Health Care Grantmakers Move into the Community

When Mick Johnson and his colleagues at The Foundation HealthSystem Minnesota researched their donors before launching a major capital campaign seven years ago, what they discovered surprised them: the hospital's donors were not interested in funding traditional "bricks and mortar" health care programs - new hospital wings, equipment and the like. However, donors were interested in giving funds that would help meet urgent and compelling health needs in the community.

That discovery played a key part in the foundation's decision to turn to a more community-focused mission about five years ago, according to Johnson, president of The Foundation HealthSystem Minnesota, which was created two years ago following the 1994 merger of Methodist Hospital and Park Nicollet Medical Center. HealthSystem uses third-party reimbursement to cover the costs for its internal hospital programs and services, and now focuses the foundation's resources on responding to community health-related needs. Over the last five years, the portion of the institution's funds going back out to the community have increased from about 12 percent to 66 percent of its grantmaking dollars.

"We were created by the community, and the focus of our mission has always been to respond to the health care needs of the community," Johnson says. "But we're moving beyond the very narrow definition of being fund raisers and grantmakers, and into the area of being health partners in the community."

HealthSystem Minnesota's growing outward focus on community needs is a trend mirrored by many of Minnesota's health care grantmakers (foundations or giving programs affiliated with a hospital, insurance plan or managed care system). And as they meet the challenges associated with becoming effective community partners, health care grantmakers also must determine how to best help their institutions deal with the ongoing pressures in today's health care marketplace to reduce costs and meet growing needs.

Increased Community Focus

Health-related giving in Minnesota has remained fairly stable in recent years. The Minnesota Council on Foundations' latest Giving in Minnesota report shows that the state's grantmakers gave the same percentage of total dollars to health in 1994 as in 1992: 6 percent. (Nationwide, grantmakers gave 15 percent of all dollars to health in 1994.)

But the visibility of health care grantmaking has grown in recent years in communities throughout Minnesota. Health care grantmakers are making more external grants to nonprofit organizations, developing more community partnerships, and taking more of a leadership role on community health issues. This year for the first time, two health care grantmakers appeared in Giving in Minnesota's list of top 25 corporate grantmakers: Allina Foundation and Blue Cross and Blue Shield of Minnesota Foundation (both are classified as nonprofit corporations).

Minnesota's health care grantmakers cite many reasons for their growing outward emphasis on the community. One common explanation is that many hospitals have redefined their missions in recent years to focus not just on serving their patients but also on improving the health of the communities around them, partly in response to federal cutbacks and a growing uninsured population.

"Some philanthropic dollars that have traditionally gone to curing disease and treating injury are now being used in different ways within the community to improve the health of its citizens," says Mike Christenson, executive director of the two-year-old Allina Foundation, the philanthropic arm of Allina Health System, Minnesota's largest health system. Allina Health System was created three years ago through a merger of the HealthSpan health care system and Medica health plans. Allina Foundation gave more than $2.6 million in grants in 1995.

For The Foundation HealthSystem Minnesota, which relies solely on donations from individuals for its charitable giving funds, another reason for the organization's increased community focus is the fact that it appeals to donors. "It's easier to describe an urgent and compelling need as it relates to a small child who lives in a single-parent family where there's unemployment, than it is to describe why you need a new piece of technology in the hospital," says Johnson, "especially when donors are reading about premium increases."

Focus on Prevention

But perhaps the key reason for the increased community emphasis by Minnesota's health care grantmakers is a growing realization that the best way for them to help their institutions achieve their missions of improving community health is to focus on prevention - going "upstream," to use a common phrase in the health care industry - which requires reaching out more to the community. For many health care foundations and giving programs in the state, prevention is their top priority.

Health care grantmakers are increasingly looking to the provider side of their organization to take care of intervention when people are sick or injured, while focusing their charitable dollars on preventing people from getting sick or injured in the first place. The Foundation HealthSystem Minnesota, for example, has a strategic goal to increase the immunization rate of children 0 to 24 months of age in HealthSystem's service area to 90 percent by the year 2000. One of the strategic priorities of the Blue Cross and Blue Shield of Minnesota Foundation is to reduce the use of tobacco in the state.

One key reason for this increased prevention emphasis is an economic one, according to Allina's Christenson. Health care costs continue to rise in this country in part because health care has traditionally been a "downstream" function of society, addressing problems in their last stages. "Part of what most health systems in Minnesota are looking at is whether we can be more effective in preventing that very expensive function," he says. "Can we help our society manage the risks of harmful behavior, be it smoking or violence or drinking and driving, as well as dealing with the tragic consequences?"

