Health Affairs, 27, no. 3 (2008): 882-885 doi: 10.1377/hlthaff.27.3.882 © 2008 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

This Article Full Text Submit a response to this article Services E-mail this article to a friend Alert me to new issues of the journal

GrantWatch

EDITOR’S NOTE: Some parts of the GrantWatch section are published on the Web only. The online-only material usually includes selected coverage of both recently announced grants and publications about or funded by foundations. (Reporting of selected grant outcomes and key personnel changes at foundations, as well as GrantWatch essays, reports, and interviews, are published in both print and online form.)

Online GrantWatch material is posted twice a month. Click here to sign up to receive an e-mail alert when new content is posted.

GrantWatch is funded in part by the Robert Wood Johnson Foundation.

Mental Health Care

Announcement:

The New York State Health (NYSHealth) Foundation has a new funding priority area called Integrating Mental Health/Substance Use Services. This five-year, $10 million effort will strive to “effect change at clinical delivery sites to achieve integration throughout all phases of the recovery process” as well as to “address systemic policy barriers to achieving and sustaining integrated services,” said the funder’s Web site. In a 21 May 2008 e-alert, the foundation mentioned that this effort includes $5 million “to create a Center of Excellence aimed at tackling the challenges” facing people who have “both substance use and mental health disorders.” The foundation will work with the state mental health and substance abuse service agencies, which “have committed $2 million” over two years to provide support to providers for integrating services, a foundation spokesperson told Health Affairs. According to data cited in a foundation press release, more than half of New Yorkers “with co-occurring mental health and addictive disorders” do not receive treatment for them, and fewer than 10 percent of people in the state with such co-occurring disorders get “evidence-based treatment for both conditions.” The release stated that “mental health and substance use disorders are traditionally treated separately, resulting in poorer health outcomes for individuals and higher costs for publicly funded treatment systems.” Jacqueline Martinez heads up this effort at the foundation.

Report received:

Gray Land: Housing for People with Serious Mental Illness in Maricopa County, Roger A. Hughes, Carol Lockhart, Stephen L. Day, and Ann O’Hara, January 2008, 55 pp., http://www.slhi.org/publications/issue_briefs/pdfs/ib-2008-January.pdf. Funded by St. Luke’s Health Initiatives (SLHI). Part of SLHI’s Arizona Health Futures series, this issue brief resulted from a collaboration between SLHI and the Technical Assistance Collaborative, in Boston. Focused on the housing needs of people with serious mental illnesses and co-occurring disorders in Maricopa County, Arizona (county seat: Phoenix), the brief provides “a critical framework for a discussion of the issue that might inform practice and policy decisions now and in the future.” It considers the experiences of several states (Louisiana, North Carolina, and Pennsylvania) and makes recommendations.

Related foundation-funded resources:

Collection of eleven issue briefs, MacArthur Foundation Network on Mental Health Policy Research, released 7 April 2008 at the Fundamental Policy: Spotlight on Mental Health conference, http://www.macfound.org/site/apps/nlnet/content3.aspx?c=lkLXJ8MQKrH&b=1139559&content_id={FCAE9FC4-F14D-42A0-9AF0-FB5B4A9132F6}&notoc=1. Topics include mandated community treatment, evidence-based practice in children’s mental health, and reducing disparities in mental health.

“Mental Illness Prevention: Interview with Thomas H. Bornemann, Ed.D., Director of the Carter Center Mental Health Program,” Carter Center 29 November 2007, http://www.cartercenter.org/news/current_qa/bornemann_112907.html. The center’s Mental Health Program receives general operating support from the Annenberg, Boston, Charles Engelhard, and Conrad N. Hilton Foundations, as well as from some individuals. The program receives support for specific efforts “from several foundations, corporations, and government entities,” a spokesperson told Health Affairs. “Prevention in mental health means identifying and treating mental illnesses before they become full blown syndromes or identifying people at risk for a condition, such as children who have endured abuse, violence, or poverty, and intervening with appropriate treatment and counseling,” Bornemann explains in this document. In response to a question from Health Affairs, he explained that “there is a clear relationship between poverty and mental illnesses,” but “we do not know if it is a causal relationship.” He added, “Nonetheless, there is an increased rate of mental illness among the poor.” The Carter Center works in partnership with Emory University.

