John A. Hartford Foundation June 2012 Strategic Plan Review

Aging and Health Program: Strategic Review - Downstream Shift

Aging and Health Program

Strategic Review“Downstream” ShiftJune 2012

Goals for Today

• Quick review:– Where we have been– Discussions to date

• New directions – the “Downstream” Shift• Operational plans• Transition• Continuing issues• Role of Trustees

Aging and Health Program: Strategic Review - Downstream Shift2


Grantmaking Approach

• Only national funder focused on aging and health mission

• Highly strategy driven• Expert staff, engaged

in the field• Drawing on brand and

reputation• Strong partnerships• Creating change, not

grants alone 2012 2013 2014 2015 201610

15

20

25

30

18.3 18.3 18.1 17.7 17.5

Projected Payout ($ millions)

3


Prior Strategies - E.g., Medicine

All PhysiciansCompetentto Care for Older Adults

Faculty Development

Centers of Excellence

ADGAP –Leadership

Surgeons Initiative

Reynolds Foundation Programs

CurricularChange

MSTAR

Beeson

Williams

Jahnigen

Scholars Programs

Internal MedicineSpecialist Initiative

ADGAP –Chief Residents

4

The Gap

Aging and Health Program: Strategic Review - Downstream Shift 5

• Preventable Adverse Events – 20%• 30-day hospital readmissions – 20%• Fragmentation and silos• Assessing Care of Vulnerable Elders:


Principles to Date• Shift “downstream” away from faculty production towards

practice• Bridge the education<->practice gap with increased focus on

continuing education and practice redesign

• Mobilize our best asset – Hartford “alumni”• Break down silos among professions and bring disciplines

together – prioritize teams to deliver comprehensive care

• Focus on the frailest and most expensive older adults – top

20%• Capitalize on high-leverage opportunities in reform and

strategic partnerships (e.g., Medicare, VA, private industry)• Avoid direct Foundation participation in policy, rather support

the involvement of grantees in policy6

Reduced Costs/

Business Case

Build IT/Quality Measures

Engaged Geriatric

Experts and Alumni

Improved Policy and Payment

Improved Practice and Educational Regulation

Engaged Health Care

Decision Makers

Health of Older

Americans

New Theory of Change

7Aging and Health Program: Strategic Review - Downstream Shift


Proposed New Grantmaking• Interprofessional Leadership in Action

– Center for Medicare Innovation Advisors Program Augmentation (w/ Atlantic Philanthropies) (9/12)

– Interdisciplinary Leadership Network (3/13)• Support leadership training and workgroups on high priority issues

(e.g., dementia, family care, quality measures). Mix established and new leaders.

• Linking Education and Practice – National Interprofessional Education Center (w/ Robert Wood

Johnson, Macy & Health Resources and Services Admin.) (12/12)

– Social Service Agency Continuing Education/Redesign (3/13)

– Primary Care Continuing Education/Redesign (9/13)

• Developing and Disseminating Models of Care– Social Innovation Fund – IMPACT Expansion (6/12)

– Colorado Care Transitions Intervention Dissemination (9/12)8

Proposed New Grantmaking (cont.)

• Tools and Measures for Quality Care

– In development

• Communications/Policy– Eldercare Workforce Alliance (Tides Center) (12/12)

– National Health Policy Forum (12/12)

• Other


Hypothetical Grant Allocations

• Interprofessional Leadership in Action

25%

• Linking Education and Practice

20%

• Developing and Disseminating Models of Care

20%

• Tools and Measures for Quality Care

15%

• Communications/Policy

10%

• Other

10%


Graceful Transition – Final Renewals

• Social Work Scholars and Fellows (9/2012)• Centers of Excellence in Geriatric Medicine

(9/12)• Nursing Scholars & Centers of Excellence

(12/12)• Paul B. Beeson Faculty Scholars Program (9/12)• MSTAR (Medical Student) Program (12/2012) • Communications strategy for exit• Grantee sustainability support and capacity

building


Payout transition over time ($ millions)

2012 2013 2014 2015 20160

2

4

6

8

10

12

14

16

18

20

New StrategyTransitionLegacy


As we move forward:• Develop specific progress measures and goals• Get more feedback from you and external

stakeholders• Regularly review strategy and what we are

learning with the Board

Role of the Board:• How can we best support your governance role?• How can we get you involved?• Presenting a united front to soon-to-be-former

grantees


Discussion



AACN – American Association of Colleges of NursingAAMC – Association of American Medical CollegesADGAP – Association of Directors of Geriatric Academic ProgramsBAGNC – Building Academic Geriatric Nursing CapacityCMMI – Center for Medicare/Medicaid InnovationCMS – Center for Medicare and Medicaid ServicesCGNEs – Centers of Geriatric Nursing ExcellenceGSA – Gerontological Society of AmericaHPPAE – Hartford Partnership Program in Aging EducationIM – Internal MedicineMSTAR – Medical Student Training in Aging ResearchMSW – Master’s in Social WorkNYAM – New York Academy of MedicinePHI – Paraprofessional Healthcare InstituteSIF – Social Innovation Fund

Acronyms

15

Aging and Health Commitments: 2003 - 2010 (in thousands)

Outcomes (in dollars) 2003 2004 2005 2006 2007 2008 2009** 2010 Grand Totals('03 - '09)