This prevention focus is based, of course, on the assumption that it is cheaper to prevent a health problem from occurring than it is to deal with its consequences down the road. "There's some proof to that, and there's no other theory to work on," says Christenson, "except to accept the upward spiral of costs."

Community Partnerships

As health care grantmakers have focused more on prevention, they've quickly come to the realization that they can't go it alone. Since health affects just about every aspect of society, from education to housing, health care grantmakers are looking for community partners who can help them leverage their resources and make health prevention efforts work.

"The health system lacks the infrastructure at present to execute prevention alone," says Christenson. "We need schools; we need county governments; we need police departments; we need domestic abuse shelters. All of those partnerships we need desperately to have an impact on prevention. It's that simple."

For example, last year HealthPartners health system, which was formed by the merger of Group Health and MedCenters HMOs and Regions Hospital (formerly St. Paul-Ramsey Medical Center), started a partnership with the Minority Media Coalition to promote health prevention issues to minority populations in the state. HealthPartners is the primary sponsor of a weekly section on health in Insight News, a newspaper of Minnesota's African American community, as well as a quarterly section on health and culture that appears in all Coalition newspapers. "The partnership is meeting a lot of our objectives in terms of getting those health messages out there effectively," says Patti Hague, director of community relations for HealthPartners, "and it's meeting the newspapers' objectives in terms of providing more comprehensive news and information to their readership. And it's doing it in a way that neither of us could do alone."

The foundations of Allina and Blue Cross and Blue Shield of Minnesota also have been particularly active in seeking community partners throughout Greater Minnesota, in part because their service areas cover the entire state. Blue Cross and Blue Shield of Minnesota Foundation, for example, recently teamed up with Northland Foundation in Duluth to help implement its tobacco reduction initiative in northeastern Minnesota.

Health care grantmakers also are developing partnerships in which they make available to communities the vast array of data they collect every day through their health care operations, to help improve the planning and evaluation of community health initiatives. A case in point: Allina Foundation's Project Reach, a new $1 million initiative designed to provide evaluation and technical assistance to communities looking to assess the effectiveness of their efforts to build healthier communities. If a community has funded an anti-smoking campaign, for example, Allina can provide it with the latest data on the impact the program has had on reducing teen smoking in the area.

A Convening Role

Along with creating more partnerships, health care grantmakers are also playing an increasingly important role as a convener and collaborator to help communities improve their well-being.

In early October, for example, HealthPartners sponsored a community dialogue on supporting early childhood brain development. And every quarter, The Foundation HealthSystem Minnesota brings together superintendents of the 12 schools in HealthSystem's service area to discuss school-related health issues.

By playing a convening role on health issues, health care grantmakers say they are not only able to raise the level of discussion on health issues in the community, but also can increase their profile as a viable community partner. "We've become known as a partner in the village and people have become aware of the fact that we do work with the whole continuum of care and are not just a hospital," says Johnson. "And as they've become more aware of our interest in helping, they've made their needs known to us."

Meeting Health Philanthropy's Unique Challenges

As is always the case when organizations refine or refocus their mission, playing a larger community role is not without its challenges for health care grantmakers. One of the biggest challenges, these grantmakers say, is to get society out of the mindset of viewing health care organizations as only capable of dealing with the traditional "downstream" health function of treating illness and injury.

"Health care philanthropy in this state is in relative infancy," says Christenson. "People aren't used to this idea that the health care system can be very helpful at a much earlier stage in problem solving than the emergency room. The idea that the health system would participate in some useful way in preventing illness and injury doesn't strike many citizens as logical or crucial, so it is a challenge to reorient people to prevention and particularly to the health system's leadership."

Focusing on prevention also poses some special challenges for health care grantmakers in evaluating the effectiveness of their efforts. "Health care in many ways is both an art and a science, and it's difficult to put in place the right indices so that we can demonstrate that we've made a difference," says John T. Anderson, executive director of the Blue Cross and Blue Shield of Minnesota Foundation. "So many of those measures will be affected by long-term, systemic change."

And just how far upstream should grantmakers go? HealthPartners' Hague points out that there are studies correlating high unemployment and poor housing with poor health, but both areas are outside a health care institution's typical area of expertise. "The challenge is to determine how we can focus on prevention and early intervention without going so far that we've reached beyond our areas of core competence," she says.

In general, most Minnesota grantmakers affiliated with health care institutions don't expect any dramatic increases in their grantmaking dollars in the near future, citing the tight financial situation in the entire health care industry right now. But by working more closely with others in the community, health care grantmakers hope to maximize the impact they can have on the overall health and well-being of Minnesota's communities.

© Copyright 1997 Minnesota Council on Foundations. Reproduction in any form without the written permission of the publisher is prohibited.

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