How has your career prepared you for your current role?
The bulk of my career has been spent working for our community hospital, first in hospice and volunteer management and then in marketing and administration. Because it was a small rural hospital, I had the opportunity to wear many hats and gained experience in diverse roles and sides of the business. One of my roles was to create a “healthy communities program,” where the hospital granted 10% of its assets back to the community as a tithe. In the process of establishing and administering this program, I learned how to do community health planning, work with other stakeholders to create systemic change, apply for and award grants, and about the value of data and of taking an epidemiological approach.
As a member of a courageous management team, I helped to craft a strategic plan to reinvent and literally rebuild our hospital in terms of how it met the needs of the fastest growing population base in Alaska, competed with the large tertiary level hospitals an hour’s drive away and improved access to and the complement and quality of services offered. Our nonprofit entered into an LLC partnership with an equity partner to build Mat-Su Regional Medical Center, where I helped lead the business planning and learned to value data and analysis even more. It took both — the community support and relationships and the analytics to build and successfully launch this new hospital.
These same supports drive my work today and are fundamental to the approach we take at the MSHF, which is still in this LLC partnership. We have a foot in both worlds so to speak — co-owning a hospital that takes care of people when we’ve failed to prevent illness and injury and making grants to create a measurably healthier Mat-Su population. We are at the apex of health reform that seeks to achieve the Triple Aim (better care for individuals, better health for populations and lower per capita costs.) My experience creating healthy communities and helping to manage a hospital has prepared me for this challenge.
What are the most important health issues in your community?
Per a 2013 Community Health Needs Assessment (CHNA), the top five health issues in the Matanuska-Susitna (Mat-Su) Borough are all behavioral health related: alcohol and substance abuse, child abuse, domestic violence, and depression and suicide complicated by a lack of access to mental health care. In addition, Mat-Su has one of the fastest growing senior citizen populations in Alaska and the nation. This aging demographic is beginning to place significant demand on the senior services community-based system, which is not designed for the influx it will see over the next 30 years. A 2016 CHNA will focus on the social determinants of health to round out our data repository.
Through an elaborate process that included data and analysis of the CHNA, 24 community forums across a borough the size of West Virginia and a cost benefit analysis, the MSHF board selected three focus areas for our work to address the above: healthy aging, healthy minds and healthy foundations for families. The board recognizes this is generational work, and is committed to funding these areas for the long term.
What are your core strategies for addressing these health issues?
One strategy deployed across all three areas is to complete a formal environmental scan across the continuum of care for that area, publish the results and “tell the story” widely. These scans include qualitative data (interviews with consumers, providers, government officials and policy makers), quantitative data (analysis of emergency department utilization, other provider and government data, prevalence, etc.) and policy reviews, along with evidence based strategies and policies to address the findings. (We have worked for years to augment and establish better data sets at the state level in order to get valid and reliable data at the borough level.) By the time we have published the scan, most of the providers and policy makers and others (law enforcement, hospital administrators, etc.) are engaged as formal partners in the strategies that follow. We also tell the story over and over and over again to these and other stakeholders (including our local delegation) in numerous meetings across our borough and Alaska. We’re the storyteller of sorts, and what we find, is that the other players start to help to change these systems on their own, follow the recommendations made in the plans and work with us to change policy, processes and systems. We then “feed and water” with grants and technical assistance where others have engaged and planted the seeds of change recommended in the reports.
We issue what we call “discovery RFPs” to address the findings and recommendations in the research. In our current discovery grant round, five of nine proposals have requested start-up funding for behavioral health treatment services for children and youth currently unavailable in our community. We provide capacity building to ensure the agencies can create the new service and sustain it as part of a solid business plan. We simultaneously work with our community partners to help the state and borough change statutes and regulations and funding to address the larger systems barriers. We are currently working to establish a Regional Behavioral Health Authority in our borough to better plan for a behavioral health continuum of care, fund and manage these services in a more proactive way for example.
As a foundation with an explicit mission to serve a community, how do you include that community as an integral partner in your work?
We believe fundamentally that we are community-driven. Our nonprofit was formed by a group of committed citizens that recognized that the community and economy would not flourish without critical healthcare infrastructure. And they succeeded in building and staffing that infrastructure. MSHF is a membership organization, so anyone who lives in the borough, is over 18 and pays $5 can be a member. We reach out to our membership for input, for publicity and for accountability.
As a hospital, the Affordable Care Act mandates that we conduct a CHNA every three years and that it engage a broad base of stakeholders. But most importantly, we find that we have to have community input and buy-in and priorities in order to measurably improve the health of our population. The community brings assets and strengths to the table, and where the community is driving the change, strengthening the social fabric, we are more successful in hitting our targeted outcomes. We have community members serve on steering committees for our environmental scans, participate in focus groups for feedback, attend community forums to share their input on select issues and actively engage in MSHF’s social media to carry conversations forward. MSHF always includes consumer interviews in our data and research as well.
What’s been a recent big success for your organization and what excites you about it?