Military Health

Announcement:

NYSHealth Initiative for Returning Veterans and Their Families, a component of the NYSHealth Foundation’s Integrating Mental Health/Substance Use Services priority area described above, focuses on veterans who have served in Afghanistan and Iraq. “The gaps in services and lack of funding for programs that support veterans’ reintegration compromise the health of our communities and weaken the public health system,” the foundation explained in an April 2008 press release. NYSHealth’s investment for this one-time initiative “to address the reintegration needs of returning veterans” is $2 million. The funding will be used to address vets’ needs, “including access to timely primary and specialized care, as well as mental health and substance abuse services”; and to “strengthen collaboration between public and private sectors” for reintegration services. Two grantees thus far have been selected: Rochester Veterans Outreach Center Inc. and Jewish Board of Family and Children’s Services (in collaboration with the James J. Peters Veterans Affairs Medical Center [Bronx, NY]). Each received a grant of approximately $372,400 to provide services. Also, the foundation, “in collaboration with its grantees and other veterans-related organizations, seeks to conduct an assessment of the need for and availability of reintegration services in New York State,” according to a Statement of Need on the funder’s Web site. In addition, “public policy efforts will be essential for systemic changes at the Federal and State levels to sustain improved access and availability of reintegration services for veterans and their families.” A fact sheet notes that “New York State has seen between 30,000 and 50,000 veterans return from the wars in Iraq and Afghanistan.” For more information, go to http://www.nyshealthfoundation.org/section/priority_areas/integrating_mental_health_substance_use_services/nyshealth_initiative_for_returning_veterans_and_their_families.

Recent reports:

Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries, Terri Tanielian and Lisa H. Jaycox of RAND (project coleaders) and coauthors, released April 2008, 52 pp., http://www.rand.org/pubs/monographs/MG720.1. Free download or available for purchase as a paperback. Funded by the Iraq Afghanistan Deployment Impact Fund, which is administered by the California Community Foundation, located in Los Angeles. According to RAND’s Web site, “the study discussed in this monograph focuses on post-traumatic stress disorder [PTSD], major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general.” This monograph by RAND’s Center for Military Health Policy Research is a shorter version of a much longer RAND document.

U.S. Military and California Health Personnel: Select Comparisons—2008, Melissa Knox, Catherine Dower, and Ed O’Neil of the Center for the Health Professions at the University of California, San Francisco, released February 2008, 40 pp., including appendices, http://futurehealth.ucsf.edu/pdf_files/US%20military%20health%20professions%20021508.pdf. Funded by the California HealthCare Foundation (CHCF). California faces health workforce shortages and geographic maldistribution “in many of the health care professions,” the authors note. “One potential pool” of workers “includes former military personnel returning from active duty or retiring with years available for service in the civilian labor force.” The authors compare “a select set of U.S. military health occupations” with similar civilian health jobs in California; sometimes the differences “are negligible.” In other cases, the military “training and job title might not translate easily into a civilian position.” For example, dental specialists in the military are overqualified to be dental assistants “but do not easily qualify” for licensure as dental hygienists in California. Here, “with some policy changes and career guidance, these individuals might be able to help address the many dentally underserved areas in California,” the authors suggest.

Related resources:

“Md. Offers Vets Back from War Guidance to Mental Health Help: New Program Aims to Improve Access to VA Treatment,” Steve Vogel, Washington Post, 5 June 2008, http://www.washingtonpost.com/wp-dyn/content/article/2008/06/03/AR2008060304158.html. This article discusses a $2.8 million Maryland program “to help service members get treatment.”

