Lessons Learned: Achieving High Impact in the Health Sector

The Rhode Island Foundation has invested significantly in healthcare during the past 15 years. Here, we share critical ingredients for achieving impact with these investments:

Use all of the tools in the toolbox

• Wise investments through responsive and pro-active grants.
• Attracting investments from national funders.
• Providing advice and technical assistance to grantees.
• Convening organizations around common themes.
• Fostering long-term conversations with policymakers.

Foundation investments in developing a system of dental services for low-income children involved a variety of different kinds of grants during a 10-year period. Partnerships with two programs of the Robert Wood Johnson Foundation brought $2.5 million in new resources to Rhode Island. Facilitation of a “common table” in the form of the state’s Oral Health Commission resulted in the emergence of a diverse group of leaders who met regularly to exchange information and to support one another.

Study the fiscal incentives in the system

Almost none of us want to go to a nursing home. Still, our system is structured in ways that provide incentives to fill nursing home beds. In 2005, the Foundation supported the development of PACE (Program of All-Inclusive Care for Elderly), administered by CareLink. PACE takes a blended Medicare/Medicaid rate and provides services that allow frail, low-income elders to live at home for as long as they’d like. Because it is fiscally “at risk” to pay for any adverse health events that affect its members, PACE is motivated to provide any kind of service its members require to lead healthy lives at home. When the fiscal incentives of programs parallel the ways individuals wish to receive services, everyone wins.

The healthcare workforce matters

Rhode Island does not have a dental school, and our reimbursement rates are low, making it making difficult to attract dentists and other oral health professionals to practice here. In 2004, we supported St. Joseph Hospital in developing a pediatric dental residency program in collaboration with Lutheran Medical Center in New York City. Working through teleconference links to provide conferencing with supervisors at Lutheran, the program has proven the value of creatively responding to the shortage of pediatric dentists in the state.

Achieving sustainability is essential

Hasbro Children’s Hospital’s Draw a Breath program, an innovative school-linked asthma education program for children and parents, is a case study in the value of sustainability. We asked ourselves at the beginning, “What are we creating here and for whom does it have value?” After years of conversations, insurers now reimburse Draw a Breath for its classes because they see powerful results in terms that affect their bottom-line – dramatically reduced emergency room visits for the children they cover.