HEALTHCARE GRANT FUNDING LANDSCAPE:
TOP PRIORITIES FOR HEALTHCARE INSTITUTIONS NAVIGATING ACA REFORMS
All healthcare organizations require consistent, diverse funding streams to keep vital community programs up and running. Unfortunately, many of these organizations lack a comprehensive, strategic plan that integrates philanthropic giving and grant development. Worse, some shy away from competitive grantseeking as an active component of resource development altogether. This document serves as a primer for those experiencing common challenges and provides solutions for bolstering grantseeking efforts to improve healthcare service delivery and population health.
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Healthcare Development Center
Hanover Research
Healthcare Grant Funding Landscape
OVERVIEW: In FY2015, Patient Protection and Affordable Care Act (PPACA) mandatory funding rises to $3.6B for the Community Health Center Fund1, while the Center for Medicare and Medicaid Innovation continues to spend down its current $10B authorization (FY2011-2019) to test innovative payment and service delivery models2. This sounds like good news for community health centers, as well as states and health systems that have the infrastructure and capacity to participate in CMS-sponsored demonstrations. However, many charitable and safety-net hospitals are hustling to meet new regulatory requirements, maintain high quality care, improve patient satisfaction, and increase cost efficiency – all while bracing for continued reductions in Medicaid and Medicare Disproportionate Share Hospital (DSH) payments and other shifts in payment structures. The National Association of Community Health Centers (NACHC) warns, “Although health centers will serve more Medicaid and privately insured patients, approximately 40% of health centers’ currently uninsured patients could remain without insurance coverage, and new insured patients will turn to health centers as their best option for care.”3 However, the Health Center Trust Fund is slated to expire by the end of FY 2015, resulting in a 70% funding reduction for all existing health centers, according to a recent NACHC report4. In addition, the Robert Wood Johnson Foundation recently published findings5 that state and local public health budgets have been cut at drastic rates for several years.5 From FY2008 to FY2013, state median per capita spending on public health decreased by 17%. During 2012, close to one-half (48%) of all local health departments reduced or eliminated services in at least one program area, including immunizations and maternal and child health. With only about half of states opting to expand Medicaid so far, hospitals and health providers face the challenge of providing more and better care in an increasingly dynamic—and challenging—environment.6 While they have learned to “build the plane while flying it,” they are now doing so with shifting blueprints and missing tools. How, then, do safety-net hospitals, rural providers, and other acute care facilities secure the funding required to embrace new standards of care and invest in population health and community wellness? In addition to short-term federal funds authorized in the PPACA, private foundations and state governments have been using competitive grant funding to incentivize and expand reforms in health care delivery and payment models across care settings. In the areas of healthcare delivery and population health, Hanover’s Healthcare Development Center partners have sought federal, state and private funds to support infrastructure and care delivery in traditional settings and for programs and care delivered in broader community settings. Since the implementation of the PPACA, there have been common challenges and frequent questions raised by Hanover partners as they seek grant funding in this context. Below, we summarize these frequently asked questions and offer several tips on how to address the underlying challenges identified.
1. 2. 3. 4. 5. 6.
