The Rhode Island Foundation last week announced the first $1.6 million in grants from its Fund for a Healthy Rhode Island, a $20 million endowment created in late 2007 as part of a settlement between Blue Cross & Blue Shield of Rhode Island in a federal case.
The eight grants focus on three specific goals: improving access to primary care, making affordable medications available in connection with primary care; and increasing public awareness of the importance of primary care and of taking care of one’s own health.
Owen Heleen, the foundation’s vice president for grant programs and leader of health care grant-making efforts for nearly a decade, answered questions about the fund.
PBN: You have spearheaded the foundation’s grant-making in health care for many years. How does this new fund fit with your broader vision for health care in the state?
HELEEN: The fund is a great fit for the Foundation’s work in health care. Just this year, we developed parameters for each of the six broad sectors in which we provide funding — education, human services, community and economic development, arts and culture, the environment, and health. What we’re trying to do in each of these areas is focus our grant-making and other work to achieve more well-defined impact. So, it’s been a focusing, but a focusing that’s part of a Foundation-wide initiative.
Our goal in health is to increase the access, affordability and quality of primary care for Rhode Islanders. Besides the goals of the Fund for a Healthy Rhode Island to support ways to make primary care more accessible for all Rhode Islanders, to make affordable medication available in connection with primary care, and to promote the importance of primary care and taking personal responsibility for our health behaviors, we’re focusing on programs that expand health insurance coverage, efforts to change the way the system pays for primary care, programs that integrate oral health and mental health into primary care, and programs that improve primary care management of chronic conditions like diabetes and asthma. …
The primary care focus has also become central to all the national debate around healthcare reform. Our friends to the north in Massachusetts have dramatically expanded health insurance coverage. Elements of their approach are featured in the Obama administration’s plans. Very early on in that experiment, Massachusetts found pronounced shortages in the availability of primary care. Cost containment is going to have to be a big element in the Obama plan that finally emerges. A well-functioning system of primary care is the most cost-effective way to provide health care.
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PBN: The foundation got this money with some guidance but also a fair amount of freedom. How did you determine what the grants should look like?
HELEEN: First, we spent a considerable amount of time determining that the focus of the fund should be on primary care. We convened a small committee of Foundation directors and staff members. Next, we contracted with JSI Consultants to conduct structured interviews with a wide range of community experts, ranging from political leaders to physicians. Primary care rose to the top of the list as a result. [Then] we decided that 75 percent of the available grant dollars would go toward the areas that are generally regarded as the most critical: increased access, affordable medications, and community outreach, especially around chronic conditions and preventative care. The remaining 25 percent will be used to seed a loan forgiveness program, details of which we plan to announce later this year. We created an RFP for grants based on criteria we developed internally, communicating clearly to potential grantees that we were seeking innovative projects that would have impact on the greatest number of Rhode Islanders. We also stated that collaborative projects would be favorably regarded, as would projects that could be implemented quickly and effectively. Given our interest in measuring long-term impact, we also encouraged multi-year projects. The Fund for a Healthy Rhode Island is the only grant program in which we do that.
PBN: What was the response like?
HELEEN: As it turns out, the Fund for a Healthy Rhode Island became our most competitive grants program overnight. We received 47 applications totaling just over $13 million. The quality of the applications was outstanding and led us to quickly decide to grant most of the available dollars now rather than wait for a second round of applications. I think we really tapped into a wellspring of creativity. All sorts of organizations — community health centers, hospitals, independent practices, and others — seemed to be primed for this. … Their creativity resulted in very practical, sustainable solutions to the problems addressed in each of the Fund’s three areas. We carefully considered sustainability when we made our grant decisions, and we are in good shape here. I’m confident that all of these projects will be around for the long term. Not surprisingly, we received most of our proposals in the area of increasing accessibility to primary care. But we also saw competitive pools in the areas of affordable medications and outreach.
PBN: What do you hope this first round of grant recipients can accomplish?
HELEEN: There is the promise of increasing access to health care to more than 13,000 of the 66,000 Rhode Islanders who are currently without access. This does not count those reached through the projects focused on outreach and education. Those numbers are bigger, but you’d be getting into apples and oranges. Each grantee organization has the ability to measure how many Rhode Islanders are touched by the funded projects. We are developing additional metrics that should be easy to put into place so that we can evaluate what works and what doesn’t. If these projects are successful, we hope to attract additional funders, both regional and national, and we certainly hope that several of the funded projects can serve as national models. Access and affordability are not issues unique to Rhode Island, but we do have a unique opportunity in our small state to apply new and creative approaches and to come up with new ways to tackle longstanding challenges. The projects we funded — from Rapid Access RI to Shape Up RI — could be in the vanguard of national health care reform.
PBN: It’s been a rough year for the financial world and for the nonprofit world that relies on investment income to produce funds for grant-making. How big an impact has the foundation as a whole felt, and how has that affected this fund in particular?
HELEEN: At the close of 2008, in line with the markets, the Foundation’s endowment had declined nearly 27 percent and we ended the year with total assets just over $455 million. The Fund for a Healthy Rhode Island is invested with our other 1,140 component funds and so of course it took a comparable hit. Having said that, we rely on our prudent investment policy to create a smoothing mechanism against sharp economic declines. As investors for the long term, we expect that the Fund will come back over time, and in fact will grow to exceed its February 2008 value of $20 million.
