Blog
Due Diligence: Moving Beyond Status Quo
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So why is due diligence so important to foundations anyway? For MeHAF, the decision to fund a grant is based on a balance of strategic fit with its priorities and mission and an objective review process. The challenge for all foundations is that we want to learn as much as we can about an applicant organization without asking for information we do not need or may not use. When reviewing an application, MeHAF considers whether or not the proposal corresponds with its guidelines and priorities, as well as the merits or value of the proposed activities. In addition, the proposal is evaluated for its qualities compared to the other proposals received.Project Streamline is a collaborative effort of grantmakers and grantseekers studying application and reporting practices, their impact on both groups of stakeholders, and the implications for the field. The goal of Project Streamline is to create a set of standards to inform grantmakers' decisions about their application and reporting practices.[1]
Results from Project Streamline prompted MeHAF to take a look at its due diligence process. Doing due diligence well requires learning enough about the applicant organization so that the foundation feels confident in making a grant without putting a huge burden on the applicant. It can be difficult to tell if an applicant is a good fit based on just a written proposal. We also want to know more about the organization's mission and goals, its programs, leadership,staffing, and finances.
Because applicants have expressed that the due diligence process can be frustrating ...
Patient and Family Engagement Ramps Up in MaineGeneral System
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This post is from both Barbara Leonard, Vice President for Programs, Maine Health Access Foundation, and Joan Orr, Project & Operations Manager for MaineGeneral physician practices. MaineGeneral has received MeHAF grant funding for their project, "Effective Patient Engagement in Primary Care Transformation." Joan serves as the program director, and Barbara oversees the grant for MeHAF.Barbara: "Some of these items make sense, but some of these are less important to me." This was the reaction I heard from a patient at a February meeting of the Winthrop Patient and Family Advisory Council. Council members were reviewing categories included in a summary of patient experience reporting on the performance of Winthrop Family Medicine and Winthrop Pediatric and Adolescent Medicine. Why were these patients and family members even looking at the information? Because MaineGeneral is committed to trying new ways of engaging patients and families to help improve how health care is delivered. The Advisory Council noted that for them, communication, as well as respect and trust between patient and provider are very important to a positive patient experience, whereas waiting time is less crucial. It was so good to see patients, family members and staff working together to figure out what elements of care are most important and think about how to make things work even better. I've asked Joan to share her perspective as program director.
Joan: Patient and Family Advisory Councils were started in 2010 at the Winthrop practices, and their work is translating to the system level. We at MaineGeneral are involving patients and ...
How Integrative Care Improves Life for Nursing Home Patients With Mental Health Diagnoses
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Natalie Truesdell is a consultant with John Snow, Inc, which has been providing evaluation services to the MeHAF Integration Initiative since 2009.
Mental illness, dementia and other behavioral health conditions in the nursing home are well-recognized challenges in both the clinical and policy arenas. It is estimated that 65-91% of adults in a nursing home have a significant mental disorder, such as depression or dementia.As one of MeHAF's 43 Integration Initiative grants, the Northeast Integrated Geriatrics Care project focused on changing the way mental health care is provided to elderly people, both in the nursing home and in the hospital. The Rosscare Nursing Homes led the project in its network of four homes, partnering with Eastern Maine Medical Center and the Acadia Hospital.
Rosscare found that older adults with mental health or dementia diagnoses were staying in the hospital for extended periods of time, even after their acute medical needs had been met. For example,from October 2008 through June 2009 there were 14 geriatric extended-stay patients who were in the hospital a total of 557 days with an average cost of stay for each patient of $724,100. To make matters worse, their mental health deteriorated as a result of staying in the disorienting hospital environment.
Often the reason these patients were not discharged to nursing homes was because nursing home staff did not feel prepared to care for patients with behavioral health conditions. Of course, many of these homes already had patients with mental health needs, for whom there was a lack ...
Vital Questions to Improve Your Vital Signs
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As a pediatrician I could always tell when the latest edition of Parent Magazine hit the grocery news stand. Parents would come into the clinic with questions prompted by the latest news stories about children's health. Those questions helped motivate me to brush up on the latest scientific evidence on issues like the relationship of vaccinations to autism, the risk of alar levels in apples, or even the impact of too much TV on infant brain development.Questions from well informed parents - and patients - keep doctors, nurses, psychologists and other providers on our collective toes. Asking questions helps build an open, trusting partnership between patients and their health care providers. Research shows that when patients and providers team up to explore questions and treatment options, patients feel better informed and are far more likely to select high quality but less invasive (and usually less costly) treatments.