“Justification of Estimates for Appropriations Committees: Fiscal Year 2015.” Health Resources and Services Administration, Department of Health and Human Services. http://www.hrsa.gov/about/budget/budgetjustification2015.pdf “Justification of Estimates for Appropriations Committees: Fiscal Year 2015.” Centers for Medicare & Medicaid Services, Department of Health and Human Services. http://www.cms.gov/About-CMS/Agency-Information/PerformanceBudget/Downloads/FY2015-CJ-Final.pdf “Health Centers and the Uninsured: Improving Access to Care and Health Outcomes.” National Association of Community Health Centers. May 2014. http://www. nachc.com/client/documents/research/Uninsured%20FS%200514.pdf “Access Is the Answer: Community Health Centers, Primary Care & the Future of American Health Care.” National Association of Community Health Centers. March 2014. http://www.nachc.com/client/PIBrief14.pdf Levi, J., Segal, L., & Laurent, R. “Investing in America’s Health: A State-By-State Look at Public Health Funding and Key Health Facts 2014.” Trust for America’s Health and Robert Wood Johnson Foundation. http://www.rwjf.org/content/dam/farm/reports/reports/2014/rwjf413110 “Status of State Action on the Medicaid Expansion, 2014.” The Henry J. Kaiser Family Foundation. http://kff.org/health-reform/state-indicator/state-activity-aroundexpanding-medicaid-under-the-affordable-care-act/
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Healthcare Grant Funding Landscape
IMPROVING HEALTHCARE SERVICE DELIVERY IN TRADITIONAL SETTINGS (INPATIENT AND OUTPATIENT): Keywords: chronic disease management, infection control, care transitions, enhanced outpatient services, palliative care, medication management, behavioral health integration, comorbid mental health and substance abuse treatment, interprofessional practice teams, technology infrastructure and health informatics, alternatives for emergency department superusers, risk-sharing payment models, patient centered medical home
Challenge
Tips • Most federal grant opportunities occur on a standard schedule or forecast, and can be mapped out to support a comprehensive grantseeking strategy.
How do we align the schedule for planned infrastructure and care delivery improvements with the timing of grant funding opportunities and awards?
• Grantseeking should complement planned investments and fundraising programs, so that grant development planning comes alongside strategic priorities of the organization. • Diversification of funding sources for specific grant projects reduces income volatility, since it allows planners to balance income from sources that have a relatively short turnaround time for results (e.g., regional foundations) with those that require a longer term review cycle (federal grants). • Strategic planning of grantseeking efforts helps prevent abrupt shifts and unexpected resource gaps for sponsored projects and initiatives.
How do we propose to engage in feasible, responsible quality improvement strategies (e.g., Plan-Do-Study-Act) when there is constant pressure to both innovate and rely on evidence-based reforms? How do we know if we are being “innovative” or if our model is unique?
• Invest in literature research and/or a clinical library of best practices, including peer reviewed journals, to monitor evolving research and government reports. • Monitor Institute of Medicine reports and publications from major research institutes and philanthropic foundations.7 • Analyze your current data sets to identify patterns and pinpoint challenges for your providers and patient populations. • Conduct a pilot of the project on a small scale prior to developing a proposal for grant funding. Use preliminary outcomes to demonstrate the merit of the proposal. • Partner with university or medical center researchers to add credibility and ensure capacity for analysis and evaluation of the proposed project. • It is not necessary to be the first to implement a model, but if you are applying for a national grant program, the proposal will generally be more competitive if it has not been implemented in a setting or population exactly like yours.
Can we replicate a proven model of care or do we always have to be the first adopter / innovator to capture grant funding?
• Identify what makes your population unique and how your service delivery method meets the needs of your specific patient population. • Appeal to regional foundations that have a vested interest in the health and/ or quality of life of residents in your geographic service area (e.g., largescale employers, community development financial institutions, economic development entities). • Appeal to foundations that seek to improve the health and well-being of a sub-set of your patient population (e.g., elderly), and frame your intervention or program based on the needs of that population.
7.
See http://www.iom.edu/ for additional information.
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Healthcare Grant Funding Landscape
IMPROVING HEALTHCARE SERVICE DELIVERY IN TRADITIONAL SETTINGS (CONTINUED): • Local / regional funders are often interested in improving care for a specific geographic population, so commit to improving the wellness and health outcomes of a specific patient pool.
How do we engage a grant funder to meet a relatively common need without overwhelming them with the larger issues wrapped up in health care “reform” (e.g., chronic disease management, ED use, behavioral health access)?
• Unless the funder has an expressed interest in improving care efficiency and cost savings, focus on the patient-centered outcomes of the project (e.g., improved health outcomes, reduced caregiver stress, easier navigation of care, etc.) • Use data sets and information on a state, regional, and organizational level. National data sets are helpful to frame the significance of the project or scope of the problem; however, be sure to match the data level with the scope of the funder. • Keep in mind that health market factors, shifts in federal payment structures and regulatory reforms are impacting ALL providers, so general discussion of these changes in the healthcare landscape won’t differentiate your project from others in the applicant pool. • Review the landscape of providers in your service area to identify available healthcare services and reveal current gaps.
