The Affordable Care Act has set the course signaling landmark changes that include many areas of health care. Payment reform, health insurance mandates, population health, transparent sharing of health information, accountability related to health outcomes, efficiencies in managing health care delivery, and access to health care in the right setting at the right time, are just some of the areas where fundamental change is taking place. Prevention and palliative care have moved to the forefront.
The river of our health care delivery system is roaring and whitewater abounds. It’s a frenzied environment reflecting urgent efforts. Already we are hearing mantras becoming part of the mainstream: ‘Know your Number’ and ‘Choosing Wisely’ are just two of the best known.
It turns out there’s a lot to hear, but the question is, who is listening?
What’s the difference, you ask? Hearing is the process of receiving auditory stimulation. Listening is the process of interpreting or comprehending the stimulation. Understanding the difference between these two words and processes is key to engaging patients and colleagues in the process of change. Authentic, attentive listening requires being still enough to understand.
I wonder about the impact of all of the efforts taking place across Maine. We all want sustained improvements in health care systems and changed behaviors that lead to better health outcomes and better population health rankings. But will we get there without acknowledging the value of attentive listening in the process of aiding one another?
In parts of Maine where the factors that influence the health ...
It’s hard to think that we will be able to look to our state and federal governments to lead the way to healthier communities. “Big” government is viewed by many as inefficient, wasteful and incapable of managing complex systems (regardless of the success of the Medicare program, for example). Proponents of “small” government seem to think the private sector will come up with better solutions. But since the private sector is focused primarily on profit, any proposed solutions will leave a void that will need to be filled.
MeHAF board members frequently talk with staff about how to best support change in today’s environment. Questions of sustainability plague both grant funders and grantees. How can we ensure that small organizations will be able to carry on the longer-term tasks that are required to effect meaningful change after their funding has ended? In order to better understand the proposals developed by grantees, members of the MeHAF Grants Committee have joined staff to conduct site visits for many of our projects.
Recently, I had the chance to participate in three site visits in two MeHAF programs: the Healthy Community program and Access to Quality Care program, and the visits changed my view of how to promote change. It was enlightening to see diverse organizations collaborating in a way that previously had not easily occurred. The organizations were actively seeking input from the community for direction and decision making. This was not a situation where town leaders or professionals were directing a “top down” organization, or a ...
Is there such a thing as urgent patience? If so, philanthropy needs to cultivate it. It seems to be in short supply in our line of work, for understandable reasons. Grant funding has been traditionally short-term in nature, often broken into artificial 12-month project periods driven by funder planning horizons and convenience, rather than the needs or objectives of the projects and its participants.
Also, as I noted in a recent blog post, most funders have traditionally measured success through work and activities that are easy to count. This might be appropriate for technical approaches or models to foster change, but they’re not well-suited to the complex issues that sit at the intersection of many systems, such as health. For these complex issues, funders must provide the kind of support that can advance the adaptive capacity* of grantees and their communities, allowing them to immerse themselves in the relationships and systems within their community in a way that enables them to identify common interests, align strategies and activities, and develop solutions that potentially solve many problems.
It takes time. It takes trust. It takes not being process-averse, but actually viewing process as action. It takes urgency. We know that change moves at the speed of trust, yet we act differently when the bell rings. We want to get straight to the action – to the deliverables. We let urgent action and our drive for results trump the need for patient attention to the relational and process components so critical to systems change.
This was the case ...
L to R: Kelli Ohrenberger, Safety Net Solutions; Heather Pelletier, Executive Director, FRRH; Norma Landry, Dental Program Consultant FRRH; Dr. Rebecca Reeves, FRRH; Dr. Mark Doherty, Safety Net Solutions.
