Health Philanthropy

Announcement to grantseekers:

 The George Gund Foundation announced in its 2006 annual report, just released in spring 2007, the following: “We will require all organizations seeking grants from the Foundation, beginning with proposals submitted for our September 15, 2007, deadline, to include statements about what they are doing or considering doing to reduce their impact on the accumulation of greenhouse gases. For many grantees, this will be a new consideration. . . . Finally, it is important to note that these changes [to proposal requirements], although emanating from the Foundation’s long-standing environmental concerns, apply across all program areas.” Gund, which is located in Cleveland, Ohio, does some funding in the health policy area under its Human Services program. See the foundation’s Grant Program Guidelines on pages 44–45 of the annual report for details.

For additional information on the climate change policy, go to http://www.gundfoundation.org/NEWS_AND_PUBLICATIONS/NEWS/Climate_Change_Policy.asp.

Oral Health Care 

Recently awarded funding:

“Robert Wood Johnson Foundation Pledges an Additional $4 Million to Improve Dental Health for Low-Income and Underserved Populations,” Robert Wood Johnson Foundation (RWJF) and Pipeline Profession and Practice: Community-Based Dental Education program press release, 30 April 2007, http://www.dentalpipeline.org/newsandmedia/pressreleases/news-rwj_pledges.html. This $4 million is going to the Pipeline program, which the RWJF created in 2001; its initial grant for this national program was augmented by funds from the California Endowment and the W.K. Kellogg Foundation. The RWJF’s $23 million total investment in the program “is the largest investment [by] any foundation in oral health in [the past] two decades,” according to the release. Judith Stavisky of the RWJF noted in the release, “The recent deaths of children in Maryland and Mississippi from lack of dental care illustrate the importance of the dental safety net for vulnerable populations.”

Recent report:

Denti-Cal Facts and Figures: A Look at California’s Medicaid Dental Program, California HealthCare Foundation (CHCF), March 2007, 42 pp., including glossary, http://www.chcf.org/documents/policy/DentiCalFactsAndFigures.pdf. The foundation reminds us that “oral health is essential to overall health and quality of life.” California provides “dental services to both children and adult” Medi-Cal (California Medicaid) enrollees, even though the federal government only requires it to provide such services to children under age twenty-one. Although technically the term Denti-Cal refers “only to dental services [obtained] through Medi-Cal fee-for-service (FFS),” this report also includes claims filed by dental managed care organizations serving Medi-Cal enrollees. One access barrier affecting Denti-Cal use is that just “40 percent of California’s dentists accept publicly insured patients.” (This statistic comes from a 2003 University of California, Los Angeles, survey.) In a section called “Recent Legislation and Policy Changes,” the CHCF notes that a requirement, effective January 2007, for “an oral health screening within [the] first year of entering public schools,” is going to “put additional demands on all dentists to see children enrolled in Medi-Cal. Also, despite the health dangers of periodontal disease for pregnant women and their babies, only 20 percent of pregnant Medi-Cal enrollees went to a dentist, the report says. It contains a helpful glossary, the source of which is the American Dental Association (ADA). Len Finocchio was the lead CHCF staffer on this project; analysis was done by Thomson-MEDSTAT.

Recently announced foundation funding area:

When the CHCF recently underwent a programmatic restructuring, following a new strategic plan, it added an oral health funding objective: “Improve the availability of specialty and dental care for underserved Californians.” This falls under its broader Innovations for the Underserved program.

For more information, read the Frequently Asked Questions about sending an unsolicited proposal, or send e-mail to Len Finocchio, senior program officer, lfinocch@chcf.org.

Related resources:

Fluoridation Facts, ADA, 2005, 69 pp., http://www.ada.org/public/topics/fluoride/facts/index.asp. This booklet includes “answers to frequently asked questions regarding community water fluoridation,” according to the ADA Web site. Several of these questions, the ADA maintains, “are based on myths and misconceptions advanced by a small faction opposed to water fluoridation.” The ADA says that the answers in the booklet “are based on generally accepted, peer-reviewed, scientific evidence.” The booklet may be purchased for $17.95 (nonmembers) and $11.95 (members) by doing a search of the association’s online catalogue.

“Hearing on Md. Child’s Death Explores Dearth of Dental Care,” Mary Otto, Washington Post, 3 May 2007, http://www.washingtonpost.com/wp-dyn/content/article/2007/05/02/AR2007050202539.html.

