Effective leadership of an organization includes being sensitive to the needs of the people it serves, the staff, and the organization's mission. The day after the Boston Marathon bombings, the Opportunity Alliance CEO Mike Tarpinian sent this email to his staff, acknowledging the impact the bombing has had on people, but also encouraging staff to speak out to correct claims inaccurately suggesting that the perpetrators of violence are violent because they have mental illness. We join Mike in recognizing that we all have opportunities to reduce stigma by sharing accurate information about persons who experience mental illness. We applaud Mike for this sensitive and balanced message, and, with his permission, wanted to share it with the MeHAF community.
From: Mike Tarpinian
Date: April 16, 2013
Subject: Tragedy of Boston Marathon
As I head out of town to spend some time with my family during school vacation, I could not let the events of yesterday go by without connecting with each of you.
Our hearts and prayers go out to the people of Boston and to the families of the victims and injured as they begin to face the realities of lost limbs and months of rehabilitation, but none so tragic as the loss of life and especially the loss of a child.
As we try to process the senseless bombing of innocent victims at the finish line of the Boston Marathon, there are many people who are trying to find quick answers to a very complex situation. To begin to explain so soon ...
I sat stunned as I listened to news reports of yet another tragedy of mass violence causing at least three deaths and over 170 injuries. This time, the horrific event was even closer to home-in Boston. Another person had shattered the social contract we expect of all people-to nurture fellow humans and not to kill them. The act of violence killed and maimed; it also diminished our trust in others.
The pain of the trauma seemed personal to me as I imagined how awful it must be for not only the victims, but also their loved ones who would be receiving phone calls telling them about the suffering or death. You see, because of my husband's death in an accident, I know what it is like to receive a call saying the person you love more than life itself has died unexpectedly and suddenly. It reopened wounds of grief and loss I thought had long ago healed.
Because most of us have experienced loss or other traumas, events such as the Newtown, CT, or the Boston tragedies can re-traumatize us. The war veteran sees images of the bomb blast on television that are too similar to what she experienced in the war zones, prompting symptoms of Post Traumatic Stress Disorder (PTSD). A first responder at the scene or an emergency health care provider at the nearby hospital is impacted by having to rescue a wounded child, recognizing how fragile his own son's life is. He has intense nightmares for weeks.
When we collectively experience ...
Mia Poliquin Pross, Esq. is the Associate Director of Consumers for Affordable Health Care.
Since shortly after passage of the Affordable Care Act (ACA) in 2010, Consumers for Affordable Health Care (CAHC) has participated in a collaborative effort with 10 other organizations supported by MeHAF to get the word out on what the ACA will mean for Maine people. As part of this effort, CAHC conducts workshops across Maine where we often ask people: How many of you have heard that you must have health insurance in 2014? Almost all raise their hands. We then follow it up with this question: How many of you know that there will be subsidies that will help you pay for health insurance?
Crickets. No hands.
Therein lies the rub, and our job as advocates during this critical year for implementation of the ACA.
I venture to guess that many people reading this blog are health advocates or are otherwise "in the know" on health reform. This year, our job as advocates is to remember that we know more than the average person, and to share what we know - as often as we possibly can. Our health care system (using that term loosely) is a complex, tangled web of laws and regulations and all sorts of variables and moving targets. Putting all the wonk-talk aside, however, from our experiences at CAHC talking to real people on our HelpLine and in communities, here are 3 basic things about the ACA that all advocates and others in the know should tell people ...
Jaime Rosenthal, a senior at Washington University in St. Louis, recently got a lot of attention for her summer research project on the availability of health care cost information. She called 122 hospitals around the country to ask the cost of hip replacement surgery for her (fictitious) uninsured grandmother who had the means to pay for the surgery. The report, published in the online version of JAMA Internal Medicine, sparked a media frenzy, including press coverage at NBC News, blogging by the New York Times, Reuters, and numerous commentaries in health care industry journals.