When I first spoke with Heather Pelletier in the summer of 2012 she had just taken the reigns of Fish River Rural Health, a federally-qualified health center with offices in Eagle Lake and Fort Kent. Fish River provides integrated physical, behavioral and oral health services to over 3000 people, and is the primary safety net provider in the St. John River Valley. I had called Heather to see if she might be interested in participating in a practice improvement program for Fish River’s oral health services. When she said yes with some gusto I chalked it up to the enthusiasm of a new CEO, but after working with Heather for a couple of years I now know that “enthusiastic” is her middle name.
Within a few months of our conversation, Fish River was participating in Safety Net Solutions’ practice improvement program. Safety Net Solutions is a Massachusetts-based consulting group affiliated with the DentaQuest Institute. They work with safety net oral health providers to support the efficiency and long-term viability of their practices, ensuring people have access to the dental care they need. The Maine Health Access Foundation (MeHAF) has provided funding for 14 practices to participate in the program since 2010, and has supported most of those practices in the implementation of their improvement plans. Safety Net Solutions has had great success nationwide, and as we ...
After six years of board service, I recently finished my two-year term as chair of the Maine Philanthropy Center board. As I thought about what I would say to my fellow board members at my last meeting, I landed on sharing with them some “this I believe” statements to share my thoughts about why I serve on nonprofit boards and to sum up my experience on the Maine Philanthropy Center board.
For those not familiar with it, the original 'This I Believe' series was hosted by Edward R. Murrow in the 1950’s. The series encouraged people to write and share essays articulating the core values that guide their daily lives. It was a venue for people from all walks of life to talk not just about what they do, but why. This I Believe was revived in 2004, with broadcasts on National Public Radio.
Why did I serve on the board of the Maine Philanthropy Center?
This I believe: Nonprofit organizations at their best form a web that upholds and enriches society. And the boards of these organizations have a sacred trust with the public to ensure that they meet the intent of their nonprofit status.
A nonprofit is a special type of corporation formed to achieve charitable purposes for the benefit of the broader community. Board members of a nonprofit are responsible for guiding the organization and ensuring that it is fulfilling its charitable purposes. They must, by law, employ the “duty of care,” which means acting and making decisions with prudence; and the ...
Successful entrepreneurs tap into it. Harvard business grads hear it over and over. Diversity enriches the workplace and makes good organizations better.
That’s a big reason why MeHAF was excited to welcome two summer interns from the Daniel Hanley Center for Health Leadership into our ranks. We’re a pretty ‘seasoned’ crew, so having the input of two 20-somethings from early June through late August cast a new light on our work.
Planning for their arrival, everyone at MeHAF was asked to think about how an extra set of hands or a fresh set of eyes might be deployed on current or new projects. We began by identifying some of those nagging projects that, while important, never seem to rise to the top of our priority lists. Each of MeHAF’s ten staff members carved out time for lunch or a walk with the interns at least once over the 12 weeks of the program.
For the students, interning at MeHAF gave them an opportunity to develop new skills and gain some real world experience while building both their resumes and their professional networks - something that wouldn’t necessarily be the case if they’d worked the summer as a camp counselor or server at a restaurant.
The interns worked through a substantial and varied list of activities that involved researching and compiling information, updating resources and lists, generating new materials (like our very first infographic), participating in and taking notes at grantee site visits, and assisting with preparations for meetings- all valuable activities that ...
The news that Robin Williams died of an apparent suicide earlier this week shocked us. He is among the nearly 40,000 people who complete suicide each year nationwide. 1 This translates to a suicide every 13.3 seconds. Almost 79% of suicide deaths are men. Overall, suicide is the tenth leading cause of death in the United State, higher than murders.
Even though Williams was very public about the fact that he experienced depression, and in the past had been a cocaine and alcohol abuser, most of us had a hard time reconciling our notion of depression with the exuberant—almost manic—comic energy he brought to stage or screen. How could someone so energetic and high-spirited suffer from debilitating levels of depression?
