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  1. 1. GrantWatch Grants A separate CHCS grant enables the HCRTP Children’s Health Care to increase the child welfare capacity in its Allies Against Asthma Program. The site visits to determine the impact of managed Robert Wood Johnson Foundation (RWJF) behavioral health plans on children and fami- has chosen eight community coalitions to re- lies and to ensure that findings from its sur- ceive planning grants under this $12.5 million veys are coordinated with the CWLA surveys. national program, the goal of which is “to help A federally funded George Washington Uni- combat the rising tide of asthma among chil- versity managed care contracting study is be- dren,” said a press release. The broad-based ing expanded under another CHCS grant to coalitions—in locales such as Long Beach, include site visits to assess how child welfare California; Washington, D.C.; and San Juan, at-risk contracts are linked to Medicaid man- Puerto Rico—will use the grants to develop aged care contracts. The three projects will models that improve access to and quality of jointly publish reports “that link findings in clinical care for kids with pediatric asthma, child welfare to those in behavioral health reduce symptoms, and “foster patient and care.” The CWLA noted, “For the first time, community education.” The key to the initia- policymakers, administrators, advocates, and tive “is to tackle” this chronic condition other stakeholders will be able to find, in one “through coalitions that integrate clinical, en- source, comprehensive data on managed care vironmental, and community-derived ap- efforts across public sector systems responsi- proaches,” Noreen Clark, director of the pro- ble for serving children and families.” gram, noted in the release. The aims of the $98,796 over five years. Funded by the CHCS under 279 program, administered by the University of the Annie E. Casey Foundation’s Children in Managed Michigan School of Public Health, include re- Care Initiative. ducing “hospital admissions, emergency room University of California, San Francisco, In- visits, and number of missed school days by stitute for Health Policy Studies, San Fran- children with asthma,” the release said. cisco, CA. This grant supports three studies $1,191,609 over one year. Funded by the Robert Wood that aim “to identify the major health care fi- Johnson Foundation. nancing and delivery problems affecting ado- Child Welfare League of America (CWLA), lescents and the health care providers who Washington, DC. This grant partially funds serve them,” according to grantee materials. two national surveys of child welfare adminis- Paul Newacheck, a principal in the San Fran- trators. Through these surveys researchers cisco office of the Maternal and Child Health will determine “how managed care initiatives Policy Research Center, will direct a national affect the financing, management, and deliv- health insurance study to assess teens’ cur- ery of physical and mental health care services rent insurance status and coverage trends for to children and families served by the child them. Among areas receiving attention is welfare system,” said a Center for Health Care “whether recent expansions in Medicaid and Strategies (CHCS) press release. The CWLA S-CHIP [the State Children’s Health Insur- will fully coordinate this survey work with ance Program] have resulted in” fewer unin- that of the Health Care Reform Tracking Proj- sured adolescents. Margaret McManus and ect (HCRTP)—a partnership of Georgetown Harriette Fox, principals in the center’s two University, the University of South Florida, Washington, D.C., offices, will direct a study and the Human Service Collaborative— of the “benefit policies and cost-sharing re- which receives major funding from the federal quirements” in the biggest health mainte- government, the grantee said. The HCRTP nance organizations and preferred provider tracks behavioral health care under Medicaid. organizations in each state regarding services HEALTH AFFAIRS ~ May/June 2001