The bottom line was that the prices she was able to obtain varied enormously, for no discernible reason, from about $11,000 to over $125,000. It was very difficult for Ms. Rosenthal to get any kind of price estimate from a significant percentage of the providers she called. Co-authors of the report from the University of Iowa recommended that patients should put pressure on providers to be more transparent about costs and that "patients seeking elective THA (total hip replacement) may find considerable price savings through comparison shopping."
To test the researchers' recommendations, I did some savvy shopping of my own. In a quick check on the Maine Health Data Organization's (MHDO) Health Cost Calculator website, I discovered that Maine reflects the nation pretty closely: payments made for hip replacements varied from around $10,000 all the way up to nearly $100,000, with most in the $15,000 - $25,000 range. (For more detail on the cost data I ...
In the decade that has passed since the Enron collapse (yes, it really has been that long!) and the overhaul of the board governance standards we often refer to with the shorthand "Sarbanes-Oxley," it has become not only a best practice but, increasingly, a standard practice for organizations of all types - including publicly-supported 501(c)(3) non-profits and private foundations - to adopt conflict of interest policies. At the heart of every one of these policies is the core concept that board members, staff, volunteers, and their close family members should not personally benefit from the decisions in which they are involved or over which they have some influence.
Most conflict of interest policies focus on what are described as "business conflicts," which tend to be relatively easy to spot and navigate, as long as all involved openly disclose potential conflicts. Basically, if the foundation is considering a financial transaction and you, your family, or your business could benefit from that transaction, the foundation's conflict of interest policy should have guidelines that either prevent you from voting, remove you from the discussion, or disqualify you (or your family member or business) from consideration. Failing to avoid such conflicts or running amok of the IRS regulations on "self-dealing" can jeopardize the foundation's nonprofit status and have legal ramifications for all involved.
While foundations may choose to limit their conflict of interest policies to deal with business conflicts, the Maine Health Access Foundation (MeHAF) has taken its own conflict of interest policy a step further to include ...
In case you missed the announcement by the U.S. Department of Health and Human Services late last week, Maine was one of the first states to receive State Innovation Model (SIM) funding to test new ways to lower costs and improve care within the Medicaid program.
Other states in this first group of six are Arkansas, Massachusetts, Minnesota, Oregon and Vermont, which will implement plans to transform their health care delivery systems under President Barack Obama's health care reform law, the Affordable Care Act. Twenty-five states will eventually share $300 million in funding for the overall venture.
This new award advances some key initiatives that MeHAF has supported over the last decade, particularly integrated care, payment reform, and Health IT.
Exciting news for health reform in Maine!
With the rest of America, I watched in horror as details emerged on the shootings at Sandy Hook Elementary School in Newtown, Connecticut in December. Even though I know better, I’ll admit that the thought crossed my mind: “How can a sane person brutally murder so many fellow humans, especially innocent children and educators?”
I know better because I understand that violence is not associated with “insanity,” i.e., mental illness. I know it is as absurd to say, “People with mental illness are violent” as it would be to say, “People with diabetes are violent.” People without mental illness commit 96% of the violent crime in America. Research consistently shows that the two greatest risk factors for violent behavior are being male and being young.
I know better because data show that the rate of persons with mental illness who commit violence is no higher than the general population’s rate of violence. After eliminating confounding factors, the MacArthur Violence Risk Assessment study published in the June 2003 World Psychiatry concluded that the rate of violence committed by non-substance-using persons with a major mental disorder is the same as the rate for the non-substance-using general population. For some mental illness conditions, it is less. Substance abuse, however, does increase the risk of persons from both groups engaging in violent behavior.
Contrary to pop culture depictions of people with mental illness, I also know that this group is more likely to be victims of violence rather than perpetrators of it. A recent study of criminal ...
On the third day of the Policy Leaders Academy bus tour, one of the stops was the Margaret Chase Smith Library in Skowhegan, where the group ate lunch and heard several panel presentations. The library is in Margaret Chase Smith’s former home, on a knoll overlooking the Kennebec River, with downtown Skowhegan just downstream.