Within hours of his death, many blogs and other commentary appeared, exposing misconceptions about suicide as being selfish or citing research connecting creativity and mental health struggles. However, what really struck me was how Robin Williams exemplified the fact that most people with severe mental illness can be and usually are high functioning in our society. They contribute tremendously to the greater good. Think of how many laughs you enjoyed because of Robin Williams’ genius.
Robin Williams was among the 16 million adults in the U.S. who had at least one major depressive episode in the past year. These are people who have experienced at least two weeks with either a depressed mood or a loss of interest or pleasure, and a loss of functioning in multiple other areas, such as ...
“The difference between the right word and the almost right word is a really large matter- it’s the difference between the lightning bug and the lightning.” – Mark Twain
Every day health and social service professionals meet to talk about the populations served by their organizations. If you were a fly on the wall in these meetings, you would often hear the individuals being served described as "the marginalized,"the poor," "the homeless," "the patient or consumer." You might also hear about "the autistic," "the schizophrenic," or "the diabetic."
Why is there often an awkwardness in using language that accurately describes the cohort of people being discussed while still honoring and respecting the individuals being served?
Health and social services professionals often focus on the condition, diagnosis, socioeconomic status or experiences before considering the actual person who maybe living with the condition or situation. Using situational conditions to categorize individuals may arise from the best of intentions: it may be mandated by reporting requirements, or necessary to respond to an RFP aimed toward helping specific populations. Where the language may be lacking is simply in the placement of words.
The power of word placement is fascinating. Several of us from MeHAF attended a recent workshop at Colby College on poverty led by Dr. Donna Beegle. In the workshop, Dr. Beegle described an activity she did with a class of college freshman. Dr. Beegle asked the class to list the things that automatically came to mind when she used the words “homeless person.” The class immediately listed ...
Knowing that over 44,000 Mainers signed up for more affordable health plans through the new Obamacare Health Insurance Marketplace is great news. Hopefully, more Mainers now have the security of having a comprehensive plan that includes prescription drug coverage for needed medications.
However, without the expansion of Medicaid to low-income Mainers, many of our neighbors and friends continue to be unable to get care or afford medications that are vital to treatment and recovery.
Ensuring people have access to affordable medications has been a long-standing issue in Maine, particularly for people with low incomes who often have to choose between purchasing food versus medicine. In 2006, the Maine Health Access Foundation launched a multi-year initiative designed to help patients access free or reduced-priced medications. Over three years, organizations developed pharmacy assistance programs for their lower-income patients that are still in operation today.
We recently received an update from Connie Coggins, President and CEO of HealthReach Community Health Centers, about the growth of their proactive patient pharmacy assistance program. HealthReach’s multiple clinical sites use DataNet, a program supported by MaineHealth, which helps manage pharmacy benefit applications and calculates the value of the prescription support provided to patients.
Over seven years, the clinical sites have had significant growth in the need for access to prescription assistance. In 2007, DataNet recorded $217,580 of free medications that were ordered for patients. The chart below illlustrates the significant increase in need through 2013:
Raise your hand if you’ve watched any World Cup matches this year. I don’t follow soccer in general, but must admit to being a bit of a fanatic when it comes to the World Cup. The timing of this year’s just-completed tournament has coincided with my thinking a lot about learning and evaluation for MeHAF’s new community-based initiatives,* and the foundation’s growth as a learning organization. I’m seeing lessons everywhere, even in my downtime as I watched the World Cup with my family.
Historically, we (the royal we: funders/nonprofits/social sector) have tended to focus on things (metrics and indicators) that are relatively easy to count – ones we think can best determine and/or demonstrate our hoped for impact. These emerge from within our current underperforming systems and are often framed within a linear concept of change: X causing Y resulting in Z. Is this the best way to assess the work – especially that of complex systems change – given traditional funding timeframes?
For example, in our educational system we often measure a student’s grade point average and SAT score as predictors of future success. However, recent research** indicates that the level of a student’s social-emotional intelligence might be a more accurate predictor. But how do we measure that?