If we have many of the same needs as other health providers, how do we stand out among applicants?
• Identify your unique offerings, competencies, patients, and collaborations. • Move beyond national accreditations and standard credentials to examine the unique “ethos” of your organization, including results of employee surveys and the reasons your patients choose your hospital / health facility for care over competitors. • Consult with your marketing and strategy departments. How do they differentiate your products and services from other providers in the area?
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Healthcare Grant Funding Landscape
POPULATION HEALTH AND PLACE-BASED HEALTHCARE DELIVERY Keywords: preventive care, health literacy, social determinants of health, diagnostic screenings, cross-sector collaboratives, school-based care delivery, telehealth services, mobile health units, non-traditional care delivery sites, care for incarcerated populations, integration of social services and healthcare, culturally targeted self-management programs, health-risk behavior modification, home-based care for aging and multi-morbid populations, patient navigators / community health workers, cancer patient support
How do we prove need for a project if local health data sets don’t focus on the particular problem or population being targeted?
How do we identify and address the logistical challenges of providing care and conducting outreach outside of traditional inpatient and outpatient healthcare settings?
• Administer a survey for providers, key stakeholders or representatives of the target population. • Extrapolate data from similar communities and/or state and national data sets. • Replicate methods used to conduct a Community Health Needs Assessment (CHNA), but do so on a smaller scale. For example, stakeholder meetings, focus groups, and other qualitative methods of data collection can complement quantitative data. • Involve collaborative partners in project planning several months before the development of a grant proposal. • Allow all partners to contribute their particular expertise – knowledge of the population, required care protocols, support for caregivers, etc. • Conduct a review of similar programs that have been conducted in communities like yours – examine differences and similarities, processes that were developed, challenges faced, and outcomes that resulted. Start a dialogue with the program directors and/or staff of these programs, if feasible. • Engage the cognizant state agency/agencies to solicit advice and ensure compliance with applicable regulations.
• Leverage current relationships and established cooperative agreements when pursuing grants for collaborative projects.
How do we entice community and provider partners to engage in a broad coalition across sectors?
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• Identify specific collaborators or types of collaborators that would be beneficial to the project. For each collaborator, identify their expected role in the project, how their involvement benefits the project, how the collaborator will benefit from the project, and any potential challenges that may hinder their collaboration. • Articulate how the project can address or mitigate anticipated challenges / barriers to participation, and then engage the group of current partners to recruit additional collaborators through established networks.
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Healthcare Grant Funding Landscape
POPULATION HEALTH AND PLACE-BASED HEALTHCARE DELIVERY (CONTINUED)
• Establish one of the project partners to serve as the “backbone” organization of the collaborative effort (See Collective Impact framework).8
How do we demonstrate that our project is sustainable when it is being delivered across sectors and providers?
• Institutionalize improvements and trainings across care settings and service providers to reduce the amount of funding needed for ongoing operations of the project (vs. those required for startup). • Improve efficiency and reduce overlap among agencies to better utilize current resources. • Integrate services, functions, and processes across care providers to reduce costs and solidify operational relationships. • Calculate the projected cost savings and/or financial sustainability of the project by engaging multiple stakeholders and experts (e.g., CFO, program evaluator, etc.) to develop a pro forma financial statement for the project.
Our CHNA identifies some pretty broad categories of “need” (e.g., health care access, substance abuse, mental health care). How do we identify grant funding and target grant programming in a way that will “move the needle” in these areas?
