Graciela Couchonnal, Vice President of Programs, Health Forward Foundation
Health Forward Foundation is celebrating 15 years of grantmaking. In this time, the foundation has anchored access to safety net health care for those most in need in the Kansas City region.
Our inaugural grant in 2005 supported a health levy ballot initiative in Kansas City, Missouri. That small investment of $25,000 has leveraged close to $50 million annually in safety net health care for uninsured Kansas Citians. Since that first grant, we have partnered with more than 500 organizations and infused the region with over $300 million dollars in investments that have resulted in healthier people in healthier communities. This includes funding to increase access to safety net health and oral health services that brings about better health, better health care, and smarter spending.
Along the way, we have learned valuable lessons about maximizing our investments through innovations and partnerships to benefit those most in need.
Lesson 1: Philanthropy is uniquely positioned to pursue bold action.
Health Forward has long recognized that lack of insurance is a critical barrier to health. As such, we have been proud to be a leader in the effort to expand Medicaid in Missouri.
After Maine passed Medicaid Expansion in 2017 through a ballot initiative, Health Forward began convening partners around a campaign to bring the decision of Medicaid expansion before Missouri voters instead of the legislature, where it had not gained traction.
On May 1, 2020, the Healthcare for Missouri campaign submitted nearly twice the required signatures to place Medicaid expansion amendment on the ballot, and on August 4, 2020, Missouri became the 38th state to expand Medicaid.
The campaign underscored the critical importance of grassroots, “grass-middle”, and “grass-tops” collaborative efforts and multisector, bipartisan support. While Health Forward initiated the exploration of expanding Medicaid via ballot initiative, it was the coalition of stakeholders that achieved the goal. The Healthcare for Missouri coalition included over 300 organizations throughout the state representing business, labor, seniors, faith communities, health providers, and civil rights organizations.
Health Forward invested nearly $2 million, significant sweat equity, and much political capital to ensure the campaign’s success. Health Forward is regionally known as a non-partisan entity focused solely on issues that improve the health of our communities. Medicaid expansion is a partisan issue in the region, so we risked our reputation for the benefit of more than 250,000 Missourians who lack health insurance. This calculated risk-based investment was one we were willing to take given the magnitude of a successful outcome.
Lesson 2: Philanthropy is positioned to advocate for social care reimbursement.
Early on, we recognized the promise of community health workers as an emerging role in health care. Community health workers (CHW) improve patient well-being and reduce preventable health care use and costs. They also play a vital role in promoting health equity for communities of color.
While Health Forward was an early investor in supporting the role of CHWs in our region, we knew that this could also be an opportunity to spur change at the state level. It would take considerable advocacy, funding, and leveraging partnerships.
With a total investment of $1 million, we partnered with the Mid-America Regional Council on the Kansas City Regional Community Health Worker Collaborative, which adopted a common definition, curriculum, scope of practice, and approach for community health workers across Missouri and Kansas.
The collaborative functioned as an organizational structure supported with bylaws, monthly subcommittee meetings, and dedicated administrative and policy support to promote the collaborative’s strategic plan and its efforts to foster the growth and sustainability of CHWs.
The collaborative remains committed to expanding regional awareness, influencing state policy, and recruiting payers. More recently, it has played a key role advocating for a Missouri state plan amendment for Medicaid to cover reimbursement for community health workers.
Lesson 3: Partnerships are necessary to address gaps in clinical services.
The absence of universal health coverage and Medicaid expansion starkly underscores the need for innovative solutions and strategic partnerships to combat complex health problems.
Federally qualified health centers and safety net providers struggle with a high volume of patients with complex comorbidities while also lacking the capacity to offer a full spectrum of specialty services.
Health Forward Foundation is in its 14th year of supporting a partnership that connects low-income and uninsured patients to specialty care they could not otherwise access or afford. Our $4.5 million total investment supports a bi-state partnership between two regional medical societies and a safety net specialty care access program, presently known as MetroCARE. This partnership created a referral network that donates services and hospital resources to increase specialty care access.
In 2018, 925 specialty physicians scheduled over 1600 consultations at a value estimated to exceed $8 million—leveraging a 16-fold return on Health Forward’s investment of $500,000 that year.
The partnerships extend beyond physicians to include hospitals, labs, and physical and occupational therapists who all donate staff time and facilities as well as needed medical equipment and supplies.
While we have leveraged significant services through our investment, it is important to highlight that this is by no means the ideal solution to the gap in specialty care access. This is a temporary solution to an issue that requires careful attention, action, and support from our stakeholders throughout the health care ecosystem. We continue to advocate for real, systems-level change.
Poverty is one of the most common barriers to health among the people we serve. We know the underpinnings of poverty are income, wealth inequality, and structural racism.
Health Forward will spend the next year refining our focus for measurable impact on these social factors. We will engage in an internal process that will explore strategic paths at the nexus of health, economic well-being, and race equity.
We are committed to addressing the strengths and challenges of accessing and growing philanthropic funding for organizations led by and serving people of color.
It will take innovation, collaboration, and bold action to effect change at such an entrenched level in our nation and region. We will be counting on our partners to join us in developing equitable asset building opportunities with and in communities that improve health and economic well-being. It will take time and a continued commitment, but together we can move health forward.