Suppose we look at a soccer match as a system, and at the measurable indicators that might have been expected to predict the results of two World Cup matches played in the first round: shots on goal, fouls (the ...
Do you ever think about your teeth? What do teeth mean? A pretty smile? The best approach to a crunchy Maine apple? A highly prized form of currency? (Yes, better than bitcoin if you’re the Tooth Fairy.)
But there’s a much more serious side to teeth. Good teeth can mean the difference between a good job and unemployment. Extensive dental disease can lead to excruciating pain.Tooth decay is the most common chronic disease in children – five times more prevalent than asthma. For kids, dental disease and the pain it causes can result in poor performance in school, with long-term implications for lifetime health and success.
As then-Surgeon General David Satcher noted in the comprehensive report, “Oral Health in America,” published in 2000, there is a silent epidemic of dental disease in the United States. We have not made much progress in the past decade and a half, in spite of knowing even more about successful strategies to improve oral health than we did then. In recent years, Dr. Satcher has continued to call for action to address the profound oral health disparities that exist, especially for poor children and children of color.
MeHAF has been involved in efforts to improve oral health and access to dental care from the beginning of our grantmaking activities in 2002. We’ve made grants to support improvements to safety net dental clinics, including replacing aging and obsolete dental equipment, and purchasing software and hardware to support digital radiography. Since 2002, we’ve provided grant support of more ...
Access to direct health care services is necessary, but not enough when it comes to improving our health. This concept is at the heart of the Robert Wood Johnson Foundation’s (RWJF) Commission to Build a Healthier America, and the evidence is clear: where we live, work, worship, learn, and play has a huge influence on how healthy we are and can be.
Just prior to National Public Health Week – April 7-13, RWJF and the University of Wisconsin’s Population Health Institute released their 2014 County Health Rankings. I encourage you to take a look and see where your county ranks, and see what some of the factors are that are either helping or creating barriers for people in our communities to improving their health.
To improve public health, we have to examine the intersection of many systems and sectors within our communities to see how those systems can support better health. Housing, transportation, access to healthy food, economic and community development, education, land use, and, of course, health care are just a few of the systems that make up our communities’ health infrastructure. Trying to improve, align and connect these systems is what MeHAF’s new Healthy Community grant program is all about. The systems have developed separately over a long period of time, so the process of examining and aligning them to support communities’ efforts to nurture healthy people and healthy places will also take much effort and time.
In November, MeHAF announced awards to twenty Healthy Community grantees. At the center of ...
We are a culture enamored with innovation, with “new, improved” gadgets and solutions. We continually try to build a better mousetrap. Along with our culture’s constant drumbeat for new and improved products and solutions is the quintessentially American concept of the isolated, independent innovator or inventor. Picture a lonely genius hunched over a laboratory table from an old MGM movie, or someone like Steve Jobs single-handedly sparking the computer age from his garage.
But innovation in and of itself – change for change’s sake – shouldn’t be the Holy Grail, particularly when it comes to tackling long-standing, complex, issues that involve the interplay of human, physical and other networks, such as improving community health. And however beloved the image of the solitary problem-solver is in our culture, it’s not the most fruitful approach when pursuing systemic change.
At MeHAF, our experience supporting systemic change in health care in more than a decade of work has shown that what does work, what has a greater chance of long-term success, is a greater commitment to collaborative, networked approaches. With a goal such as improving community health, in all its complexity, MeHAF believes significant and sustainable progress can only come from the collective action of many players – it cannot be the sole responsibility of a single organization or sector.
This networked, collaborative approach is central to our new priority area, Achieving Better Health in Communities and the Health Community Grants program. For MeHAF it is less about the ‘what’ – that is, the specific health issue(s) participating ...
It was a rowdy, sold-out packed house on January 17 at the Civic Center in Augusta. Event organizers were forced to implement special crowd control efforts. Was it the Maine Sportsman’s Show or a Bonnie Raitt concert? No. It was the Maine Summit on Aging.
