Health Policy Institute of Ohio (HPIO)

Updated materials originally presented to interested foundations in late February, 2003

How the Project Arose

The Health Foundation of Greater Cincinnati’s Board felt it was time for us to do more policy-oriented work

We began a process of talking with health policy officials, researchers and funders across the state

Several themes arose, and a number of researchers, officials and sister foundations encouraged us to look at forming a policy institute; a proposal was written

What We Found: Policymaker Issues

Because of term limits, legislators have lost the history and their knowledge bases about Medicaid

Lobbyists are the only source of information, and their information always supports their causes; no independent sources

State officials are hard-pressed to generate information and analyses

In-state studies not ready when neededMore Medicaid coverage decisions have been

delegated to the state

What We Found: Researcher Issues:

MEDTAPP (program of Medicaid & Board of Regents) is funding only a few projects

Most research is clinically-oriented rather than policy-oriented

Most researchers working on Medicaid and the uninsured are isolated

This work has low priority and prestige in academic departments – partly because it is poorly funded

Little research reaches legislators

What We Found: Ohio Health Policy Research Centers

UC: Institute for Health Policy & Health Services Research

U of Akron: Institute for Health and Social Policy

Federation for Community PlanningOSU: Center for Health Outcomes, Policy &

Evaluation Studies

CWRU: Center for Urban Policy & Social

Change

What We Found: Health Advocacy Issues

It is hard to get good information out of the state system

Important issues do not get attention because there is no way to back them up

Most advocates do not have the ability to do analytic work directly

What We Found: Foundation Issues

Most health & community foundations do not act to influence state policy – but policy is critical for sustainability of local programs

No coordination of policy efforts among health foundations

Policy efforts are isolated; hit-and-miss for priorities, and last-minute

What is Different About Our State

Ohio is one of four states that have multiple urban centers

No single city dominates the state

What is Different About Our State

Ohio is one of three states that have multiple urban centers

No single city dominates the state

Our cities differ in their cultures

No statewide health grantmaker

Work in Other States

At least 1/3 of states have, and 11 states plan a health policy center

Three foundations in Colorado just announced creation of a center

They did substantial research prior to acting, and we have borrowed liberally

Three Models for Health Policy Centers

1. Subsidiary of a health foundation

2. University-based center

3. Independent center

What We Are Proposing

An independent center that works to improve the health of all Ohioans through research, analysis and communication about vital health concerns affecting the state, with particular emphasis on the Medicaid, uninsured and underinsured populations, and issues of public health in Ohio

What is Different About Our Proposed Center

More emphasis on communication with and education of policymakers

Less emphasis on data warehousing or clearinghouse functions (we can link to existing sources in Ohio)

Multiple local funders joining to fund a state policy center as a way to advance regional interests through state-level interventions

Success Issues

Quality of HPIO leadership:– Competent with research, economic

analysis– Non-partisan, no political agenda– Communication and relationship skills to

interact with policymakers

Success Issues

Stable funding during start-up (or we won’t recruit well and money issues will distort the work selected)

Board that represents the state, but has no vested interest (i.e., no income to them or their organizations from changes in state policies)

Work of the Institute: Health Policy Research Agenda for Ohio

Generate through state-wide inclusive process

Working closely with ODJFS Ohio Health Plan (Medicaid), Ohio Department of Health and others

Attuned to issues likely to arise and to closing gaps in useful information

Work of the Institute: Reports

Informational Brochures (2/year)– Such as Ohio Medicaid Basics

Issue summaries (12/year)– Translate studies done across the state

into materials understandable by policymakers

White papers (3/year)– In-depth research or analysis

Work of the Institute: Reports

Biennial district and local reports– Bringing abstract issues into focus in a

legislator’s district

Report to the Community– The Center’s annual report (but done

biennially)

Work of the Institute: Meetings

Legislative BriefingsResearch Conferences & RoundtablesPublic meetings for setting policy

agendaMedia Briefings

Governance

The Board will consist of appointees of the Founders during the starrt-up years

Broader participation will be engaged through advisory groups convened by the Institute

The Institute will convene:

The Ohio Health Policy Advisory Group… to develop

consensus about state policy research issues & priorities

The Institute will convene:

Ohio Health Policy Researchers Advisory Group… to develop researchers

to share work

to simplify work

to enhance health policy work in Ohio

The Institute will convene:

Scientific Review Advisory Group... to review the

Institute’s scientific activities and to oversee a formal evaluation process in Year Four

HPIO Benefits for Ohio:

Decisions affecting Medicaid & uninsured will be more data-driven

Hare-brained solutions may wither sooner

Contentious issues will be examined more thoughtfully, with better understanding of consequences

Opportunities for reform will be used

Useful Information from Ohio Medicaid Basics

Publication by the Health Foundation of Greater Cincinnati and the George Gund Foundation - as an example of potential HPIO output and impact(Report available at www.healthfoundation.org/publications)

Medicaid Enrollment

Medicaid per member, per month costs

Medicaid Expenditures

How does Ohio compare?Ohio’s per member per month (PMPM) costs for most Medicaid-eligible populations are at or below national

averages

Other Things Being Equal, Decisions about Medicaid coverage will balance:

• Covering the optimum number of people

• Providing the optimal services• Maintaining Ohio’s financial integrity• Promoting family & community self-

sufficiency, self-determination, & health

Health Policy Institute of Ohio: Benefits for Foundations

Permits foundations to inform policy based on what they learn from their local projects

Research and analysis can help foundations choose and focus projects for best impact

Source of health outcome studies and indicators for evaluating own work

Health Policy Institute of Ohio: Benefits for Foundations

Source of expertise for getting certain types of projects done

Allows Ohio health grantmakers to collaborate

Will keep us out of crisis-driven and fragmented policy work

Permits state-level interventions that we have not used up to now

Discussion

HPIO Funder Status 2003 2004 2005 2006 2007 20085-Year Total (excl. Yr 0)

Health Fdn of Greater Cincinnati $190,000 $300,000 $300,000 $300,000 $300,000 $300,000 $1,500,000Gund Foundation * # $100,000 $125,000 $125,000 $125,000 $125,000 $125,000 $625,000Anthem Fdn of Ohio/Greater Cincinnati Foundation * ## $100,000 $100,000 $100,000 $100,000 $100,000 $500,000Mt. Sinai Health Care Fdn # $100,000 $100,000 $100,000 $100,000 $100,000 $500,000St. Luke's Foundation ** # $100,000 $100,000 $100,000 $100,000 $100,000 $500,000Srs. of Charity, Canton & Cleveland * ## $100,000 $100,000 $100,000 $100,000 $100,000 $500,000Cleveland Foundation ^ $63,000 $0

* has a three-year grant length constraint indicates a projection for which there is no commitment presently** has a one-year grant length constraint indicates an award made# intends to fund an additional cycle(s) indicates proposal still being processed## willing to fund an additional cycle(s) ̂cannot commit further at this time due to

strategic realignment in process