This month I attended the AcademyHealth National Health Policy Conference (NHPC) in Washington, DC, an excellent annual conference that offers the perfect balance of broad landscape view and deep dives into emerging trends in health policy and health services research. (See Academy Health’s NHPC blog recap). While in Washington I also took the chance to meet with some federal government insiders to discuss this year’s funding priorities and anticipated competitive grant opportunities. Below are just a few highlights for my fellow grant seekers and change makers.
NEW AND EXPANDED FUNDING OPPORTUNITIES
The Social Impact Partnership to Pay for Results Act (SIPPRA) was signed into law last year, but this week the Department of Treasury posted the first funding announcement of the SIPPRA demonstration grant competition for states and local governments. Congress appropriated $100 million for the SIPPRA program to implement “Social Impact Partnership Demonstration Projects” and feasibility studies to prepare for those projects. This opportunity was referenced at NHPC as a potential funding source to address SDoH, in that itcan support a wide range of social outcomes, like increasing rates of high school graduation, reducing rates of homelessness, improving early childhood development among low-income families, and reducing recidivism among juvenile offenders. The Treasury Department maintains a page of SIPPRA FAQS and the Urban Institute offered an early analysis based on legislative language.
Centers for Medicareand Medicaid Services (CMS) reform and state efforts to reduce costs of care were prominent issues discussed at NPHC. Several Section 1115 waivers are pushing the envelope and testing limits both in terms of Medicaid eligibility requirements and addressing SDoH like housing and transportation. This month the CMS Innovation Center issued announcements regarding three new demonstration models. Integrated Care for Kids (InCK) and Maternal Opioid Misuse (MOM) are two new models designed to improve care delivery for vulnerable Medicaid and CHIP beneficiaries, in particular those affected by the nation’s opioid crisis, and to improve quality of care and reduce expenditures for beneficiaries. Up to $128 million in funding is available for InCK and up to $64.5 million for MOM. CMS has issued the Notices of Funding Opportunity (NOFOs) and published a fact sheet that compares these two models.
CMS also announced details of the Emergency Triage, Treat, and Transport (ET3) model, which will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare beneficiaries following a 911 call. Under ET3, CMS will pay participating ambulance suppliers and providers to (1) transport an individual to a hospital emergency department (ED), (2) transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or (3) provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth. An ET3 request for applications is expected later this summer.
Interventions and policies to prevent and treat opioid misuse will continue to receive increased federal resources thanks, in part, to the bipartisan Comprehensive Addiction and Recovery Act (CARA) of 2016 and related legislation. Upcoming competitions will include federally funded Opioid Centers of Excellence to synthesize best practices and provide technical assistance, Department of Labor initiatives focused on developing the U.S. workforce needed to address the opioid crisis, increased SAMHSA funding to expand Certified Community Behavioral Health Clinics and state funding to provide wraparound services for individuals in treatment and recovery. Several federal competitions focused on opioids will have preference priorities or “set asides” for applicants serving rural areas. Watch Grants.gov for these solicitations.
HEALTH TRENDS INFLUENCING GRANT PROGRAM DESIGN
This is by no means an exhaustive list, but these trends and lessons caught my attention:
- Federal policy makers are pushing more funding and prerogative to the state level. If you have previously sought only federal grants, get to know your state players.
- Insurance coverage is no longer viewed as a proxy for health care access, as legislators and regulators field consumer complaints over high co-pays, increased drug prices and “surprise billing.”
- Technology, data analytics and web-based resources must be balanced with more “old school” outreach and engagement (e.g., paper forms, telephone support). Not everyone we need to reach has broadband internet access, smart phone data and/or computer literacy. Consider a “both/and” approach to client/consumer/patient communications.
- Social isolation is a critical concern and serious health determinant. Health interventions should balance upstream SDoH efforts with investments in “personal determinants of health” like resilience, optimism, purpose and connection. There is also more explicit acknowledgement of the health impacts of systemic racism and toxic, chronic stress. This focus on personal connection and individual agency of patients demonstrates the value of roles like Community Health Workers (CHWs) and investments to deliver culturally responsive, trauma-informed care in clinical settings.
- Though everyone seems to be talking about SDoH, there are varied opinions regarding how far “upstream” SDoH policies should reach and who should be attempting to identify and address SDoH factors (e.g., clinicians, public health officials, legislators, regulators). Two recently published perspectives offer a glimpse into this debate: an interview with Rishi Manchanda, MD, MPH, Founder and President of HealthBegins, and a Health Affairs blog by Brian Castrucci, CEO of the de Beaumont Foundation and John Auerbach, CEO of Trust for America’s Health.
The good news is that there will be a plethora of grant opportunities competed this spring and summer. To prepare, backbone organizations, health systems and cross-sector coalitions should crystalize their “north star” vision and reach consensus regarding the strategies and priorities that best fit their capacities and areas of expertise before grant solicitations are published. We can use these forecasted insights to calibrate our population or program foci, but grant seeking is most successful when it is used to bolster and align existing strategy and investments.
If you need help aligning your collaborators to define your common agenda, shared measurement infrastructure, mutually reinforcing activities, communications plan or partner roles then contact me.
Let’s get your team on track and #grantready for these new opportunities in 2019!