For patients who want to be more active in managing their health and health care, the federal Agency for Healthcare Research and Quality has developed a list of ten questions that they suggest should be routinely asked of health care providers to get better, higher quality care:
- What is the test for?
- How many times have you done this procedure?
- When will I get the results?
- Why do I need this treatment?
- Are there any alternatives?
- What are the possible complications?
- Which hospital is best for my needs?
- How do you spell the name of that drug?
- Are there any side effects?
- Will this medicine interact with medicines that ...
MeHAF has gone paperless!
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Or at least our Discretionary Grants have. We've got to start somewhere, right?Over the last few years, Cathy Luce, MeHAF's Grants Manager, has worked tirelessly to implement our online application and online review processes. Yet, even while we were joining the modern world with one part of our system, there was another part that was clearly stuck in the dark ages: our filing system. We have several large (and I mean large) filing cabinets holding years worth of grant files scattered around the MeHAF office, not to mention our storage archives, which I've never seen, but am convinced are in some secret location deep under a mountain somewhere.
Needless to say, we are practically buried in paper. Why so much paper? Mostly due to requirements by the IRS and our auditors, but also because until Cathy got our online process up and running, paper was the only way to record and save information from our grant programs.
So last year, after Cathy and I worked together to develop the online review for Discretionary Grants and Meeting Support applications, it occurred to me: why aren't we paperless? I think there are some very good reasons why other programs at the Foundation can't go paperless yet, although I think they're mostly due to an attachment to hanging folders. But, as the administrator for the Discretionary Grants program, I do not have any kind of attachment to hanging folders, filing cabinets or paper clutter and decided we should be brave and make ...
Reaching More Maine People
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Here at MeHAF we've been working with a group of grantees since 2010 to reach out to Maine people, especially the uninsured and underserved, to inform them about changes in health benefits resulting from national and state health reforms. To help us be more inclusive in this work, we released a request for proposals in the summer of 2011, seeking organizations that could help us better reach communities with diverse language or cultural needs. We were able to fund two organizations, Maine Migrant Health Program (MMHP) and The Somali Culture and Development Association (SCDA), to expand the scope and impact of the larger group's work.With this grant funding, MMHP and SCDA have reached the people they serve, many of whom are new immigrants and migrants, with important messages about eligibility for a variety of health benefits and programs. Maine Equal Justice Partners (MEJP), a grantee from the first round of outreach funding, served as the content expert for the information they shared.
You may have seen the article in the Bangor Daily News summarizing some of the recent changes to eligibility for different benefit programs here in Maine, including MaineCare. These changes have the greatest impact on Maine's newest arrivals who have not yet been residents of the United States for five years. Working with MEJP, the MMHP and the SCDA worked to ensure that these complicated changes were explained clearly in appropriate languages and in a culturally sensitive manner.
Maine Migrant Health Program (MMHP), in partnership with Mano en Mano, reached ...
Wellness Innovators in Somerset County
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I recently attended a celebration meeting of the Micro-Wellness Project for Small Businesses, to acknowledge their first year of work, which is partially funded by MeHAF. This group is forging ahead with something that many would say isn't possible: providing comprehensive worksite wellness for rural micro-businesses.Why is this important? In Maine, about 64% of private businesses have 4 or fewer employees and 20% of workers are in businesses smaller than 10 employees.
What's a Somerset County micro-business? A law firm, a greenhouse, a printing shop, a grist mill, the local hospice volunteer organization. Some have only one or two full-time employees. All have a strong belief in the importance of healthy employees as an important element of business success. Greater Somerset Public Health Collaborative, the local Healthy Maine Partnership, has teamed up with Medical Care Development and the Somerset County Chamber of Commerce Wellness Council with support from Redington-Fairview General Hospital. Their aim is to create a virtual wellness program for these small businesses and to provide incentives similar to those enjoyed by larger businesses as part of insurance coverage and tax credits as proposed in the federal Affordable Care Act. The incentives and tax credits will be funded through grant funds, with a long-term goal of making a case that insurers could support such incentives even for small businesses.
By taking advantage of centralized, shared resources such as wellness coaches, model policies, and health risk appraisals, micro-businesses can offer customized wellness programs to their employees that might otherwise never have access to ...
Does the shoe fit?
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What do foundations look for in a good grant proposal?As a nonprofit applying for a grant, how do you know that your program or project is the right fit for a specific grant opportunity?
At MeHAF, we know the application process can be cumbersome. That is why we have spent a tremendous amount of time working on streamlining our proposal processes and why grantseekers are our first consideration as we put together our funding guidelines.