“National Council Hosts Congressional Briefing on Stigma of Mental Illness among Public and Veterans,” National Council for Community Behavioral Healthcare, press release, 28 May 2008, http://www.thenationalcouncil.org/cs/press_releases/national_council_hosts_congressional_briefing_on_stigma_of_mental_illness_among_public_and_veterans. The National Council hosted this 22 May 2008 briefing; it “highlighted the critical need to encourage people with mental illness to seek treatment.” Speakers included Rep. Jim Ramstad (D-MN); Kathryn Power, director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration (SAMHSA); and Joe Pantoliano, an actor from the HBO television series The Sopranos. Ramstad and Rep. Patrick Kennedy (D-RI) sponsored the event. The National Council is “a not-for-profit 501(c)(3) association representing 1,300 organizations providing treatment and rehabilitation to help people recover from mental illnesses and addiction disorders,” according to its Web site.

“Recent Trends in VA Treatment of Post-Traumatic Stress Disorder and Other Mental Disorders,” Robert A. Rosenheck and Alan F. Fontana of the Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, Health Affairs, November/December 2007, http://content.healthaffairs.org/cgi/content/abstract/26/6/1720. The center funded this study.

“VA Official Testifies on PTSD Stance in Latest Email Flap,” Jacob Goldstein, Wall Street Journal Health Blog, 5 June 2008, http://blogs.wsj.com/health/2008/06/05/va-official-testifies-on-ptsd-stance-in-latest-email-flap/?mod=sphere_ts&mod=sphere_wd. This blog posting discusses an e-mail from, and subsequent testimony by, a Central Texas Veterans Health Care System psychologist about veterans and PTSD.

“VA Testing Drugs on War Veterans: Experiments Raise Ethical Questions,” Audrey Hudson, Washington Times, 17 June 2008, http://www.washingtontimes.com/news/2008/jun/17/va-testing-drugs-on-war-veterans/.This article describes results of a Washington Times/ABC News investigation.

2008 Presidential Election: Health Care Cost Containment

Putting the Brakes on Health Care Costs: Would the Candidates’ Plans Work? Are There Better Solutions?” was the subject of a 3 June 2008 Alliance for Health Reform briefing for reporters, which was held at the National Press Club, in Washington, D.C., and was funded by the Robert Wood Johnson Foundation (RWJF). (Later that week, Hillary Clinton dropped out of the race, the New York Times reported.) Speakers at the nonpartisan alliance’s gathering were Paul Ginsburg of the Center for Studying Health System Change, Mark McClellan of the Brookings Institution, and Uwe Reinhardt of Princeton University. Citing examples, Ginsburg said that he “would criticize all the candidates because a lot of the things they say certainly are not on the list of things that can really make a big dent in our cost trends.” Citing a Congressional Budget Office (CBO) report, McClellan, cochair of the RWJF’s Commission to Build a Healthier America, commented that whether health information technology saves much money (a strategy favored by the candidates) depends on whether “underlying changes in the health care system” occur. Reinhardt said that it “is not so clear” whether candidates’ proposals actually save dollars per year, but the proposals would “give us more value for the dollar.” He commented that in the United States it is difficult to determine definite prices for medical procedures, and administrative costs are high.

Ginsburg said that restructuring payment mechanisms is a key to more efficient delivery of care.  This would include multi-provider per episode payments for acute care and elements of capitation for management of chronic diseases. McClellan stated that Medicare’s price setting has not helped much because the real growth problem is increased amounts of care. In a memorable quote, Reinhardt quipped, “Who has . . . gone shopping for a good [hospital] pathologist” in an effort to find one providing high-quality care?

Ginsburg contended that “perhaps the most powerful cost containment idea” among the candidates is John McCain’s proposal to change “the tax treatment of health insurance” and, in the process, “make people more sensitive to what they pay for health care.” Ginsburg explained, “This is a potentially powerful idea,” although not a new one, he said. The tax exclusion of health insurance would be replaced “with a tax credit that can be used to buy health insurance.” See McCain’s “Straight Talk on Health System Reform.”

McClellan reminded the audience that there is not much “new money” in the federal budget to be used for making “care more affordable and available,” so we need “to get more value” for the money spent. He later defended the Medicare Part D program by saying that it had lowered drug prices and its “overall costs” were lower than projected. (That program started while he was administrator of the Centers for Medicare and Medicaid Services.)

