From right, Amy Berman, John A. Hartford Foundation President Terry Fulmer, Jon Broyles of C-TAC, and Bud Hammes of Respecting Choices engage in a convening held in June 2015 by JAHF on "End of Life and Serious Illness."

The John A. Hartford Foundation’s dedicated staff is constantly monitoring the dynamic health care landscape to identify powerful opportunities for large-scale change that will result in better care and better lives for all older adults. I am very pleased to announce that our Trustees last week approved three new grants totaling $6.7 million that leverage these opportunities.

One of the keys to effective grantmaking is to partner with innovative leaders at the very top of their fields. That is certainly true of the Foundation’s new grants.

We are thrilled to announce a $3.5 million initiative to create a collaborative, led by Dr. Tony Back, co-director of the University of Washington’s Cambia Palliative Care Center of Excellence, that brings together a veritable dream team of innovators who will work cooperatively to greatly accelerate and expand better end-of-life and serious illness care. In addition to Vital Talk, which is housed at our grantee hub at the University of Washington, the other “dream team” members are: Ariadne Labs/Serious Illness Care Program, led by Drs. Susan Block and Atul Gawande; the Center to Advance Palliative Care, led by Dr. Diane Meier; the Coalition to Transform Advanced Care (C-TAC), led by Tom Koutsoumpas/Respecting Choices, led by Dr. Bud Hammes; The Conversation Project, led by author Ellen Goodman; and National POLST Paradigm, led by attorney Amy Vandenbroucke. In addition to the collaborative strategy, our grant supports scaling up these six innovative national models, resulting in improved care for at least 300,000 people.

We are also excited to work with Sandy Markwood, Chief Executive Officer of the National Association of Area Agencies on Aging (n4a), on a separate $2.9 million grant to support an initiative to successfully build and strengthen partnerships between social service agencies and health care systems and health plans so older adults will have access to evidence-based programs that help them live with dignity and independence in their homes and communities as long as possible.

And we look forward to working with Dr. Barbara Brandt, director of the University of Minnestota’s National Center for Interprofessional Practice and Education, on a $300,000 grant to establish geriatric team care in community-based settings and inform the development of interprofessional curricula in nursing and other health professional schools.

Each of these grants capitalizes on opportunities to advance and accelerate needed changes to improve the care of older adults.

Working Collectively to Accelerate Progress in End-of-Life Care

Remember the cries of “death panels” that arose seven years ago in the early Affordable Care Act debates? They effectively silenced policy discussions about end-of-life planning and care. Now, Medicare has instituted new payment codes for advance care planning that are overwhelmingly supported by the public. This was propelled by newspaper stories and best-selling books that began presenting a new narrative about end-of-life experiences. Innovations in models of care for people with serious illness or at the end of life also have been maturing and are demonstrating positive results.

While we originally foresaw an investment in one particular model, our two years of exploration showed that we need a multi-pronged approach. That exploration process included a convening the Foundation held on end of life and serious illness in June 2015 that brought together leading innovators in the field and funders with deep interest in this area. The six supported programs I mentioned earlier range in focus from clinician training to community engagement. In addition to the six innovators, our work has sparked a national collaboration among 18 funders.

Just as important as supporting the work of these innovators individually is the creation of a collective strategy among them, with shared goals, common metrics, and mutually reinforcing field-building activities. While the innovators have been aware and supportive of each other’s work, this will be their first coordinated endeavor. Other funders over time will augment both the scaling of the individual models and the collective activities with their own unique approaches and funding strategies. We are enthusiastic and optimistic about this work leading to dramatic changes in end-of-life and serious illness care, which will have an enormous impact on older adults and their families.

Building the Business Acumen of Social Service Agencies

n4a_logo_250pOver the past several years, new models of health care payment have incentivized hospitals, health systems, and health plans to provide the social supports and services that can help older adults remain safe and healthy in their homes instead of in higher-cost care settings. These services include evidence-based health promotion programs, delivery of nutritious food, transportation, and many others.

These supports and services are delivered expertly by community-based organizations, including Area Agencies on Aging, which traditionally receive funding through federal grants funded as part of the Older Americans Act. Unfortunately, the Older Americans Act remains unauthorized and severely underfunded. Changing payment and delivery mechanisms, including the rise of managed care, have provided an opportunity. Community-based organizations can create new sustainable revenue streams in partnership with health systems and plans, enabling more older people to access these services.

We had already invested in building prototype networks of community-based organizations in California and Massachusetts, which showed that they can successfully contract and partner with health care delivery organizations. It requires building business acumen in areas such as the pricing of services, developing billing mechanisms, and outcomes data collection.

Now, through this grant to the National Association of Area Agencies on Aging (n4a), in partnership with the American Society on Aging and the Independent Living Research Utilization program (which focuses on the younger disabled population), we will support the development of a National Resource Center. The resource center will provide training and disseminate tools to help hundreds more community-based organizations contract with health systems to deliver social services integrated with medical care that can keep older adults living as healthy and independent as possible.

Advancing Geriatric Team Care

NCIPE_logo_250pStarting in 1995, the Foundation invested $11 million in the Geriatric Interdisciplinary Team Training initiative. That successful effort was ahead of its time in many respects. Now, new investments and changes in health care professional training have opened up opportunities to create systemic changes in interprofessional education and collaborative practice.

With this grant, we will seize that opportunity and support up to 20 nursing school-led, community-based programs that will be awarded grants to develop interprofessional courses and activities while cultivating collaborations among health professions, educational, and community partners. The project will utilize the research, experience, and resources of the National Center for Interprofessional Practice and Education at the University of Minnesota. It will build on current and previous work supported by the U.S. Health Resources and Services Administration (HRSA), as well as a consortium of funders (The Robert Wood Johnson FoundationThe Josiah Macy Jr. Foundation, and the Gordon and Betty Moore Foundation). Our grant support ensures a focus on care for older people within this more than $2 million initiative.

We are thrilled to present these new grants that capitalize on emerging opportunities in aging and health by partnering with innovative leaders in the field. From scaling up proven programs and building a collective strategy to accelerate better end-of-life care, to providing the resources necessary to better integrate community-based social services with medical care, to advancing geriatric team care, these investments will have a significant impact on the lives and care of older adults.