our respective organizations and as a collaborative, and share leadership as the work moved from concept to completed project. We questioned one another openly and sought out the input of other peer foundations and oral health leaders to achieve the best possible outcomes for the project. In the end, we believe this new guide offers solid direction and a clear pathway for improving oral health throughout the country.
Watch for the December 2016 issue of Health Affairs, which will be chock-full of oral health content. It will be released on Monday, December 5, and a Health Affairs briefing on oral health will be held on Wednesday, December 7, in Washington, D.C. Click here to register for the briefing. A number of foundations are supporting these efforts.