Responding to a question on McCain’s proposal to allow individuals to buy insurance across state lines, Reinhardt said that he believes that state insurance mandates have only “a small effect” on costs. The questions that should be asked instead are, Why are there “huge regional variations” in health care costs in the United States, and why has Congress “studiously avoided” addressing this problem?

A reporter from Modern Healthcare asked McClellan a perhaps inevitable question about the recently released book by his brother, Scott McClellan (one of President George W. Bush’s former press secretaries) and whether its findings were applicable to health care in this Bush administration. Mark McClellan said, diplomatically, that his experience on the policy side of the Bush administration was “very different” from that of his brother.

In a question for the panelists on whether the candidates’ proposals (described as “kind of political comments” and perhaps not having much “substance,”) Reinhardt said that Barack Obama’s and Hillary Clinton’s proposals were somewhat old and “staid” but “commonsensical” proposals that had been heard before. Agreeing with Ginsburg’s earlier comments, Reinhardt said that actually McCain “is the true radical,” compared with Clinton and Obama, for wanting to abolish the tax preference for health insurance. That strategy is “almost un-American,” Reinhardt remarked.

When journalist Jerry Brazda asked panelists whether health care will be “a major issue” in the presidential campaign, the consensus seemed to be no. Reinhardt said that for most voters, their health care is “sort of OK,” and other issues dominate. McClellan predicted that the major issue could be some international event (say, “a major turn in the war”), the economy, or tax reform. He added that in surveys, most Americans say that the United States “needs major [health] reform,” but few U.S. voters are eager to change their own access to care. Ginsburg commented that health care “is so complicated” that it is hard for candidates to distinguish themselves from their rivals on this issue so as to energize voters about it.

A transcript and Webcast of the briefing are available via links to the Henry J. Kaiser Family Foundation’s Kaisernetwork.org.

Related foundation-funded report received:

Snapshot: Health Care Costs 101, 2008 Edition, CHCF, April 2008, 26 pp., http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=133630. Funded by the CHCF. This report, written by Katherine B. Wilson, “provides general background on U.S. medical spending, with detail for California where available,” says an e-alert.

Recent survey of voters:

“Economic Woes Affect Americans’ Views of Health Care Reform,” Bill McInturff and Elizabeth Harrington, 13 May 2008, http://www.rwjf.org/pr/product.jsp?id=29571&typeid=142. This RWJF Web page has links to key findings and the complete questionnaire for an April 2008 national survey of 800 registered voters. Public Opinion Strategies’ Bill McInturff and Liz Harrington conducted the survey for the RWJF. In one part of the poll, respondents were read a list of ten items and asked “how effective” each “would be in helping to improve the current economic situation in America.” Respondents’ top priority to achieve this was “making health care more affordable”—that is, the largest percentage (37 percent) of respondents ranked that statement “very effective.” As for respondents’ goals for health reform, when those polled were given a choice of “making health care more affordable” or “covering more of the uninsured,” 68 percent chose affordability, and 28 percent, more coverage. The survey was released at a Health Affairs event in Washington, D.C.; see this blog posting by journal staffer Rob Cunningham, http://healthaffairs.org/blog/2008/05/16/over-the-rainbow-reform-and-reality.

Related resources compiled by the Alliance for Health Reform include the following:

“Candidates on Health Care,” Brookings Institution’s Opportunity 08 project in partnership with ABC News, Candidate Views series index, updated 9 June 2008, http://www.brookings.edu/papers/2008/~/media/Files/rc/papers/2008/0222_healthcare_mcclellan_opp08/0222_healthcare_mcclellan_opp08.pdf.

Geographic Variation in Health Care Spending, CBO, February 2008, 31 pp., http://www.cbo.gov/ftpdocs/89xx/doc8972/02-15-GeogHealth.pdf. CBO director Peter Orszag states in the preface, “Per capita health care spending and patterns of medical practice vary widely across the United States.” Policy recommendations are not offered because of the “CBO’s mandate to provide objective, impartial analysis.”