Improving Oral Health Care for Young Children, Shelly Gehshan of the National Academy for State Health Policy (NASHP) and Matt Wyatt of the University of Iowa, April 2007, 36 pp., including appendix and notes, http://www.nashp.org/Files/Improving_Oral_Health.pdf. This report, which addresses the challenges that must be surmounted to improve oral health care for this population, includes a useful table on “Provider Capacity for Working with Young Children.” Another interesting table, “The 15 Most Populous Non-Fluoridated Communities,” reveals that this list includes San Jose, California; Tucson, Arizona; and Newark, New Jersey. Among the “promising models” described is Washington State’s Access to Baby and Child Dentistry (ABCD) program; the report says evaluations of it “have demonstrated its overall effectiveness.” The report’s suggestions for policymakers include “Congress should consider making dental services a mandatory benefit, and a required part of well child check-ups, in the reauthorization of the SCHIP [State Children’s Health Insurance Program] in 2007.”

“Medicaid Dental Help Expanded to Adults,“ Ashlee Clark, Washington Post, 14 June 2007, http://www.washingtonpost.com/wp-dyn/content/article/2007/06/13/AR2007061302302.html. Read this news about the District of Columbia’s Medicaid program.

“Wynn Proclaims: Make Access to Dental Care for Children a Priority,” Office of Rep. Albert R. Wynn (D-MD), 24 May 2007 press release, http://www.wynn.house.gov/index.php?option=com_content&task=view&id=392. This release describes H.R. 2472, the Essential Oral Health Care Act of 2007, which Rep. Wynn sponsored. H.R. 2472 has been referred to two House committees.

State Health Policy

Recent reports:

Aiming Higher: Results from a State Scorecard on Health System Performance, Joel C. Cantor and Dina Belloff of the Rutgers University Center for State Health Policy and Cathy Schoen, Sabrina K.H. How, and Douglas McCarthy of the Commonwealth Fund, released 13 June 2007, 73 pp., including appendices, http://www.commonwealthfund.org/usr_doc/StateScorecard.pdf?section=4039. Funded by the Commonwealth Fund. This “first-ever” scorecard ranking each state and the District of Columbia on thirty-two measures was prepared for the Commonwealth Fund Commission on a High Performance Health System, according to an e-alert. The measures relate to access, avoidable hospital use and costs, health care equity, “healthy lives” (which, the report says, is “ability to live long and healthy lives”), and quality of care. Among the report’s “cross-cutting” findings are that “across states, better access is closely associated with better quality” of care; important opportunities exist “to reduce costs as well as improve access to and quality of care”—higher quality of care “is not associated with higher costs across states”; and all of the states “have substantial room” for improvement. The authors find that “health system performance often varies regionally. . . with those [states] in the lowest quartile concentrated in the South.” As to adults age fifty or older “receiving all recommended preventive care,” the median for all states in 2004 was only 39.7 percent. When the authors looked at the percentage of “children insured,” the median for all states in 2004–2005 was more encouraging, 91.1 percent. The publication includes suggested policy strategies in the chapter “Moving Forward: The Need for Action to Improve Performance.” Another report prepared for the commission, Why Not the Best? Results from a National Scorecard on U.S. Health System Performance was released in September 2006.

Health Care Vision 2007 and Beyond: Colorado’s Health Care Marketplace, Colorado Health Institute, released 2 February 2007, 23 pp., including appendices, http://www.coloradohealthinstitute.org/documents/HealthCareVision2007.pdf. Research funded by the Colorado Health Foundation. The institute’s Pam Hanes says in the introduction to this policy brief, written by Amy Downs, that “in many ways, [it] represents an oral history of health reform in Colorado since the early 1990s.” Four major topics are discussed: private health care market trends (such as consolidation of health plans); small-group health insurance reforms; effects of the tobacco settlement (the 1998 Master Settlement Agreement) and Amendment 35 on the state; and the various public programs, such as Medicaid and Child Health Plan Plus. Among the brief’s key findings are that despite the state having implemented, back in the mid-1990s, “some of the most far-reaching” reforms in the United States to Colorado’s small-group market (many of which were “undone” in recent years by the Colorado legislature, while others were “federally codified through the Health Insurance Portability and Accountability Act [HIPAA] of 1996), the number of people “covered in the small group market has decreased substantially.” Another finding was that the fate of publicly funded health programs in the state "has been heavily influenced” by “fiscal conservatism [there] and the electorate’s desire” for state government to have “a limited role”; the brief notes that “Colorado’s Medicaid program is viewed as among the leanest in the country.”

