Like many other nonprofits, the Milbank Memorial Fund (MMF) spends time assessing the impact of its work, which is guided by its mission of improving population health by connecting leaders and decision makers with the best evidence and experience. Staff recently gathered around a flow chart, armed with sticky notes, assessing how we might determine if our peer-reviewed journal, The Milbank Quarterly; our reports; and our work with state leaders are having an impact.
At the top of our list of impact measures was this—"the health of a population improves because of actions taken with evidence and experience we have identified or coordinated." This lofty goal turned the conversation to the Reforming States Group (RSG), a bipartisan voluntary association of state health policy leaders from both the executive and legislative branches, which we have supported for twenty-three years. If any of the groups we engage with regularly could take action to improve population health based on evidence and experience provided by us, we would hope it would be the RSG.
Every year, the RSG comes together to share information, develop professional networks, and work on practical solutions to pressing problems in health care and public health. This past year, representatives from thirty-four states—almost 100 people from the executive and legislative branches—participated in the meetings. As an operating foundation, we don't make grants, but instead pay directly for the cost of these meetings and provide staff support.
The RSG's work is directed and guided by the state leaders themselves—in the form of a steering committee comprised of long-time RSG participants. Steering committee members set the strategic direction for the group, select programs, and serve as ambassadors for the RSG's work in national and local settings. Recent work has included RSG meeting sessions focused on the changing role of community health workers and paramedics in providing care, commissioning a report on the ways states have incorporated population health goals and priorities into accountable care organizations (ACOs) or ACO-like models, and learning from national experts on how states can plan for an aging population.
The MMF has supported the convening of state leaders since the 1990s, when it was first asked to hold a bipartisan meeting of state leaders to discuss how to assess and evaluate health and human services during difficult fiscal times.
We've been told by state health policy makers that these meetings continue to be unique. Our end-of-meeting questionnaires also give us a lot of positive reviews.
Here's why. During these three-day meetings (each year, we generally run three separate meetings of about thirty to forty participants at a time), we bring together state legislators and executive branch officials from across the country and both sides of the aisle to learn about each other's successes, discuss practical solutions to common health policy challenges, and develop professional networks—in a not-for-attribution environment and in the service of improving the health of their communities.
We have found that candid conversation about health policy can occur in this type of neutral, safe space, allowing policy makers to freely discuss and debate issues.
But even if these meetings are unique and well received, do they really make a difference? Does bringing together state healthy policy makers actually influence health policy? Which meeting elements resulted in the most policy action? To find out, we asked the RSG participants themselves.
Follow-Up Survey Results
This was the first time we conducted a follow-up survey to better understand the impact of our meetings. We asked the participants to identify policy steps they have taken as a result of our meetings.
The results were quite encouraging. Fifty-seven percent of state legislators stated that they authored or sponsored a specific bill on a topic discussed at the RSG meeting, and 50 percent of executive officials noted that they started an initiative or added to one already under way based on an exchange or individual associated with the RSG.
The survey also found that relationships between executive and legislative leaders within a state, a fundamental building block for policy change, improved as a result of the opportunity to learn about, reflect on, and discuss issues together. So, the networking that occurred at these meetings was not only between participants from different states, but a surprising number noted that these meetings gave them an opportunity to meet and interact with policy makers they didn't know from within their own state.
What were some of the specific actions taken?
Legislators noted that they had initiated specific bills after discussions at RSG meetings—these included authorizing a pilot community paramedicine program in rural areas of a state, altering Determination of Need standards for nursing homes, and facilitating Medicaid eligibility determination for those leaving the criminal justice system.
Executive branch officials cited developing a Medicaid reimbursement rate for community paramedics, incorporating community health workers into State Innovation Model (SIM) activities, and restructuring of payment methodologies to incentivize providers' performance and improve quality of care. Participants also said that improved relationships between executive and legislative leaders in the same state resulted in pre-legislative session discussions on the governor's and legislative priorities, improved understanding of executive department constraints, and initiation of deliberations on policy priorities of mutual interest.
Philanthropies look for ways to demonstrate they are achieving their mission. One of the ways the Milbank Memorial Fund improves population health is by helping to build relationships and increase information exchange between state health policy leaders. When we can document how we contribute to their success, our number-one impact measure is in our sights.
Editor's Note:
Related reading from Health Affairs:
"State Initiatives on Prescription Drugs: Creating a More Functional Market," by the Reforming States Group, Health Affairs, July/August 2003.
from Health Affairs Blog http://ift.tt/1Tb6vgH
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