This event was not a bunch of aging Mainers coming together to commiserate about the challenges they face. Rather, it was a diverse, dynamic group of professionals and advocates who gathered to build on the momentum started by a series of Aging Roundtables hosted by House Speaker Mark Eves.
Over the course of the day, participants dug deeply into ideas about how to make Maine a place where people who are aging, aged, elderly, and just plain old, can thrive—and be seen not only as a group that needs support and services, but also as a group that is a tremendous resource to the state and our communities.
By the end of the day, which was bookended by a video opening by Senator Susan Collins and a talk by Senator and former Governor Angus King (who announced that he will be 70 in a few months), those attending had developed plans to address high priority issues and leverage the power of Maine’s oldest-in-the-nation population.
MeHAF has recognized the challenges and opportunities inherent in Maine’s age-skewed demographics. With our new Thriving in Place initiative, we are supporting eight communities around the state in developing programs that will help people with chronic health conditions stay healthy and in their ...
The roll-out of the new Health Insurance Marketplace last fall was not exactly what anyone would call “smooth.” Stories about the malfunctioning HealthCare.gov website dominated headlines both nationally and here in Maine for the first two months of its operation. Now that the website seems to be working much better we’ve begun hearing heartening stories of previously uninsured people finally getting coverage they can afford. As of the end of December, over 13,000 Mainers had successfully enrolled through the Marketplace. Hooray!
Without a doubt, many Mainers seeking coverage through the Marketplace will find a plan that suits their needs and their budgets. Financial help for individuals with annual incomes beginning at $11,490 (for a single person household) will help make premiums and out of pocket expenses more manageable.
But we shouldn’t lose sight of other groups who, for various reasons, will find themselves without the opportunity or the means to purchase affordable coverage. One group that comes immediately to mind are folks who would have received coverage under an expansion of MaineCare, but didn’t because of an inability to override the Governor’s veto last year.
Many people in this group, and many more uninsured people- (government estimates are that around 130,000 Mainers are currently uninsured)- will continue to seek care through free clinics, community health centers offering sliding fees based on income, and charity care available through our state’s non-profit hospitals and health systems. But Maine’s health care safety net is already challenged to keep up ...
I’ll be the first to admit that I am in major denial about my own aging. However, recently my brother-in-law died and two younger cousins have died within the past couple years. Suddenly, I’m facing the fact that I’m no longer the “younger generation.” I’ve now ascended the ladder to the generation that is starting to retire, embarking on a new stage of life, feeling new aches and pains as part of daily life and for too many of us, dealing with chronic health conditions or even death. I am only a few months away from the age at which my father died.
This new recognition of my life stage makes the MeHAF Thriving in Place initiative very personal for me. By the time I need a little additional help, I want a new system of care available that will give me the option to stay safe and healthy for as long as possible in my own lakeside home, talking to my loons. From the energy I’m seeing around our state on the topic of providing support so people can age in place, I realize I’m not the only Baby Boomer thinking about a better system.
As part of the exploration of community-based innovations, MeHAF has launched our new Thriving in Place initiative to mobilize communities to develop strategies that will use local resources to create a system of support to help people with chronic health conditions, including persons with disabilities and persons with extended life experiences. (Notice how I ...
What a difference a month can make – particularly with regard to the performance of the new Health Insurance Marketplace at www.HealthCare.gov. At the end of October, only 271 Maine people had chosen a health plan, but by the end of November, 1,750 people had picked a plan. More importantly, 16,325 Mainer’s completed applications using the on-line website or mail but hadn’t yet decided on their new health plan.
After weeks of software and technical fixes, most Mainers going to the Marketplace are now able to complete the enrollment process. Because of the website problems, the federal government extended the enrollment deadline to December 23 for coverage that can start as soon as January 1, 2014.
The change in enrollment over the last two months is good news, but beyond the raw numbers, what does this jump in enrollment suggest?
