When is one and one more than two?
During a recent presentation by the medical director of a local Federally Qualified Health Center (FQHC) on the opening of a new site, I realized that Washington Square Health Foundation (WSHF) had funded a grant to the organization’s original clinic. The grant was from several years ago and it took a few minutes for me to associate that original funding to what is now the FQHC’s third site of care. It got me to thinking on how often a modest grant can have multiple, positive consequences. As I discussed this observation with Howard Nochumson, Executive Director, and Catherine Kapella, Program Director, we started to recall many examples of WSHF grants triggering additional benefits not envisioned at the time of the original request.
For example, a grant to The North Park Friendship Center, a food pantry that primarily serves the Albany Park neighborhood, was used to develop a second site in Lincoln Square. The number of clients served every month has significantly increased and the neighborhoods covered has doubled between the two pantries. How many nutritionally at risk families are now receiving more adequate and healthy food?
An ongoing grant to Lurie Children’s’ Hospital helps to fund a post-graduate fellowship in pediatric hematology and oncology. The graduates of the fellowship have gone on to do cutting edge research or to provide expert clinical care for some of the most fragile and critically ill children. Since the expense of the training program is not covered from the usual funding sources, this important resource in pediatric care could diminish without foundation support. How many pediatric lives would be at risk and families negatively impacted without these physicians?
A WSHF grant to A Silver Lining Foundation was used to bring breast cancer awareness and proper breast instruction to young women who may not receive such information until they are over 40. The original program design was twofold; to teach young women to be advocates for their own health and to become breast cancer advocates in their homes and communities. It also had an unexpected benefit with older women now requesting information based on interactions with the younger women. How many women of all ages are now aware of the importance of breast health and cancer screenings?
Loyola University Stritch School of Medicine has developed a state of the art center to assess and train fourth year medical students in the clinical knowledge and skills that they will need in the next step of their medical education – residency. WSHF helped to support the development of a competency based curriculum that enhances medical students clinical clerkships while building their team based interactions with other health care professionals. Ultimately, this clinical curriculum will improve patient safety when translated at the bedside. How many potential errors and deaths will be avoided when these students enter practice?
These are just a few examples of how a foundation’s funding can provide benefits beyond the original purpose and intent of a grant. WSHF’s staff and Board have always used, as one of their grant making criterion, the potential of a grantee to provide more than just the immediate health care service for which the funding is requested. That is, to create the possibility of enhanced future health care outcomes. A major portion of this grant making lens is focusing on grantees which have the potential to create positive, unanticipated consequences. This means not only focusing on the organization, its ommunity and its financial and health care statistics, but knowing and supporting its leadership, who often are the catalysts for organizational growth in providing positive future health care outcomes.
During this time of increasing focus on spending health care dollars more wisely, we need to hear more stories about the successful and innovative use of grant funding to amplify and multiply scarce resources.
William N. Werner, MD, MPH, FACP
Observations: What’s Ahead for Health Care Reform?
It’s been almost five years since the Affordable Care Act (ACA) was passed and signed into law. For the past two years, online exchanges or marketplaces have been enrolling millions of people into health insurance. Despite these milestones, the future of the ACA in its present form is uncertain. 2015 may bring developments that will reshape how people get and pay for health care coverage. Expect to hear about the following issues.
The new Congress may take a mostly symbolic vote to repeal the ACA in its entirety. If passed, the President would certainly veto any such legislation. I do predict that Congress will act to change or eliminate certain parts of the ACA that are controversial or unpopular. Provisions that are being targeted include a tax on medical devices, mandates requiring every citizen to have health insurance, employer mandates on work hours and an appointed board that would be required to control Medicare costs. Some of these items may have bipartisan support, but, again could face a Presidential veto.
Since Congress also controls the appropriation of funding for federal programs, there may be efforts to reduce or restrict money used to implement elements of health care reform. Funding for the operation of the health insurance exchanges or the expansion of Medicaid in states could be in question. On a state level, Illinois has a new governor who is facing very serious financial challenges. Will an expensive program such as Medicaid be looked at for cost reductions?
One of the most serious threats to the ACA is pending before the Supreme Court of the United States. A case will be decided later this year that challenges the legality of health insurance subsidies for coverage purchased through exchanges that are jointly run through state and federal governments. Subsidies help up to 80% of people buying health insurance on exchanges in several states, including Illinois. Loss of subsidies would likely make coverage unaffordable for most people and effectively would cripple the ACA. Expect a ruling sometime in June.
Another concern is the number of health young people who are buying health insurance on the exchanges. Young adults between 18-34 years of age are needed to enroll in order to help pay for older, sicker enrollees. Younger people are also needed to keep the cost of premiums lower. The ACA is not opular with some young adults both because of premium costs and the perceived lack of need for health coverage. So stayed tuned in 2015 for some very interesting debates.
Bill Werner, MD, MPH
These observations shaped a discussion at the foundation’s recent annual meeting on the future impact of the ACA on funding priorities for WSHF in 2015. WSHF will continue to consider grants that help to “fill the gaps in the ACA.” Based on the above observations, those gaps may widen, depending on the directions taken by the various stakeholders.
– See more at: https://wshf.org/annual-report/#sthash.FSh47e1P.dpuf