Funding Social and Economic Interventions to Improve Health: Health Legacy Foundation Strategies

November 24th, 2014

Nearly $1 billion in grant funding is awarded each year by health legacy foundations (which some call “conversion foundations”). These foundations are formed with proceeds from mergers and acquisitions of nonprofit health care entities and currently operate in forty-three states across the country. At least 306 of these foundations have been established over the past three decades, and in 2010, their combined assets totaled more than $26 billion.

Although this figure may not seem so impressive on a national scale, health legacy foundations can have an enormous impact at the community level. Most of these funders originated from a nonprofit hospital and restrict their giving to one or two counties, frequently mirroring the hospital’s service area.

For some communities, the millions of dollars in new philanthropic assets represent unprecedented potential to support local charitable initiatives. How health legacy foundations use these funds to respond to community health needs is a crucial issue.

The November 2014 issue of Health Affairs featured my GrantWatch article, coauthored by Bill Brandon of the University of North Carolina-Charlotte, that examined social determinants of health in communities where health legacy foundations have been established. Compared to communities without health legacy foundations, communities where these foundations are located had significantly higher proportions of racial minorities and multiple socioeconomic factors that rendered them more vulnerable to health disparities and poor health.

On the other hand, communities with health legacy foundations had lower rates of uninsured people, lower rates of preventable hospitalizations, and a better supply of physicians and dentists.

Certainly, health legacy foundations need to assess the needs and resources within their own communities before developing and prioritizing grant-making strategies. However, our study’s findings underscore the need for health legacy foundations to consider social and economic interventions as viable options for improving community health.

Many health legacy foundations have developed grant-making initiatives aimed at improving socioeconomic status. These foundations offer examples of promising strategies for health legacy foundations and other grantmakers to consider in their pursuit of better health status. Several of these initiatives are described below. Read the rest of this entry »

Game Changers: Philanthropy’s Role in Eliminating Mental Health Disparities

November 17th, 2014

“We believe funders are game changers; we have a significant opportunity to change the health care landscape,” said Rick Ybarra, program officer for the Hogg Foundation for Mental Health, located in Austin, Texas. Ybarra, together with Octavio Martinez, executive director of the Hogg Foundation, and Enrique Mata, senior program officer for Paso del Norte Health Foundation, located in El Paso, Texas, met with three dozen foundation leaders in early November during Philanthropy Southwest’s 2014 Annual Conference in Phoenix, Arizona. The panelists sought to show funders how their differing efforts, ranging from small to large in scope, can add up to help eliminate mental health disparities among racial and ethnic minorities.

The session built on the August 2013 Grantmakers In Health (GIH) special report, A Window of Opportunity: Philanthropy’s Role in Eliminating Health Disparities through Integrated Health Care. The report recommends four overarching approaches for funders to consider as ways to promote systems change and facilitate the integration of primary care and mental health services. These approaches have been shown to work in eliminating health disparities:

1) grant making: take risks, involve community members, include a broad range of grantees, fund planning and preparation efforts, focus on evidence, partner with other organizations;

2) educating: develop internal expertise at foundations, emphasize research and evaluation, share knowledge and lessons learned with stakeholders;

3) convening: serve as a neutral convener, bring experts together, form learning communities, provide safe opportunities for “daring dialogues”; and

4) advocating: support policy fellowships, host a legislative summit, promote policies for sustainability of funded projects, facilitate a policy workgroup, be a voice for cultural and linguistic competency.

Panelists emphasized that regardless of the approach, it is important for foundation staff and trustees to see firsthand the needs in their communities. Read the rest of this entry »

Oral Health: How a Foundation in New York State Is Working to Prevent Cavities in Young Children

November 5th, 2014

Early Childhood Caries—tooth decay among children under age six—is a disease process that can cause pain that affects a child’s ability to eat, speak, and learn at a time when he or she should be developing and thriving. Almost half of all children develop this decay before they reach kindergarten, with the greatest burden occurring in low-income children.

Like the American Dental Association, we are encouraged at seeing preliminary data showing that untreated decay among preschool children has fallen. But we’re still disturbed that many young children are getting cavities, because this disease is almost always preventable.

In 2011 the Health Foundation for Western and Central New York partnered with the Centers for Disease Control and Prevention to fund the development of a simulation model that compared the cost-benefit/effectiveness of seven strategies for children ages zero to five years. The model built on work done previously in Colorado. The Children’s Dental Health Project, the New York State Department of Health, and consultant Gary Hirsch, an expert on this type of model, collaborated on design, data collection, and analysis. The Children’s Dental Health Project has developed a paper outlining the key findings of the model.

The model tested oral health strategies that evidence showed were most effective at preventing Early Childhood Caries and saving Medicaid money. These included community water fluoridation, increased tooth-brushing, and fluoride varnish application. Fluoridation yielded the highest potential Medicaid cost savings in the model, although the other strategies also showed promise for reducing disease and producing Medicaid savings. Overall, researchers found that proven public health practices such as fluoridation were effective in the model, but there are opportunities that exist to increase effectiveness by using clinical guidelines and better risk assessment to reduce disease.

It is common for research to be put on a shelf or stored online, with none of that knowledge transferred to organizations working in the field. However, understanding that this model could benefit children if it were used as the basis for community engagement, the Health Foundation sought partners to create a replicable, community-based program to reduce Early Childhood Caries.

Around the time that this simulation model was ready, New York State’s health department released its Prevention Agenda. This document is the blueprint for state and local activities to improve the health of New Yorkers. For the first time, it contained specific goals for reducing dental disease in children. A program designed around the simulation model was an opportunity to help communities achieve these goals through the application of evidence-based strategies.

The Health Foundation and the New York State Health Foundation teamed up to fund the Schuyler Center for Analysis and Advocacy to manage a partnership charged with developing an oral health program to be piloted in two sites in 2014. The center is a statewide, nonprofit, nonpartisan, human services advocacy organization with a long history of working to promote policies to improve oral health in New York State. Read the rest of this entry »

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