The two large buses pulled up to the small white house and 75 Maine legislators entered a space filled with pictures, news articles, political cartoons, and memorabilia, all highlighting Margaret Chase Smith’s remarkable life. MCS (as she is familiarly referred to in many of the exhibits), was the first woman elected to both the US House and Senate, and had her name placed in nomination for US President by the Republican party in 1964.
She was born over two decades before women even had the right to vote.
And of all of her notable accomplishments, the one that resonated with me most clearly that day was MCS’s “declaration of conscience,” which put her reputation and political career at risk by opposing the tactics of McCarthyism.
She was a bit of a renegade. She didn’t tolerate nonsense. Pretty typical for someone from Maine.
During lunch, several legislators talked about how they could take a longer-term approach to complicated issues in our state. One idea was to think differently about legislative fiscal notes so that decisions about education, health care, economic development and other crucial state-supported activities are driven by fiscal understanding that looks five or ten years into the ...
Last week, I had the chance to tour the UPM Madison paper mill as part of the Maine Development Foundation's Policy Leaders Academy (PLA) bus tour of central Maine. (See Wendy's blog from 1/15 for more on the PLA.)
The mill is located in Madison, just northeast of Skowhegan, right in the center of town along the Kennebec River. Our group of 70 legislators and guests shuffled off the buses and into the historic mill where we heard from UPM Madison's CEO, Russ Dreschel. Russ gave us a brief history of the mill, including its purchase a couple of years back by a Helsinki, Finland based company, UPM.
The international nature of UPM's business brought up a lot of questions from the group about global competitiveness, including the impact of the U.S. health care system on the ability of U.S.-based operations to stay competitive. Russ explained that it costs up to 40% more for him to employ a worker in the U.S. than it would in Germany, most of which is due to the cost of providing health insurance. Germany has a national health care system so private companies don't need to shoulder the cost of providing health insurance.
There are certainly other factors to consider in that percentage difference, but 40% is a stark figure.
The good news is that UPM Madison is taking steps to lower its health insurance costs. Michael Michaud, Madison's Director of Human Resources (not to be confused with Maine ...
As members of the 126th Legislature flocked to Augusta for the new session, about 75 members of the House and Senate kicked off their terms by boarding a tour bus for a three-day program that highlights people, places, and organizations in Maine that many had never seen before. The bus tour, which is part of the nonpartisan Maine Development Foundation's biennial Policy Leaders Academy (PLA) program, provides an opportunity for lawmakers to learn from different communities and local leaders about issues, concerns, and creative solutions to some of Maine's most challenging issues.
Since 2007, MeHAF has been a PLA sponsor. Because of our involvement, MeHAF was invited to send a staff person to ride along on the tour. From the events of the first day, I took home a few lessons from the back of the bus.
First, bus rides give you the chance to get to know your fellow travelers. It's been said that a factor driving the partisan rancor in Congress is that lawmakers rush back to their home districts at the end of the week rather than spending time in Washington getting to know each other. Developing personal relationships is an important step to understanding different points of view and establishing trust - all key factors that make lawmakers more open to compromise. On our bus there was lots of friendly conversation across the aisle (literally and figuratively) as legislators got to know new and returning colleagues.
Second, bus rides give you time for reflection between stops. The first day ...
Heather Burt is the Executive Director of FARMS (Focus on Agriculture in Rural Maine Schools). FARMS was initially awarded funding through MeHAF's Fund for the Future program in 2009, with a renewal grant awarded in 2012.
With obesity rates and related diseases on the rise and local communities struggling for independent sustainability, FARMS (Focus on Agriculture in Rural Maine Schools) offers solutions. Through hands-on education, we are building a generation of educated consumers who are relearning the art of eating locally, healthfully, and with an openness to trying new things. Although FARMS is very lucky to exist in a community where action is taking place on many levels and by many people, we find that we are increasingly being called upon to offer our expertise and team approach to incorporating local foods and garden education into the school systems, camps, and the broader community. Currently FARMS is joining individuals, farmers, medical practitioners, and several small businesses to develop the FARMS Community Kitchen and Food Learning Center, a demonstration kitchen with hands-on programming that meets the needs and interests of a broad range of people. It has become clear to us that in order to ultimately change the eating habits of children, we must simultaneously support healthier eating habits in their community. This year has marked the beginning of many new and exciting opportunities.