Health Affairs asked Downs if there was anything new to report since publication of the brief. She responded that “in November 2006 Colorado voters passed Referendum C,” which lets the state retain the revenues collected that “exceed the state’s constitutional limit on revenue retention.” She noted that “this put a little over $261 million” into Medicaid for fiscal year 2005–2006 and “$256 million for 2006–2007.” Also, “the 2007 legislative session brought incremental changes that expand Medicaid eligibility to young adults in foster care” who are under age twenty-one, “eliminate health status and claims experience as characteristics that can be used to determine insurance rates in the small-group market, and allow presumptive eligibility” for children in Colorado’s Medicaid and Child Health Plan Plus programs. In 2006, Downs added, the Colorado legislature “created the Blue Ribbon Commission for Healthcare Reform, which will present its recommendations” for “broad” reform to the legislative body in January 2008.

Reports and resources received:

“Elements of State Health Reform: Prevention and Wellness as Covered Benefits,” 7 June 2007 Webcast, http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2123. This Webcast was hosted by the Henry J. Kaiser Family Foundation and the National Governors Association Center for Best Practices.

“State Health Initiatives: What’s Next?,” Alliance for Health Reform briefing, 30 May 2007, http://www.allhealth.org/briefingmaterials/Transcript-742.pdf (transcript) and http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2159 (Webcast/Podcast).The nonpartisan alliance cosponsored this event with the RWJF. The “briefing presented a nationwide roundup” of state action, and panelists commented “on how state-level activity could affect prospects for national health reform,” according to the Alliance’s Web site. Pam Dickson of the RWJF co-moderated the panel. Its members included Joy Johnson Wilson of the National Conference of State Legislatures and Enrique Martinez-Vidal of State Coverage Initiatives, an RWJF national program.

“Toward More Effective Use of Research in State Policymaking,” Jack A. Meyer and Tanya T. Alteras of Health Management Associates and Karen Bentz Adams of the National Quality Forum, December 2006 (revised February 2007), 16 pp., http://www.commonwealthfund.org/usr_doc/Meyer_towardmoreeffectiveusestatepolicymaking_980.pdf?section=4039. Funded by the Commonwealth Fund. This short document describes “a conceptual framework” for using health services research effectively in state policymaking, according to the fund's Web site. Also included is “a case study of Massachusetts’ groundbreaking health care reform legislation” passed in 2006.

Related Health Affairs papers and blog posting:

“Next Steps for Tennessee: A Conversation with Gov. Phil Bredesen,” Alan Weil of NASHP (interviewer), Health Affairs Web Exclusive, 22 May 2007, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.4.w456v1. Included here are a discussion of the TennCare program and second-term Gov. Bredesen’s views on health information technology.

“Parity for Whom? Exemptions and the Extent of State Mental Health Parity Legislation,” Thomas C. Buchmueller, Philip F. Cooper, Mireille Jacobson, and Samuel H. Zuvekas, Health Affairs Web Exclusive, 7 June 2007, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.4.w483. “This paper summarizes the extent and scope of state parity legislation in terms of the number of insured private-sector employees covered.”

“State Reforms and the Presidential Campaign: SCHIPs Passing in the Night?” Sarah Dine of Health Affairs, blog posting, 7 June 2007, http://healthaffairs.org/blog/2007/06/07/reform-state-reforms-and-the-presidential-campaign-schips-passing-in-the-night/.

“Strengthening a State’s Health Advocacy Infrastructure,” Ruth Holton-Hodson of the California Wellness Foundation (TCWF) and Ruth Brousseau, (independent consultant), Health Affairs May/June 2006, http://content.healthaffairs.org/cgi/content/abstract/25/3/856. In this GrantWatch Report, the authors comment, “Although coordination among advocates may be a critical ingredient for achieving health policy change, opportunities for discussions that lead to cooperation among advocates are rare.” They describe what TCWF is doing to try to improve cooperation among advocates: It holds an annual retreat for health advocates in California.