It's impossible to track the exact amount of effort that goes into releasing a MeHAF Request for Proposals (RFP), but nonprofits are often surprised to learn what a lengthy and thoughtful process it is. Our staff, our Board of Trustees' Strategic Planning and Grants Committees, as well as the entire Board review and approve concepts that require many hours of discussion, writing, and reviewing..."lather, rinse, repeat!"
We put in the necessary work up front with the intention of finding all the right partners to help MeHAF make a difference in the lives of Maine people.
Whether you are considering applying to MeHAF or to another foundation for funding, here are a few tips to help ensure you'll get the right fit:
- Read and analyze the RFP. Compare the guidelines with your project idea. Does the RFP truly allow you to carry out your project the way you intend?
- Is the grant funding truly worth the time and effort? Or will it actually cost your organization too much in staff time, consulting fees and reprioritization of work to ...
Can You Hear Me Now?
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I'm sure we have all seen the wireless phone commercials with the "can you hear me now" guy, and the large network that follows him wherever he goes. If they had filmed that commercial in Maine his network would have been much smaller and much less reliable-maybe one or two people who sometimes follow him around and at other times are nowhere to be found.
Consistent, reliable, and fast internet and cell phone connectivity is fundamental to competing in the global economy. While a great deal has been said and done around the issue of network connection in the state to support business development and access to education, Maine still suffers inconsistent and unreliable connections in our more rural areas. Recently, I learned this also has a huge impact on Maine's oral health safety net.
It's a fact. Recruiting and retaining dentists in Maine is already very difficult, largely due to the rural nature of our state. But what I learned on a recent learning collaborative call for safety net dental clinics is that there is another reason - unreliable and slow internet connections and spotty cell phone service. An expert advisor that has consulted with dental practices in 49 out of 50 states, including Alaska, said that he has not been in a state where it is more difficult to recruit and retain dentists than it is in Maine. His reasons? Travel distance and the condition of the roads of course, but he also highlighted cell phone service. He said he has not ...
White Coats in the Room: The Overlooked Ingredient in Health Reform
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With the death of Apple founder Steve Jobs, there has been a lot of analysis of his vision and leadership that has led us all to a transformed digital world. Visionaries like Jobs are rare, yet the reach of their work often strengthens our society.
On September 23rd, I participated in small roundtable discussion convened by another visionary leader, Dr. Don Berwick, a physician and founder of the Institute for Healthcare Improvement. As the current Administrator for the federal Center for Medicare and Medicaid Services (CMS), Dr. Berwick invited thirty "critical thinkers" from New England to discuss their insights, experiences and ideas about health care innovation. Over the course of the two hour discussion, only one person, Jim Harnar from the Daniel Hanley Center for Health Leadership, highlighted the issue of leadership development as a key strategy to push innovation and reform.
Jim's remark reminded me of another meeting I participated in a decade ago when I served as a senior policy advisor to the heads of two agencies in the federal Department of Health and Human Services (DHHS). At this meeting nearly thirty staff members from ten different DHHS agencies were discussing and drafting regulations for the State Children's Health Insurance Program. The discussion was lively with much debate, particularly around the issue of standards of care for emergency room visits.
As standards for ER wait times were proposed, I scanned the room. Most of the people were young, bright, and very accomplished in drafting regulations and legislation. Then I asked, "Who ...
The Best Health Care System in the World? Maybe . . . Maybe Not .
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We frequently hear that the United States health care system is "the best" in the world. It's hard to judge unless we know what standards are being used to determine what's bad, what's good, what's better, and what's best. Let's suppose the standards are related to medical technology and innovation. In that case, we certainly could consider ourselves best. We have outstanding technology and rapidly develop new medications and innovative techniques and products. Everyone knows someone with a new knee, a stent in their heart, or someone who is taking a new medication to help control high blood pressure.
But what if we use standards that compare how well we prevent illness and death?
On September 23, The Commonwealth Fund publicized a new study showing that the United States ranked last among the 16 high-income nations when it comes to preventing unnecessary deaths through timely access to effective health care. Unnecessary deaths include childhood infections, treatable cancers, diabetes, stroke and high blood pressure, and complications of common surgical procedures. When the U.S. figures were compared with France, Australia, and Italy, the three best-performing countries (there's that tricky word "best" again), the researchers found that 84,300 deaths in the United States could have been prevented in 2006 - 2007. That's a number equal to the populations of the cities of Lewiston, Bangor, and Waterville combined.
Perhaps it is time for us to have some real conversations about what we want from our health care system and agree on ...