Since 2009, virtually free of charge to the schools, FARMS has offered our classroom and cafeteria-wide taste tests, culinary clubs, hands-on garden curriculum, staff enrichment, Healthy Local Snacks Program, and procurement support ...
Catharine Hartnett is a communications consultant based in Portland, Maine. Clients include philanthropies, nonprofits and companies. She has provided communications support to MeHAF for several years, having the opportunity to learn the ins and outs of Maine's health care systems.
"Get rid of Obamacare!" "I like that my daughter can stay on my health plan." "I don't want the government telling me what I need for health care!" "Thank Goodness I can't be denied coverage anymore because of a preexisting condition." "The Affordable Care Act will cost too much!" "I feel more secure now that the 'doughnut hole' in my drug coverage is gone."
Figuring out how to tell people what the tangible, you-may-experience-this-tomorrow benefits of the Affordable Care Act are is a budding case study in communications challenges that may eventually rank up there with the crisis management of the 1982 Tylenol scare in communications course favorites.
As someone who advises even the smallest organizations about the importance of communications strategy, I have wondered why the new reform package didn't come with clear operating instructions. Why not direct agencies to tell their constituents, clearly and concisely, how they would benefit? Rather than endure the howling and resistance that persisted in the information vacuum, why not take the guess work out of the equation immediately?
Luckily, Maine didn't wait. Eleven advocacy organizations, funded by MeHAF, together developed a comprehensive communications strategy to tell their respective stakeholders exactly how they would benefit from reform. Representing MeHAF's priority populations of uninsured Maine ...
Natalie Truesdell, author of the study, is a consultant with John Snow, Inc, which has been providing evaluation services to the MeHAF Integration Initiative since 2009.
If the goal of health care organizations is better health outcomes for their clients, then patient engagement is key. Health care providers who are engaging patients consider the patients' needs, preferences and perspectives when care decisions are being made. Patient engagement leads to higher patient satisfaction and lower costs.
Patient engagement has been a central component of the projects funded through MeHAF's Integration Initiative, which seeks to improve the integration of primary health care with behavioral health care. MeHAF believes that engaging patients means ensuring they are active participants in their own care and that patients' perspectives are contributing to decisions made at higher levels in the organization and the health care system.
Over the course of this initiative, our grant partners have collected experiences and insights into improving patient engagement. We have gathered those experiences into a case study that describes strategies used by diverse organizations to engage patients at each level of health care decision-making.
At the level of the individual patient's experience and his/her experience with the clinic, the key to patient engagement is a trusting relationship between patient and staff. The experience starts when the patient is welcomed into the office by reception staff. One program that trained front desk staff at primary care practices on how to improve their interactions with patients with mental health conditions helped everyone at the practice to ...
This is a joint blog post from Barbara Leonard, MeHAF's Vice President for Programs, and MeHAF grantee Jim Harnar, the Executive Director of The Daniel Hanley Center for Health Leadership.
Barbara: In 2009, Maine Health Access Foundation provided a grant to the Daniel Hanley Center for Health Leadership to support the Health Leadership Development Program (HLD). The Hanley Center brings current and emerging leaders from health and public health from across Maine to develop their skills and enhance their capacity to practice Values Driven Leadership: "A conscious commitment by leaders at all levels to lead with their values and create a culture that optimizes ethical practice and social contribution."
MeHAF's grant focused on providing resources to increase the diversity of participants in the HLD program, with a particular emphasis on including participants who represent or work with individuals who are uninsured or medically underserved. The grant allowed for scholarship support for individuals who otherwise might not be able to be a part of the program, and also supported creation of an advisory committee that not only helped to recruit these "MeHAF Scholars," but also focused on enhancing the program's curriculum to address issues of diversity and health disparities.