• Starting with the CHNA Implementation Plan, evaluate the organization’s current capacity to carry out activities and strategies identified in the Plan. • Conduct grant prospecting for those activities that require significant additional resources, as well as those that must be carried out with the support of other service providers. • Identify grant opportunities that align with the Implementation Plan’s methods, projected outcomes, and/or target populations. • Leverage the expertise and networks of your community partners to help identify funding sources and prioritize activities within areas of identified need. • Grant funders expect that applications will include a lead applicant and several collaborators (sub-contracts), particularly for programs that require meaningful collaboration across providers.
Should we pursue a grant opportunity that requires one of our partners to serve as the “lead applicant?”
• If the proposed lead applicant has the capacity and expertise to manage the grant award, then serving as a sub-contractor on the project may be a “winwin” situation. • As a sub-contractor, you can focus on program activities and/or care delivery without the burden of financial and programmatic reporting requirements. • Expanding the base of lead applicants exponentially increases the potential sources for grant funding, particularly for collaborations that reach across sectors (e.g., law enforcement, faith-based groups, education, etc.)
8.
Kania, J. & Kramer, M. “Collective Impact.” Stanford Social Innovation Review. Winter 2011. http://www.ssireview.org/articles/entry/collective_impact
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Healthcare Grant Funding Landscape
THE PARADIGM SHIFT: Paul L. Kuehnert, Team Director and Senior Program Officer at the Robert Wood Johnson Foundation, says it best, “Public health is facing a sea change: Health reforms, massive budget cuts, an increased focus on accountability and the growing adoption of electronic health records are creating new challenges and opportunities. Our [Investing in America’s Health 2014] report examines health spending set against some key disease rates to help further the discussion about what the right amount of public health funding should be in order to have a real impact on helping people lead healthier lives now and for generations to come.”9 The ripple effects of healthcare reform have yet to be fully realized and understood, but the paradigm of healthcare delivery has most certainly been altered – for patients and providers. While policy makers continue to wrangle over regulatory reform and public health funding, all healthcare organizations — regardless of size, type or patient population — require consistent, diverse funding streams to keep vital community programs up and running. Unfortunately, many of these organizations lack a comprehensive, strategic plan that integrates philanthropic giving and grant development. Worse, some shy away from competitive grantseeking as an active component of resource development altogether. It is our hope that this blog serves as a primer for those experiencing common challenges and that it provides some options for bolstering grantseeking efforts to improve healthcare service delivery and population health. 9.
See “Investing in America’s Health: A State-By-State Look at Public Health Funding and Key Health Facts 2014” for additional information.
ABOUT THE AUTHOR: Teresa Wilke Grants Consultant Hanover Research twilke@hanoverresearch.com www.linkedin.com/in/teresawilke
Teresa has over 16 years of experience in program design, project management, and strategic communications, including 13 years of experience developing grant proposals and grantseeking strategies for universities and healthcare providers. She is a successful proposal writer, having secured over $21 million in new grants for nursing and science education, faculty development, laboratory and health facility renovations, student retention, health literacy, patient support, health information technology, chronic disease management, behavioral health and rural health projects. Teresa has obtained grant funds from private foundations (e.g., Lumina Foundation), state governments and federal agencies, including NSF, ED, DOJ, ACF and HRSA. Teresa has worked in several federal agencies and executive departments, including the White House, HUD, EPA, and the EEO Commission. She has served as director of sponsored programs at a large regional public university and coordinator of an NIH-funded research center at a top-tier, private university. Teresa has delivered strategic grantseeking workshops for non-profit, university and national audiences, and she is particularly interested in cross-sector coalitions, health policy and innovative models of care delivery. She also serves as a peer grant reviewer for the Health Resources and Services Administration at HHS. Teresa received her MBA from Washington University in St. Louis with an emphasis in strategic consulting. She recently completed the Institute for Healthcare Improvement (IHI) Open School basic certificate program, comprised of a 24.5 hour curriculum focused on patient safety, quality improvement, leadership, person- and family-centered care, triple aim for populations, and quality, cost and value in healthcare delivery. Teresa’s first-hand federal agency experience, research acumen, and strategic mindset allow her to align clients’ institutional strengths and resources with funding agency priorities to identify grant targets and develop persuasive proposals.
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