Recently I heard a speech that made me want to stand up and shout “That’s It!!!” like Linus in the Charlie Brown cartoon. The event? A plenary session at the Grantmakers in Health 2015 Annual Conference. The concept that nearly moved me to embarrass myself in front of a large group of people? Palliative Care, as presented by Diane Meier, Director of the Center to Advance Palliative Care (CAPC).
As describe on the CAPC website, “Palliative Care sees the person beyond the disease . . . It focuses on providing relief from the symptoms and stress of a serious illness. It is a fundamental shift in the focus for health care delivery . . . The goal is to improve quality of life for both the patient and the family.”1
It’s not that I didn’t know what palliative care is. What Dr. Meier helped me see is that every person with a serious illness should have access to care that gives truthful information about prognosis, as well as benefits, risks, and side effects of potential treatment. Most of all, providers should ask the patient what is most important, given the information that has been shared. It is only then that a coordinated care plan is developed that includes support ranging from medical treatment to meals and transportation.
But this kind of care shouldn’t just be limited to those who are fortunate enough to live in a place with a palliative care program. Anyone with a serious illness should have ready access to this approach to care. How ...
As someone who lives in the oldest county of the oldest state in the nation, I wasn’t surprised to see our local movie theater filled with older Mainers eagerly awaiting the sequel to the “Best Exotic Marigold Hotel.” For those who are not moviegoers, the film portrays the challenges and joys faced by a group of elderly British retirees who decide to "outsource" their retirement to a less expensive and seemingly exotic palace in Jaipur, India. Their new home turns out to be the decrepit but charming “Best Exotic Marigold Hotel.”
As the story unfolded, I thought about what made the film so popular with the older crowd. Certainly there’s the outstanding cast (anything with Maggie Smith and Judy Dench is sure to please), but I suspect it’s the lessons in senior living that captures people’s attention:
- Marigold Hotel residents fiercely retain their independence but find pleasure and support in their communal setting over delicious meals coupled to housekeeping services that are provided at a reasonable cost.
- The daily routine can be predictable and mundane if a resident stays within the hotel grounds or exotic and unpredictable if one ventures into the streets of Jaipur (on foot or motorbike). Those who aren’t afraid to expose themselves to new ideas in their foreign surroundings seem to thrive.
- Chronic illness and death are part of the story, but the residents seem to accept these as a natural part of living and soldier onward (perhaps a testament to the stiff British upper lip?).
- More ...
“Great city. Great conference,” is how I would summarize the March 2015 Grantmakers in Health (GIH) conference in Austin. MeHAF was well represented with four Trustees and five staff attending. MeHAF staff co-presented 6 of the 32 workshop sessions. More than once, colleagues from across the country joked that “MeHAF seems to be everywhere this year.”
For me, the highlight was a powerful plenary session on behavioral health (a first for GIH), featuring former Congressman Patrick J. Kennedy II, who wrote and championed the Mental Health Parity and Addiction Equity Act of 2008. He stirred the crowd with a passionate appeal for more attention to the needs of the 57 million Americans who experience mental illness and/or substance abuse each year.
He reminded us that health foundations can’t be effective if we aren’t addressing behavioral health needs. He challenged us to “treat the brain like a part of the body,” saying evidence-based programs such as the Nurse-Family Partnership and the integration of mental health and addiction services into primary care are essential and need our support. He explained that treating behavioral health is a “force multiplier” that impacts other areas of health and that optimizes good health. By intervening early, we can make a real difference. “At school, kids get their eyes checked, their hearing checked. How about a checkup from the neck up?” he advocated.
Kennedy pointed out how America has missed the mark by turning our jails and prisons into the largest mental health center in the US. “Today’s jails ...
As a nurse who’s worked in clinical care settings in rural Franklin County for over 30 years, I’ve derived a lot of satisfaction caring for patients. In addition to this role, I’ve also worked as coordinator of a “Healthy Communities” effort and as a care manager. But recent work – helping to lead a MeHAF-funded project to better understand who uses the emergency room (ED) and who receives free care at Franklin Memorial Hospital (FMH) – has been some of the most rewarding work I’ve done. This work, Franklin C.A.R.E.S, goes beyond clinical care to identify ways to help these individuals live healthier lives. I’ve learned a lot about the barriers the health system puts up for uninsured and under-insured people, and also about other issues that keep these individuals from getting needed care on a regular basis.
Many of the uninsured individuals I have worked with over the past 18 months have indicated a desire to keep their health concerns, illnesses, and financial matters very private. They see connecting with a primary care provider, or even enrolling in an insurance plan as a violation of that privacy. This means that making connections for health care services is viewed as intrusive and inappropriate.
Another challenge in working with people who may never have had health insurance is getting them to recognize the value of insurance and how to use it. Health insurance is really different from car insurance, which you don’t use unless something goes wrong, like a ...
Maine Community Health Options (MCHO) sent out a press release on December 29 announcing grants totaling $500,000 to eight Maine-based nonprofit organizations that work toward improving the health of individuals with barriers to maintaining health and getting health care services, such as migrants, individuals recovering from mental illness and substance use, low income Mainers, and those battling tobacco addiction and cancer diagnoses.
We congratulate MCHO on this achievement, which was only possible because of the organization’s incredible success in its first year of operation. Read Lewiston insurer is a national rock star in the January 5, 2015 issue of the Lewiston Sun Journal and Bangor Daily News.
While this news is exciting in itself, there’s a Karmic backstory that makes these grants two times – or maybe even three times – more notable. The backstory’s timeline:
• In 2000, nonprofit insurer Blue Cross Blue Shield of Maine was sold to Anthem, and as a result of that sale, $82 million was set aside as the initial endowment to start MeHAF;
• In 2010, the Affordable Care Act was passed, providing support for the creation of new Consumer-Operated and Oriented Plans (CO-OP), a new kind of nonprofit insurer;
• In 2011, MeHAF made a $200,000 grant to the Maine Primary Care Association to help them to serve as an incubator for the development of MCHO, a Maine CO-OP; and
• In 2013, MeHAF made a grant of $300,000 to MCHO to support MCHO's outreach and marketing efforts for the first year of operation of the Health ...
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 ...