Health funders pride themselves on being champions of innovation. They strive to discover new and creative models of care that will advance the triple aim of improved outcomes, better patient experiences, and reduced costs. At the same time, funders are acutely aware of the frustrations of trying to cultivate, disseminate, and sustain innovation in health care. Perverse financial incentives, delivery system fragmentation, and entrenched professional cultures too often thwart the development and broad-scale adoption of innovative practices.
The “secret ingredient” in successful innovation efforts is often meaningful collaboration among funders. As Jeffery Brenner describes in A World of Darkness: What if Thomas Edison Had to Write Grant Proposals to Invent the Light Bulb?, innovators often depend on grants from multiple funders to support the design and implementation of their efforts. The nature and strength of these philanthropic relationships strongly influence the viability of innovative pilot projects and can determine whether effective models will be brought to scale and replicated more widely.
In August 2015, Grantmakers In Health (GIH) released an inspiring example of funders working together to promote innovation. The case study focuses on Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico Health Science Center and describes how collaborative support from multiple private and public funders propelled the growth and evolution of ECHO’s transformative model.
Jeffrey Brenner identifies Project ECHO as one of the organizational leaders at “the cutting edge of population health…far from our traditional academic health care institutions.” The program expands access to specialty and high-quality primary care in rural areas by using telehealth-enabled networked learning. Essentially, it moves knowledge instead of moving patients.
Project ECHO’s state-of-the-art telecommunications technology and case-based learning cultivate collaborative mentoring partnerships between specialists and primary care providers. This innovative approach has dramatically expanded the University of New Mexico Health Science Center’s capacity to provide treatment and improve patient outcomes. It has been so successful that, from an original focus on improving access to hepatitis C treatment within New Mexico, Project ECHO has expanded to address a wide variety of conditions, including HIV, addiction and psychiatric disorders, pediatric epilepsy, chronic pain, and diabetes/endocrine disorders. Project ECHO has now been replicated across the United States and in eight other countries.
Financially, Project ECHO relies primarily on funding from private foundations and government agencies at the state and federal levels. The GE Foundation recently announced a 3-year, $14 million grant to dramatically increase the number of federally qualified health centers that participate in Project ECHO. Past and present Project ECHO funders include the Robert Wood Johnson Foundation, the Center for Medicare & Medicaid Innovation, the Con Alma Health and McCune Foundations, and the Leona M. and Harry B. Helmsley Charitable Trust.
With its replication partners, Project ECHO has worked with insurers to test more sustainable financial arrangements. However, identifying mutually acceptable arrangements has been challenging, given the constraints of traditional fee-for-service reimbursement.
The critical role foundation support plays in the sustainability of Project ECHO underscores the importance of collaborative funding. Collaboration among funders is crucial in order to accelerate the development and dissemination of innovative practices. Collaborative support for core infrastructure is particularly important, because it enables organizations to develop in entrepreneurial and flexible ways. Fragmented funding streams—regrettably the general rule—very frequently have the opposite effect, stifling organizations’ ability to evolve thoughtfully and, in so doing, to contribute to a broader base of knowledge and practice.
David Bornstein, who follows and reports on social innovation, has observed that fragmented funding is “why even the best social organizations grow slowly compared with companies. As a result, very few nonprofits ever go national—and those that do take the better part of a century to get there.” To counteract this tendency, GIH, many regional associations of grantmakers, the Social Impact Exchange, and other forums encourage funders to share promising models, align their grantmaking, and learn from one another’s experiences. In the spirit of amplifying these collaborative efforts, GIH will continue to publish case studies of innovations that are ripe for replication.
Do you know about a care model that represents a significant departure from traditional practice, has been found effective through robust evaluation, and is being replicated with support from multiple funders? Let us know in the comments!