Medicine 7,221 12,986 1,518 19,787 17,972 3,400 14,815 1,812 77,699

Nursing 3,050 4,267 18,587 591 8,173 8,181 1,331 1,780 44,180

Social Work 3,449 9,185 5,383 9,195 14,425 0 4,607 0 46,244

IIS 328 6,606 2,376 4,800 6,824 5,215 1,199 400 27,348

Aging & Health Other 0 135 2,340 1,264 74 2,403 400 0 6,616

Totals By Year (in current $s): 14,048 33,179 30,204 35,637 47,468 19,199 22,352 3,992 202,087

Cumulative Total (Current $s): 14,048 47,227 77,431 113,068 160,536 179,735 202,087 206,079

Totals By Year (in constant $s):* 14,048 32,318 28,456 32,526 42,124 16,408 19,170 3,376 185,051

Cumulative Total (Constant $s): 14,048 46,366 74,823 107,349 149,473 165,880 185,051 188,426

Outcomes (percentages) 2003 2004 2005 2006 2007 2008 2009 2010 Grand Totals ('03 - '09)

Medicine 51.4% 39.1% 5.0% 55.5% 37.9% 17.7% 66.3% 45.4% 38.4%

Nursing 21.7% 12.9% 61.5% 1.7% 17.2% 42.6% 6.0% 44.6% 21.9%

Social Work 24.6% 27.7% 17.8% 25.8% 30.4% 0.0% 20.6% 0.0% 22.9%

IIS 2.3% 19.9% 7.9% 13.5% 14.4% 27.2% 5.4% 10.0% 13.5%

Aging & Health Other 0.0% 0.4% 7.7% 3.5% 0.2% 12.5% 1.8% 0.0% 3.3%

Totals: 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Includes Projected Commitments through December 2010

*2003 Consumer Price Index Base

** Includes AFAR CoE National Program Office Grant ($8.4 million)


Medicine38%

Nursing22%

Social Work23%

IIS14%

Aging & Health Other3%

Medicine

Nursing

Social Work

IIS

Aging & Health Other

Medicine: $77,699Nursing: 44,180

Social Work: 46,244IIS: 27,348

Aging & Health Other: 6,616Total: $202,087

Aging & Health Grants Committed: 2003-2009


2003 2004 2005 2006 2007 2008 20090

5,000

10,000

15,000

20,000

25,000

Aging & Health Grants Committed: 2003 - 2009

Medicine Nursing Social Work IIS Aging & Health Other

Year of Trustee Authorization

Do

llars

(In

Th

ou

sa

nd

s)


Aging and Health Grant Payouts: 2003 - 2010 (in thousands)

Outcomes (in dollars) 2003 2004 2005 2006 2007 2008 2009 2010 Grand Totals('03 - '09)

Medicine 8,118 9,492 9,630 6,029 9,165 7,564 8,480 6,231 58,478

Nursing 7,044 6,424 6,567 5,550 6,407 4,952 6,441 3,802 43,385

Social Work 2,655 3,906 5,265 3,650 6,830 6,142 4,458 3,406 32,906

IIS 4,132 2,577 3,191 1,777 5,042 4,195 5,077 3,088 25,991

Aging & Health Other 451 429 813 1,070 1,142 832 666 620 5,403

Totals By Year (in current $s): 22,400 22,828 25,466 18,076 28,586 23,685 25,122 17,147 166,163

Cumulative Total (Current $s): 22,400 45,228 70,694 88,770 117,356 141,041 166,163 183,310

Totals By Year (in constant $s):* 22,400 22,236 23,993 16,498 25,368 20,241 21,546 2,361 152,282

Cumulative Total (Constant $s): 22,400 44,636 68,628 85,126 110,494 130,736 152,282 154,643

Outcomes (percentages) 2003 2004 2005 2006 2007 2008 2009 2010 Grand Totals ('03 - '09)

Medicine 36.2% 41.6% 37.8% 33.4% 32.1% 31.9% 33.8% 36.3% 35.2%

Nursing 31.4% 28.1% 25.8% 30.7% 22.4% 20.9% 25.6% 22.2% 26.1%

Social Work 11.9% 17.1% 20.7% 20.2% 23.9% 25.9% 17.7% 19.9% 19.8%

IIS 18.4% 11.3% 12.5% 9.8% 17.6% 17.7% 20.2% 18.0% 15.6%

Aging & Health Other 2.0% 1.9% 3.2% 5.9% 4.0% 3.5% 2.7% 3.6% 3.3%

Totals: 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Payments Made Through August 31, 2010

*2003 Consumer Price Index Base


Medicine35%

Nursing26%

Social Work20%

IIS16%

Aging & Health Other3%

Aging & Health Grants Paid: 2003 - 2009


Medicine: $58,478 Nursing: 43,385

Social Work: 32,906IIS: 25,991

Aging & Health Other: 5,403Total: $166,163

NOTE: ALL DOLLAR FIGURES EXPRESSED IN THOUSANDS


2003 2004 2005 2006 2007 2008 20090

2,000

4,000

6,000

8,000

10,000

12,000

Aging & Health Grant Payouts: 2003 - 2009


Do

llars

(In

Th

ou

san

ds)


John A. Hartford Foundation June 2012 Strategic Plan Review

Documents

health mission

date shift

quick review

policy aging

macy health resources

quality care

national health policy

primary care