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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
Aging and Health Program: Strategic Review - Downstream Shift
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
Aging and Health Program: Strategic Review - Downstream Shift
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:
Aging and Health Program: Strategic Review - Downstream Shift
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
Aging 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
9Aging and Health Program: Strategic Review - Downstream Shift
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%
10Aging and Health Program: Strategic Review - Downstream Shift
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
11Aging and Health Program: Strategic Review - Downstream Shift
Payout transition over time ($ millions)
2012 2013 2014 2015 20160
2
4
6
8
10
12
14
16
18
20
New StrategyTransitionLegacy
12Aging and Health Program: Strategic Review - Downstream Shift
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
13Aging and Health Program: Strategic Review - Downstream Shift
Discussion
14Aging and Health Program: Strategic Review - Downstream Shift
Aging and Health Program: Strategic Review - Downstream Shift
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)
16Aging and Health Program: Strategic Review - Downstream Shift
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
17Aging and Health Program: Strategic Review - Downstream Shift
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)
18Aging and Health Program: Strategic Review - Downstream Shift
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
19Aging and Health Program: Strategic Review - Downstream Shift
Medicine35%
Nursing26%
Social Work20%
IIS16%
Aging & Health Other3%
Aging & Health Grants Paid: 2003 - 2009
Medicine Nursing Social Work IIS Aging & Health Other
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
20Aging and Health Program: Strategic Review - Downstream Shift
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
Medicine Nursing Social Work IIS Aging & Health Other
Do
llars
(In
Th
ou
san
ds)
21Aging and Health Program: Strategic Review - Downstream Shift