With so many unmet health care needs in DHT’s coverage area — 18 counties and the Qualla Boundary — the process of figuring out how to divvy up grant funding each year can be an overwhelming pursuit, which is why the foundation is holding public listening sessions all across the region. DHT hosted a listening session Oct. 10 at Southwestern Community College to hear feedback from local nonprofits, government agencies and the general public and also to introduce the foundation’s new CEO Antony Chiang.
Chiang, who officially starts the job Nov. 1, was hired to lead the new health care foundation following a nationwide search. Most recently Chiang, 51, served as the president of Empire Health Foundation, an organization similar to DHT located in Spokane, Washington.
Janice Brumit, chairwoman of Dogwood’s board of directors, told the audience that Chiang’s experience in designing and building a health care foundation from the ground up would no doubt be of great value as DHT works on developing its strategic plan over the next several months. Once the strategic plan is in place and the guidelines for health-related grants are established, the foundation hopes to begin awarding funds next summer.
DHT is a “non-operating” foundation, which means it won’t provide any programming or services, but it will partner with nonprofits and government agencies to provide health-related programs and services in their respective communities. Organizations will be able to submit grant proposals to the board for funding considerations.
“We’re ready to embark on a strategic plan. We have a difficult decision in deciding where to deploy resources in the community and we want to hear from you,” Brumit said.
Dogwood Health Trust has also committed $25 million over five years toward tackling substance use and addiction. To show how quickly that money could be divided and spent, Chiang asked the room of one hundred plus people how they thought those funds should be distributed among the counties and Qualla Boundary. A majority of people said they thought it should be spread evenly over the coverage area, but a couple of people saw the benefit of putting more funds toward one large pilot project in one county and then expand the program into other counties if it’s successful.
While Chiang said there was no right or wrong answer, focusing on a couple of communities might make more financial sense than spreading the money out. Divide that $25 million over five years and then divide it by 19 communities — that’s only $263,000 a year to each. Then divide that $263,000 by the two main focus areas needed to address addiction — prevention and treatment. Attendees could begin to see how quickly those funds would dry up.
“These are the tough strategic decisions we’ll have to make. We have people suffering in every community,” he said. “We could increase the funding but that means something else won’t make the list.”
In addition to the funds earmarked annually for addiction, the foundation has to examine the other health care needs in each community. To do that, the board will be focused on the social determinants of health.
These determinants not only include access to health care services, but societal factors like poverty, affordable and adequate housing, transportation, food security, access to healthy foods, access to parks and greenways and education.
Some communities are ahead of others when it comes to addressing these unmet needs in WNC, but generally speaking the region has a lot of work to do. Many counties are dealing with a severe shortage of affordable and adequate housing. Rural counties west of Buncombe lack adequate public transportation. Those same counties also have the highest rates of overdose deaths in the state. Mental health resources are being reduced at the state level at the same time the legislature has failed to pass Medicaid expansion to make health care accessible for 500,000 more uninsured residents.
From the experts
The DHT meeting also included information from three health experts that will also be partnering with the foundation to provide valuable research data.
Rebecca Onie is the co-founder of The Health Initiative, a nationally recognized leader in population and public health. She is a MacArthur “Genius” awardee and recipient of Forbes’ Impact 30 Award for leading social entrepreneurs.
“I’ve spent 22 years obsessed with the question, ‘What do we all need to be healthy?’” she said. “We should be enabling doctors to ask patients what they need to be healthy and then connect patients to resources in their communities.”
But that’s not what’s happening. Onie said the U.S. spends the most money on health care and has the worst outcomes when compared to other countries. When studies show that social determinants account for 70 percent of outcomes and clinical visits only account for 20 percent, Onie said it shows the U.S. is not spending its health care money in the right areas.
The state of health care is a heavily debated topic, but Onie said The Health Initiative wanted to know what voters thought about their own health. Two focus groups were interviewed in Charlotte — a group of Democrat African American women and a group of Republican white women. Both groups were asked a simple question — if they had $100 to spend on their health, how would they divvy it up? To everyone’s surprise, an overwhelming majority of women in both focus groups all mentioned things outside of a hospital setting — safe and affordable housing topped the list.
“We thought it had to be a fluke but it’s not,” Onie said. “That’s very powerful. It’s about common sense and a common experience. Health care is not about changing minds or policies — it’s about changing the questions we ask and listening to the answers.”
The Health Initiative’s other co-founder, Rocco Perla, is a former director of the CMS Innovation Center, where he established the national learning system to test new delivery and payment models through the Affordable Care Act and oversaw the $1 Billion Partnership for Patients and the Million Hearts Campaign.
It was during his weekly commute to the Innovation Center that he realized all the work he and others were doing in Washington wasn’t making a real impact on people. His airport shuttle driver was a 70-year-old veteran who had to stop halfway through the ride to stretch because sitting that long was painful. He needed a hip replacement, but the VA lost his paperwork and he hadn’t had time to go through the entire process again.
“It became unbearable to ignore this gaping hole that exists between the reality of people’s lives and the decisions we make as policymakers,” he said.
That’s when he joined Onie with The Health Initiative and began seeing more discrepancies between the data being analyzed in Washington and the struggles of families. He said he had never seen the data on food insecurity in the U.S. during the five years he was working on health care reform.
“I was thinking how did I not know this was available in the last five years? We didn’t even look at that data. Has anything we’ve done had an impact on hunger in the U.S. and the answer was no,” Perla said.
To his dismay, the rates of food insecurity jumped 50 percent during the recession and stayed that way over the next 10 years despite a number of important health-related legislation being passed, including the Affordable Care Act.
Perla said leaders have to begin looking at the factors that lie beneath the diseases and illnesses to begin making a difference in people’s lives when it comes to being healthy.
Dr. Betsey Tilson, chief medical officer for the North Carolina Department of Health and Human Services, spoke about the many changes happening at the state level to impact healthier outcomes.
Just like Dogwood is looking to partner with WNC communities, Tilson said the state has the same vision of partnership and aligning with communities and foundation to move the needle on health care.
“Access to high quality health care is critically important ... but how do we address the other drivers of health that make up the other 80 percent of outcomes?” she said.
She said DHHS’s top priorities when looking to improve health are food security, interpersonal violence, toxic stress, employment and transportation. The state also has plenty of strategic plans being worked on, including an Early Childhood Action Plan, Opioid Action Plan, Health NC 2030 and NC Care 360.
For more information on those plans, visit www.ncdhhs.gov/about/department-initiatives.
For more information about Dogwood Health Trust, visit www.dogwoodhealthtrust.org.
WNC communities represented by Dogwood Health Trust
• Population of all 18 counties — 901,715
• Median Household Income — $42,670; U.S. Median, $55,322
• Persons Below Poverty Level — 15.8%; U.S. Average, 12.7%
• With Disability < 65 - 11.8%; U.S. Average, 8.6%
• Without Health Insurance < 65 — 13.5%; U.S. Average, 10.1%
• Bachelor’s Degree or Higher — 26.5%; U.S. Average 30.3%
• Civilian Labor Force — 55.4%; U.S. Average, 63.1%
• Persons Age 65 and Over — 22%; U.S. Average 15.2%