One Foundation’s Experience with Primary and Integrated Care Grantmaking

When the Foundation for a Healthy Kentucky first began making grants, they were typically a year in duration and could be filed under one of two responsive grantmaking programs:  Community Grants of up to $5,000 (later raised to $10,000) and Access to Health Care Grants, which could be as large as $125,000. Most of the latter grants typically went into unfunded extension periods, as they sought to implement the proposed project activities and measure their impact.  Learning from these earliest grants, the Foundation moved to a more strategic approach from 2007 through 2011.

The Primary Care Initiative sought to bring primary care services to underserved geographic areas of the state, with an aim to make such care more accessible to low-income families. For this initiative, funding was provided to five sites, geographically distributed across the Commonwealth, to develop their Health Plan and Business Plan to submit to the Foundation for implementation funding.

The “big story” of the Foundation’s Primary Care Initiative was the confluence of our interest in creating new access points for primary care in the Commonwealth with the federal government’s infusion of funding into the federally-qualified health center (FQHC) system; this allowed us to create new access points in medically-underserved areas of the nation. When funded sites were added to those receiving only technical assistance, the Foundation’s investment attracted over $17 million in federal resources for needed primary care service expansion.

The result was an issue brief, Rural Healthcare that Works: Access, Quality & Innovation, available on the Foundation’s website here. A Kentucky Educational Television (KET) special also lifted up innovative strategies identified through this work: Remaking Rural Health is available here. Rural Health advances and opportunities also became the theme of our 2011 Howard L. Bost Health Policy Forum.

The Integrating Mental Health and Medical Services (IMHMS) Initiative responded to a specific need identified through the meetings, to help assure that patients with both behavioral health and medical conditions could obtain the help they needed regardless of where they first sought care. As with our work in Primary Care, our earliest grantmaking taught us that a year was not long enough to design and launch a successful program, so we offered grantees the opportunity to plan a proposed delivery strategy before implementation funding was awarded.  Grant applicants were offered the opportunity to design an approach to care integration that they believed would best address the needs of the populations they already served – either newly integrating services or removing barriers to integration in an existing program.

Recognizing that we are nowhere near the goalposts of fully-integrated care, we keep carrying the ball.  To be specific, the Foundation remains connected, both nationally and within the state, to groups and organizations working to advance care integration.

When a foundation enters this playing field, where alliances may have been formed many years before our arrival and teams long squared off for battle, our neutrality is a strength but our newness is a challenge to overcome.  We must build relationships with those already engaged, so that they can grow to trust the sincerity and transparency of our purpose and our actions.  The Affordable Care Act and the growing scrutiny of costs and impacts of health care investments may increase the readiness of payers, providers and academicians to do care differently. We must be ready to act on change opportunities when they arise.

[The full text of the issue brief can be found here.]

This report was created with input from: Gabriela Alcalde, Ph.D., Amy Watts Burke, Ph.D., Mary Jo Shircliffe, MBA, and Susan G. Zepeda, Ph.D. The authors wish to acknowledge the work of the Foundation’s grantees and the members of the Integrated Care Action Team (ICAT) and the Rural Health Oversight Committee (RHOC) for helping, through the Initiatives described here, to shape the vision of a Kentucky in which all residents have access, when needed, affordable quality healthcare.