  2. 2. GrantWatch that teens need. McManus and Fox will also illness by providing an early warning system direct a study assessing the views of providers to alert public health professionals and com- in four urban communities about “their ability munities about clusters and trends in dis- to deliver needed services” for teens and about ease,” according to Pew Charitable Trusts ma- specific access barriers for this population. terials. This start-up funding goes to a new Newacheck told Health Affairs that “the project environmental health advocacy group, TFAH, as a whole will collect and synthesize infor- headed by Shelley Hearne. It “will lead the mation on the financing of health care for ado- effort” to advocate for such a disease-tracking lescents [by] using a unique combination of na- network, which was recommended by the tional, state, and community-level data sources.” Pew Environmental Health Commission. (See Health Affairs “GrantWatch,” Mar/Apr 2001, $564,369 over three years. Funded by the William T. pages 296–297.) The grantee’s broader mis- Grant Foundation. sion “is to champion federal policies to strengthen the public health system and pre- Environmental Health vent disease,” Pew said. Activities funded un- der these grants include “policymaker educa- Ambulatory Pediatric Association, tion; rigorous, nonpartisan research and McLean, VA. Although “toxic chemicals in analysis; and effective outreach” to key audi- the environment are strongly suspected of ences. The Joyce Foundation said that its contributing to serious new disease patterns grant is targeted for “a series of report cards in children, including asthma…few practicing on midwestern states’ systems for tracking pediatricians have any training in recognizing health data that may have connections or environmental factors in disease,” according causative links to environmental exposure.” to the New York Community Trust’s Febru- 280 TFAH “believes that better information can ary 2001 newsletter. This funding supports a identify disease clusters that warrant further new three-year fellowship program in envi- research, help public officials catch prob- ronmental pediatrics at Children’s National lems…early, and allay groundless health Medical Center/George Washington Univer- scares,” the foundation added. sity School of Medicine, Children’s Hospital $5 million over two years. Funded by the Benjamin ( Boston)/Harvard Medical School, and Spencer Fund, an independent foundation established Mount Sinai School of Medicine. The national in 1993. program will train three fellows in its first $2,500,000 over two years. Funded by the Pew Chari- “class” in areas including epidemiology, table Trusts. biostatistics, ethics, and policy analysis. After $250,000 over two years. Funded by the Joyce Founda- the first three years, the grantee will apply “to tion. the American Board of Pediatrics to have the $150,000 over two years. Funded by the Rockefeller fellowship approved for board certification in Family Fund, located in New York City. the new subspecialty of environmental pedi- $100,000 over two years. Funded by the Bauman atrics.” The William T. Grant Foundation and Foundation, located in Washington, D.C. the U.S. Environmental Protection Agency $100,000 over two years. Funded by the Tortuga provided start-up funding for the program. Foundation, an independent foundation established in $500,000 over three years. Funded by the Educational 1979. Foundation of America, which is located in Westport, $10,000 over one year. Funded by the Jenifer Altman Connecticut. Foundation. $150,000 over one year. Funded by the New York Community Trust. Outcomes And Quality Trust for America’s Health (TFAH), Balti- more, MD. “Nationwide disease tracking National Committee for Quality Assurance (NCQA), Washington, DC. With two other would help spur efforts to prevent [chronic] HEALTH AFFAIRS ~ Volume 20, Number 3
  3. 3. GrantWatch Commonwealth Fund grants, the NCQA “de- care provided by in dividual physician veloped the first national database” on the groups.” The CHCF hopes that “energy and quality of Medicaid managed care plans, the resources freed up…can be refocused on im- fund noted. However, “partly because of dif- proving quality of care,” the foundation’s Ann ferences in Medicaid programs, states have Monroe commented in the release. She told had uneven success in collecting performance Health Affairs that “all of the parties involved, data” from such plans. This project aims to including the regulators, are contributing determine and address problems that states time and effort to the improvement teams.” have encountered when using the Health Plan $499,000 over one year. Funded by the California Employer Data and Information Set (HEDIS) HealthCare Foundation. to measure plans’ performance. Project com- Princeton Survey Research Associates ponents are a survey of state Medicaid pro- (PSRA), Princeton, NJ. This contract funds a gram managers; analysis of survey results and survey on quality of health care for minority formulation of recommendations for the and low-income patients. As disparities in NCQA’s broad-based Committee on Perform- quality of care within the