Hitting it Out of the Park: How Teams Can Build Successful Integration Policy
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Benjamin F. Miller, PsyD, is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is responsible for integrating mental health across all three of the Department's core mission areas: clinical, education, and research. He is also the Associate Director of Research and Primary Care Outreach for the University of Colorado Denver's Depression Center. Dr. Miller received his doctorate degree in clinical psychology from Spalding University in Louisville, Kentucky. Dr. Miller is a co-principal investigator and co-creator of the National Research Network's Collaborative Care Research Network.
Policy is not a static construct, but rather a dynamically interacting set of efforts that conclude in a decision being made. This decision is often the best decision that can be made at that time, but as with most things, sometimes politics get in the way of good policy; sometimes, financial limitations and implications often trump sound policy. Most of the time, however, policy is a delicate balance of politics and financing while simultaneously trying to meet the community's needs.
Now, for a minute let's apply this philosophy to mental health and primary care integration.
On the surface, policies that address mental health and primary care are inadvertently bifurcated. Separate mental and medical systems often force different policies to be addressed depending on "whose team you are on." When it comes to integration, there needs to be a coming together of the mental health and physical health teams to address policies in tandem. This is ...
What is behavioral health, anyway?
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The next time you visit your doctor, glance around the waiting room. Of the 10 people reading the old magazines, seven are there to seek care for issues related to behavioral health. They might have symptoms of depression, anxiety or other mental health conditions. They might need to change behaviors to manage chronic diseases such as diabetes or cardiac conditions. They might have a drinking or drug use problem that is affecting their health and relationships. They might want to lose weight or to quit smoking.
Regardless of the reason for the office visit, doctors can assume that most of their patients will have both physical and behavioral health issues. Because Maine's doctors, nurses, therapists, and other health professionals want to offer the highest-quality care, a growing number are offering integrated behavioral health and primary care to their patients.
That prompts the question, "What is behavioral health?"
"Behavioral health" often is used to describe the connection between our behaviors and the health and well-being of the body, mind, and spirit. This includes behaviors such as eating habits, drinking, or exercising that either immediately or over time impact physical or mental health. It can also include broader factors such as having to live in an area with high pollution or experiencing high levels of stress over a long period of time.
Some of these behaviors are under our individual control. However, sometimes our choices are limited by factors beyond our immediate control, such as pollution by a nearby factory. For example, obesity is affected by my ...
Getting to Know Maine Communities
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My hometown of Bangor sits like the center of a compass amid Maine's many communities. With grandparents living in Mars Hill and Cape Elizabeth, I spent my holidays travelling to one end of the state or the other. I learned at an early age that each community in Maine is different, and that getting to know a community takes time and it requires building some trust. I'm lucky I had the opportunity to spend years practicing seeing what was most important to those communities so I could better understand the people who lived there. This practice of seeing and responding to Maine people and Maine communities is what both grounds and inspires my work at the Maine Health Access Foundation (MeHAF), and it is a key part of transforming the system for health care delivery in Maine and, ultimately, improving the health of Maine people.
MeHAF values the time staff spends in communities and believes the Foundation's work should be guided by the people it was created to serve; those who are uninsured and medically underserved. That commitment is evident from the Foundation’s actions. For example, one of the Foundation’s first activities was to hold listening sessions around the state in 2002. These listening sessions shaped MeHAF’s strategic approach because Maine people, many with significant health care needs of their own, encouraged the Foundation to focus on fixing the health care system instead of using the Foundation’s assets to pay for direct services or insurance coverage for a limited ... The Tools Are Up to the Task
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Does philanthropy need to be reinvented? That's the question I've been asking myself after reading articles from the New York Times and Philanthropy News Digest about how Google.org (DotOrg) has found it hard to reinvent philanthropy. DotOrg tried to harness Google's ability to incubate ground-breaking ideas and their powerful search engine capabilities to develop a new tool that would aggregate data in new and creative ways to help solve large scale social issues. But is this reinventing philanthropy? The phrase "reinventing philanthropy" implies that either we - or our tools - are not up to the task. I understand that foundations have had a difficult time providing evidence of their impact despite the considerable resources dedicated to various causes. Yet I would argue that it's a lack of imagination, and not a lack of adequate tools that keeps us from being effective. Our tools - grant funding, convening power, policy research, grant databases, evaluation, funder collaborations, program-related investment, and more - are up to the task. We don't need to reinvent, we simply need to reimagine both how we deploy our tools, and with whom we partner.
MeHAF has tried to reimagine how we can be more patient-centered by integrating physical and behavioral health. Our integration initiative emerged from multiple conversations with Maine people, and resulted in the report Maine Integrated Health Initiative: Maine People Speak About Health Care Integration. We have funded both planning and implementation grants, and all grantees have participated in an initiative-wide evaluation. We continue to support quarterly learning community ...