As a grantmaker, I try to support grantees in their work, serving as a sounding board, and when appropriate, helping to solve problems. Mostly, I try to help grantees develop clear work plans and then stand back and let them take the work forward. This grant to the Hanley Center went farther and reached heights ...
Emma Ansara is a family nurse practitioner providing primary care to patients across the age spectrum at Western Maine Family Health Center in Livermore Falls, ME. She is the clinical lead for a MeHAF-funded Integration Initiative implementation grant at HealthReach Community Health Centers in which LCSWs are embedded in the primary care setting to provide behavioral health support and limited mental health counseling. HealthReach Community Health Centers is a network of 11 federally qualified health centers serving people in more than 80 towns and cities in western and central Maine. (The patient names have been changed to protect their privacy.)
I recently met a new patient in the final visit slot of the morning. When I walked in the office, I was surprised to see Veronica, as the week before she had accompanied a well known patient, her new husband, Don at his annual check of chronic health conditions.
As a young man, Don had undergone major cardiac surgery after years of a non-specific diagnosis of gastroesophageal reflux disease (GERD). Subsequent limitations on activity had lead to a lengthy disability and job retraining that had left him frustrated and depressed. At his recent visit we spent most of the time discussing his mood. While he did not opt to pursue treatment for his depression with counseling or medications, using the PHQ screening tool, we discussed viable options and a plan for managing and monitoring his depressive symptoms.
As I started my visit with Veronica, she interrupted and said, "I know this visit is supposed to be ...
Jeff Wahlstrom is managing director of Starboard Leadership Consulting, and the Board Chair of the Maine Health Access Foundation.
For the trustees of some foundations, board service can begin to feel like an open-ended "commitment" (with all the positive and negative connotations that word can carry) stretching endlessly towards the horizon. While the continuity provided by long-time board members certainly has value, I believe that planned turnover on a board offers tremendous benefits that far exceed whatever disruption may be caused by bringing on new board members and saying goodbye to others.
As a trustee of the Maine Health Access Foundation (MeHAF), and as a governance consultant to nonprofit boards, I've seen firsthand the benefits that result from term limits. The best boards-strategic boards-see recruitment as an opportunity to enhance their skill-sets and to bring on board members who have what it takes to help them meet the challenges and opportunities that lay ahead. Rather than trying to fill board seats with people who look a lot like the people who just sat there, they ask themselves, "What are the skills and abilities we'll need around this table in three years, five years, or more?" and then they go out and get them.
At MeHAF, board members can serve a maximum of three consecutive three year terms, allowing ample time for new board members to understand how the foundation works, fully appreciate its mission, and grasp the complex work involved in promoting access to health care for the underserved and uninsured in Maine. Nine ...
Susan Grantham and Natalie Truesdell of John Snow, Inc, have been working on a state-wide evaluation of the clinical implementation component of MeHAF's Integration Initiative.
Healthy Amistad, a MEHAF Integration Initiative project, was launched to help people with mental illness improve their physical health through lifestyle changes and helping them to overcome barriers they face in getting medical care.
Studies show that people with severe and persistent mental illness (SPMI) die, on average, 25 years sooner than people of the same age without mental illness, primarily due to chronic disease and other medical co-morbidities that often are undertreated or untreated. The problem can often be traced to lifestyles, impact of medications, and increased risks of chronic health conditions.
These factors are compounded by a fragmented health care system in which mental and physical illnesses are treated entirely separately, and a health system that focuses on illness rather than wellness. Additionally, bias and stigma related to mental illness and lack of medical provider familiarity and experience caring for persons with SPMI can negatively affect care and the patient-provider relationship.
Members of Amistad, a peer support and recovery center near Portland, decided to try to address the disparities in health and life expectancy for those with mental illness. To start, Healthy Amistad focused on helping their members with mental illness improve their overall health through increased focus on healthy diet and physical activity. They hired a chef to develop a Healthy Amistad nutrition program, who introduced healthier lunch choices and a salad bar to the onsite cafeteria ...
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.
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 ...
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 ...
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 ...