U.S. population are ance Measurement; and documentation of becoming an important issue, the Common- barriers to measuring Medicaid managed care wealth Fund said that it wants to find out plan quality that are unrelated to HEDIS, such more about them and what kind of care the as “constant changes in the eligibility status of underserved are receiving. Building on a 1994 beneficiaries.” Fund materials also noted the Commonwealth survey, PSRA is now “prob- potential value of this project: “With more ing more extensively” into issues from the pa- accurate and complete information,” state tient’s viewpoint, such as patients’ prefer- Medicaid officials will be better situated to ences—a large sample is being polled in six 281 “compare plans’ performance against external languages. Survey findings on “the causes and standards and hold plans accountable for the human costs of disparities in care” will be re- quality of care they provide.” leased in fall 2001. Findings should be valu- Up to $69,955 over eleven months. Funded by the able to providers, researchers, policymakers, Commonwealth Fund. and advocacy groups. The PSRA Web site notes, “We maintain independence on all is- National Committee for Quality Assur- sues of public debate.” ance. This grant funds a partnership of the Up to $362,585 over ten months. Funded by the Com- NCQA, the California HealthCare Founda- monwealth Fund. tion (CHCF), and the Pacific Business Group on Health that aims to “streamline” oversight of physician groups in California, according to a February 2001 NCQA press release. The state has “multiple oversight requirements for managed care organizations…and their con- tracted physician groups.” The project’s goal is “to reduce the physician groups’ cost of oversight.” Using teams that include repre- sentatives of managed care and provider groups, the California Departments of Man- aged Care and Health Services, and Region 9 of the Health Care Financing Administration, the project aims “to reduce redundant over- sight and create the opportunity to institute efficient evaluation processes that will pro- vide consistent information on the quality of HEALTH AFFAIRS ~ May/June 2001
  4. 4. GrantWatch Grant Outcomes cal condition.” Poor nutrition “is likely to be a Outcomes Of Grants major contributor” to such conditions, the re- port adds. Thirty-two percent of males in the “The ABCs of Medicare: Prepare Yourself study sample stated that “they had never been for the Debate,” a briefing sponsored by the to a doctor or clinic in their lives.” The task Alliance for Health Reform and the Henry J. force plans to release its final report, contain- Kaiser Family Foundation (KFF), was held ing its recommendations, in spring 2001. In for congressional staffers and others 12 Febru- response to the recommendations, the en- ary 2001 on Capitol Hill. Diane Rowland and dowment announced on 22 March 2001 that it Trish Neuman of the foundation and Kathy pledged $50 million over five years to help to Buto of the Congressional Budget Office improve California farm workers’ health. spoke. Rowland gave a short “beginner’s The panel’s final report will be on the endowment’s course” on program basics, followed by Web site, <>. Click “Publications Neuman’s discussion of gaps in Medicare; and Reports.” The Suffering in Silence report is avail- Medicare+Choice; prescription drug cover- able there or by calling 800-449-4149, ext. 3271. age; and challenges ahead, including improv- ing benefits, paying providers fairly, and pro- “When the Smoke Clears: Tobacco Control tecting the poor. Buto discussed some of the and Prevention” was among the informative more complex aspects of Medicare. A partici- sessions at Grantmakers In Health’s (GIH’s) pant asked whether a Medicare prescription Washington Briefing, held in November 2000. drug benefit would ruin the Medigap market. Donna Grande of the RWJF’s Smokeless Neuman responded that the market would 282 States: National Tobacco Policy Initiative, change, but Medigap plans could still help en- which is administered by the American Medi- rollees with cost sharing. cal Association, chaired this session. She For more information, call the alliance at 202-466- noted that the RWJF had recently expanded 5626. For a February 2001 KFF revised fact sheet, the program by $52 million and that it was “a “Medicare at a Glance,” go to the KFF’s Web site, new program for the most part.” It hopes to <>, or call 800-656-4533 and request achieve three main outcomes: increased state Item no. 1066b. tobacco excise taxes; “clean indoor-air poli- Responding to the “alarming findings of a cies, specifically [in] restaurants and other recent benchmark study,” Suffering in Silence: public places”; and reimbursement for smok- ing-cessation programs. Applicants for A Report on the Health of California’s Agricultural Workers, the California Endowment “assem- Smokeless States, which was reauthorized for bled a blue ribbon task force…to find mean- three years, “must be able to mobilize a broad- ingful and long-term solutions to the health based statewide coalition, foster public crisis” described, a press release said. Endow- awareness of the [tobacco-control] issue, and ment president Robert Ross said in the re- advocate tobacco-control policies within lease that the foundation hopes that recom- their state,” according to a recent issue of the mendations of the panel, chaired by former RWJF’s newsletter. Rep. Esteban Torres, “will be instrumental in Ron Dendas of the Dorothy Rider Pool shaping future policy and programs in Cali- Health Care Trust reported on the Coalition fornia.” Prepared by the California Institute for a Smoke-Free Valley, which Pool (and oth- for Rural Studies and funded by the endow- ers) have funded over the years. He said that ment, the November 2000 report says that among other things, the coalition successfully “the risks for chronic disease…are startlingly increased the number of smoke-free busi- high” for farm workers—mostly “young men nesses and public sites and has “helped imple- who would normally be in the peak of physi- ment tobacco sting operations” in Pennsylva- HEALTH AFFAIRS ~ Volume 20, Number 3
  5. 5. GrantWatch Genetic Testing and Screening in the Age nia’s Lehigh Valley. “I think they’ve played a of Genomic Medicine, released in February role in reducing the number of cigarettes used by smokers” by making it harder to smoke, 2001, was supported in part by the National “but they really haven’t had the impact on get- Human Genome Research Institute and the ting people to stop” smoking, he admitted. Greenwall Foundation. This timely report Dendas later discussed roles grantmakers can from the New York State Task Force on Life play in forming a coalition. The American Leg- and the Law, chaired by Antonia Novello, is acy Foundation’s Lyndon Haviland, a physi- intended “as a guide to policy makers in New cian, discussed its advertisements that use York State and elsewhere who are grappling public health messages. She added that Leg- with the difficult issues associated with pre- acy is evaluating its activities “extensively” dictive genetic testing” in the clinical context. and that it has a large amount of data. Focused on such testing (which includes “re- productive testing and late-onset testing of For more information about the session, call GIH, healthy adults to determine future disease 202-452-8331. For information on Smokeless States, risks”), the report also discusses informed call 312-464-4903. Call Ron Dendas at 610-770-9346 consent, confidentiality, insurance and em- about the Coalition for a Smoke-Free Valley. ployment issues, genetics counselors, and is- Publications sues surrounding using genetic tests as popu- lation-based screening. The panel, having Falling through the Cracks: Health Insur- examined ethical, legal, and social issues, ance Coverage of Low-Income Women, a makes numerous recommendations to en- February 2001 report funded by the KFF, was courage safe and effective testing. (It con- prepared by Roberta Wyn and colleagues. cludes, for example, that “it is generally inap- 283 They look at the current state of coverage for propriate for federal or state governments to poor women and at changes in their coverage mandate population genetic screening.”) Dur- from 1994 to 1998. For example, they examine ing the three-year project that culminated in certain subgroups of such women who are at the report, two themes emerged: (1) “the enor- especially “high risk for being uninsured and mous potential that predictive genetic testing have been disproportionately hard hit by pol- poses for health care and the need to promote” icy changes” in that time period; these include its use “in both research and clinical care”; and low-income single mothers, who had “the (2) despite the “potential promise” of such largest drop in Medicaid coverage…as the wel- testing, the existence of “potentially dangerous fare reform policies took hold.” The authors misunderstandings and misperceptions within caution that “unless they are disabled, non- the general public about the role of genes.” elderly adults without children generally do For information on ordering the 411-page report with not qualify for Medicaid, no matter how a base price of $6.75 a copy, go to <> and poor.” The effects of race and ethnicity and click “Medical Ethics,” or call 518-439-7286. work status are also discussed. The authors The Origins and Implementation of Badger propound the view that public and private Care: Wisconsin’s Experience with the efforts are needed to improve the plight of State Children’s Health Insurance Pro- low-income women. “Providing incentives gram (SCHIP) was issued by the Milbank and opportunities” for them to join the work- force offers them “the promise of financial inde- Memorial Fund in February 2001. Author pendence—but the protection of health cover- Coimbra Sirica recounts the history of this age is needed” for these new opportunities to successful program “that since 1999 has pro- have the desired effect. vided health insurance to working parents with low incomes and their children,” the The report (Pub. no. 1611) is available on the KFF’s Web site, <www.>, or by foreword by Dan Fox and Samuel Milbank explains. Wisconsin, under then Governor calling its publication request line, 800-656-4533. HEALTH AFFAIRS ~ May/June 2001
  6. 6. GrantWatch Tommy Thompson, “had enrolled almost 95 states (five did not participate), the District of percent of all uninsured children in families Columbia, and Puerto Rico, the report notes with incomes up to 200 percent of the federal that “states spend more on the problem of poverty level” as of November 2000, as other substance abuse than they do on Medicaid.” It states were struggling to enroll kids in also points out that alcohol is “linked to the SCHIP. In a nutshell, BadgerCare’s premise is largest percentage of state substance abuse that “covered adults have an incentive to en- costs.” Among the report’s recommendations roll their eligible children in an insurance pro- are that states target treatment and preven- gram.” Kids are covered under SCHIP, and at tion “to selected populations that hold prom- the time the report was written their parents ise for high return” and expand the “use of were covered by Medicaid under a waiver. state powers of legislation, regulation and (However, in January 2001 the U.S. Depart- taxation” to reduce substance abuse’s im- ment of Health and Human Services approved pact—for example, by requiring persons who a landmark SCHIP waiver for Wisconsin, al- are in state-funded programs to get treatment. The report is available on CASA’s Web site, <www. lowing it to now use SCHIP funds to cover parents with incomes above 100 percent and>, or by sending a check for $15 to below 185 percent of the federal poverty level CASA, Nineteenth Floor, 633 Third Avenue, New with continuing coverage up to 200 percent of York, NY 10017-6706. poverty.) Among the report’s important The Commonwealth Fund’s Task Force on points are that BadgerCare has a comprehen- the Future of Health Insurance recently is- sive benefit package and uses creative out- sued two reports. The January 2001 Challenges reach efforts. However, the program has been and Options for Increasing the Number of Americans “more expensive than originally projected,” 284 with Health Insurance, by Sherry Glied, discusses Sirica explains in this succinct overview. issues surrounding “incremental insurance The report is available from Milbank either on its Web expansions.” Glied later provides an overview site, <>, or by calling 212-355-8400. of various policy options using incremental Shoveling Up: The Impact of Substance expansions for helping “the working unin- Abuse on State Budgets was released by the sured, whose family incomes often fall above National Center on Addiction and Substance 100 percent of the federal poverty line.” The Abuse at Columbia University (CASA) in options draw on ten task force–commissioned January 2001. Funded by the Starr Founda- papers, which were written by insurance pol- tion, RWJF, Carnegie Corporation of New icy experts and extend other researchers’ York, and the Abercrombie Foundation, as work, on topics such as the pre-Medicare well as Primerica Financial Services and the population, an extended Federal Employees National Institutes on Drug Abuse and on Al- Health Benefits Program, and various kinds of cohol Abuse and Alcoholism, the report, using tax credits. conservative assumptions, found that states Expanding Employment-Based Health Coverage: spent $81.3 billion “to deal with substance Lessons from Six State and Local Programs, a Feb- abuse” and addiction in 1998, but only 3.7 per- ruary 2001 report by Sharon Silow-Carroll cent of that amount was used for prevention and colleagues, profiles two community- and treatment. CASA chairman and president