1. The HealthCare.gov website is “fixable” – and the fixes are happening quickly. Although the roll-out of the website was a nightmare for consumers, people are having more and more success enrolling every day. Based on feedback from Maine’s community navigators and certified application counselors, their clients are far more likely to complete enrollment than be bumped off the site.
2. While the jump in enrollment is good news, getting enough people to enroll in new health plans takes a lot of outreach and education. Maine didn’t receive any federal (or state) dollars to do marketing, so it’s slow going getting the word out about this new way ...
The young man sitting on the exam table before me was breathless, pale and distressed. We had never met, but he asked for me at the clinic desk. Staff at another hospital where he had received care for nearly 20 years gave him my name when they saw he was uninsured.
Despite having a significant congenital heart condition, he had been reasonably healthy. Married, with two children, he was an independent plumber. It provided a decent living but not enough to be able to afford insurance — even if he could have qualified for coverage. With his pre-existing condition, no insurer would accept him.
For years he did what people who are uninsured do — defer regular doctor visits and hope he was lucky enough nothing bad happened. But his luck ran out. Now he was unable to work and could barely walk.
After receiving a new heart valve, he returned to his business, pledging to pay what he could for his care.
Hospitals see lots of “charity cases,” but it’s become harder and harder to balance margin with mission to care for the increasing number of uninsured. The most recent Census (2012) found 48 million Americans were effectively shut out of our health care system because they lacked basic health insurance coverage.
As the public (and political) furor over the Affordable Care Act failings dominate the headlines, it’s important to keep perspective about what this complicated health reform law is trying to accomplish. There are some real problems, but there are many things Obamacare is ...
The two day-old Health Insurance Marketplace has experienced a few newborn hiccups. The press has reported some delays and other technical glitches from people eager to complete applications for quality, affordable health insurance. Anyone involved in the launch of a new online program or website (as MeHAF has been with the recent launch of enroll207.com) knows that a new site is bound to have issues that can’t always be anticipated and corrected until the site goes live.
Such technical glitches were anticipated by many of us who are working to get people signed up for coverage. No one wants to cope with delays, but there’s another side to this story. As of this morning, HealthCare.gov, the site that operates the Marketplace in Maine and other federally-facilitated states, reported 6 million unique visitors to the site! Even Apple or Microsoft might experience issues on their sites with that volume of traffic. In Maine, organizations providing enrollment assistance, including Consumers for Affordable Health Care are reporting a similar flood of calls about the Marketplace.
The good news behind the Marketplace glitches is that people across America – and Maine – desperately want health insurance. Even in day two, the interest and response from people looking for coverage is still jamming the new website. It’s hard to ask people anxious to enroll to be patient, but the bumps and glitches will get fixed and Mainers will have time to review their options and sign up during the initial open enrollment period (which lasts through March 31 ...
In our first video blog, Dr. Jay Want, a health care consultant based in Colorado, talks with Barbara Leonard, MeHAF's Vice President for Programs, on what motivates health care professionals and their organizations to not only undertake, but persevere in long-term system change. Dr. Want was the featured speaker at the August 13th quarterly meeting of MeHAF Payment Reform grantees. A transcript of their 5-minute conversation follows.
BL: Jay, thanks for joining us to talk with our payment reform grantees today. I think it was really helpful for them to get your perspective on the work that they're doing. One of the things that you mentioned was that there are kind of three buckets of human motivation. I think you said [they were] financial, and social and ethical, and that seemed to resonate with a number of the grantees in the room. Can you talk about that a little bit?
JW: OK, I'd be happy to. I was actually taught this by a physician that I worked with several years ago. He said, you know, there really are only three big buckets of things that motivate people, and so if you're looking at the reward systems that you have for us as a practice group or whatever, you ought to think about these things. He said, they're financial, and social, and ethical. Financial is kind of self-explanatory, social is what others think of me, ethical is what I think of me. They're different, and the differences actually bear a ...