based and four state-administered programs Joe Califano commented in the introduction, set up to provide coverage to the working un- “The choice for governors and state legislators insured. The authors include a helpful sum- is this: either continue to tax their constitu- mary table. Most of the programs discussed ents for funds to shovel up the wreckage of focus on small employers and their workers. alcohol, drug and nicotine abuse and addic- Challenges for policymakers and those plan- tion or recast their priorities” to focus on pre- ning programs include “spreading risk and ad- vention and treatment. Based on a survey of dressing adverse selection” so as “to prevent HEALTH AFFAIRS ~ Volume 20, Number 3
  7. 7. GrantWatch the programs from spiraling into a high-risk outcomes are abstract and hard to communi- pool and to retain private health plan partici- cate; assistance from the media is needed. He pation” and having “a stable and sufficient also mentioned that some system is needed to funding source.” safeguard patient data. Kanter stated that the foundation would allocate $1 million in addi- Both reports (Glied: Pub. no. 415, Silow-Carroll: Pub. no. 445) are available on the fund’s Web site, <www. tional funds for developing a database proto- type and for communications efforts targeted>, or by calling toll-free 888-777-2744. at physicians, disease groups, and policy- makers. Craig Turk, former chief counsel of Announcements Sen. John McCain’s campaign for president, is the foundation’s executive director. The California Wellness Foundation will For more information, visit HELP’s Web site, <www. soon add the following funding priority areas:>, or call 202-638-5687. environmental health, diversity in the health professions, women’s health, healthy aging, and The Robert Wood Johnson Foundation and mental health. Teen pregnancy prevention, vio- Johns Hopkins University ( JHU) launched lence prevention, and work and health will re- Partnership for Solutions: Better Lives for main priority areas. The work and health pro- People with Chronic Conditions on 26 Febru- gram, however, will make changes to its grant ary 2001. The initiative’s intent is “to raise making, a spokesperson told Health Affairs. Each awareness of the challenges faced by children area includes five “themes,” including unders- and adults with chronic conditions and help erved populations and policy, the foundation’s policymakers identify possible solutions,” ac- Winter 2000–2001 newsletter reports. New cording to a press release. The initiative “does “grant application guidelines are expected to be not endorse a specific approach to improving 285 released in spring 2001.” the delivery and financing of care for people For details, visit the foundation’s Web site, <www. with chronic health conditions, [but] it is>, or call 818-593-6600. committed to fostering a national discussion about a wide array of private and public solu- The Kanter Family Foundation and the U.S. tions,” Lew Sandy of the RWJF said in the Agency for Healthcare Research and Quality release. Also that day results of a Harris Inter- (AHRQ) are “jointly pursuing the feasibility active poll of adults were released. The survey, of a national outcomes database that doctors conducted during March–November 2000, and patients can use to determine which found that 94 percent of respondents “favor treatments work best for specific diseases and adding a prescription drug benefit” to Medi- conditions,” according to the Web site of their care, and 92 percent favor each of these poten- public/private project called the Health Leg- tial solutions: “government-funded long-term acy Partnership (HELP). Other goals of HELP care insuran ce” and “a tax break for include providing people with information caregivers.” A consortium of partners joins the based on science—evidence-based medicine RWJF and JHU in this initiative, directed by and outcomes research—and encouraging Jerry Anderson of JHU. standardization of outcomes data “through- For details, visit the initiative’s Web site, <www. out the healthcare system.” HELP held its first>. conference in October 2000 in Washington, D.C. Businessman, philanthropist, and cancer survivor Joe Kanter and physician John Key Personnel Change Eisenberg, AHRQ director, both spoke to a crowd of more than 200 persons. Kanter told them that HELP was not seeking money—the Gary Yates, president and chief executive offi- cer of the California Wellness Foundation, project just needed help educating the public about these issues. Eisenberg commented that is GIH’s new chairman of the board. HEALTH AFFAIRS ~ May/June 2001