As detailed above, we are working hard to improve access to behavioral health care in our borough. One recent success that buoys our spirits and has translated into behavioral health “wins” came from an unexpected place: law enforcement. MSHF’s first behavioral health environmental scan was on the crisis response system for behavioral health in our community. It included a deep dive on emergency department utilization and we found that our emergency department had five times the number of behavioral health visits than our community mental health center. One recommendation in the report was that first responders in Mat-Su receive Critical Incident Training (CIT).
The captain of the borough detachment of the state troopers was interviewed for the scan, expressed his frustrations about the system’s shortcomings and also his doubt that the system could be improved. He read the report and recommendations and took the CIT training (40 hours) on his own. Then he used his training on behavioral health related calls — he got different information from dispatch, gave his officers different instructions and they had positive outcomes with people and families that in the past would have resulted in a physical altercation and an arrest.
Seeing the effectiveness of the training, he convened all the first responders in the borough with a goal to provide this CIT training to every first responder (EMS, fire, police and even folks in the court system). They have developed a plan, starting with mental health first aid to help officers learn some basics and then hopefully create a more solid demand for the 40 hour CIT training. In December, over 100 first responders were trained in mental health first aid.
Part of their plan includes addressing some of the greater systems change issues. We’ve provided facilitation for his convenings and funding for the training, but he has provided the leadership (and has the credibility) to carry out the plan, make sure his fellow first responders show up and make it happen. We think this is a great model for community-driven change, and highlights how telling the story, engaging others in telling the story and sharing the data and best practice can help to create meaningful systems change.
What’s the single biggest challenge your organization is tackling right now?
The first two reports in our Behavioral Health Environmental Scan (BHES) show very clearly that the state has not put together any kind of rational plan for funding behavioral health services at the state or regional level. Funding streams have developed fairly haphazardly, are not based on community need and don’t aim to accomplish anything like SAMHSA’s “good and modern continuum of care” for behavioral health services. Almost all the dollars go to acute needs, and some demographics (like children and youth) are particularly underfunded in terms of services.
Our number one recommendation from our BHES is to establish a Regional Behavioral Health Authority (RBHA) in our borough to design this comprehensive plan for a behavioral health continuum of care, and then to fund and manage these services in a more proactive way. MSHF is actively working with the State of Alaska, Alaska Mental Health Trust Authority and contractors to design this RBHA, create the plan and new funding mechanisms to make it possible. Because Alaska is in a fiscal crisis and is redesigning the Medicaid program, this recommendation is timely, and Alaska DHSS is supportive of the idea. It will be a feat to pull it off — and to fund it — but that’s MSHF’s biggest challenge in this particular focus area.
What are the most important public policy issues for you this year, and what are you doing about them?
Every year, MSHF establishes a policy agenda. Last year, it was Medicaid Expansion, and we stepped up to the plate to help advocate for this and to support the Governor in his decision to unilaterally expand the program. Over 8000 Alaskans are signed up so far. This year, our advocacy efforts include the following:
- SB1 — a clean indoor air statute that prevent tobacco products (including e-cigarettes) from being used in workplaces across Alaska.
- Reforming the Medicaid program to increase access to quality behavioral health services in a more cost-effective way. (We’ve been active in the redesign and will be supporting legislation that includes redesign principles we believe will result in the above.)
- Ensuring the state does not cut behavioral health services as legislators significantly cut the state budget due to the fiscal crisis.
- Title IV Statute Rewrite — all the statutes governing the marketing, sale and distribution of alcohol (MSHF is a partner to Recover Alaska, which spearheaded the rewrite of the laws to a more public health viewpoint. The bill was introduced last session and has bi-partisan co-sponsors.)
In addition, the MSHF public policy committee has recommended support of a number of bills that address pieces of the behavioral health access issue (such as paving the way for more telemedicine usage for services, addressing access to prevent recidivism, etc.) and also to support the Governor’s proposal to increase the alcohol tax and the tobacco tax (and add coverage of e-cigs). All of these are going through our process at the moment but will likely be endorsed by our board in February.
MSHF scores legislation based on a matrix that we’ve developed. It rates the legislation based on a number of factors, including community need and evidence of effectiveness. The score ties to the level of support we give it — from issuing a resolution, to meeting with our local delegation and other key legislators, to testifying at hearings, to financial support for a political rally, advertising, phone messaging, grass roots organizing and more substantive lobbying. For instance, with SB1 above, MSHF has funded a grass roots organizer and polling in Mat-Su (which has been effective in getting e-cigs included in the borough tobacco tax and having Palmer pass a clean indoor air ordinance) and has engaged in a lobbyist at the state level. Along with our partners and the bill’s sponsor, we participated in a statewide press conference revealing new polling data and MSHF’s support. We will rally others to testify and will testify every chance we get as the bill moves through. If we can get this bill through, we already know we have the votes for it to pass.
What’s one more question we should ask you, and how would you answer it?
You should ask me: What are the most important things you’ve learned in your tenure at the foundation?
Incidentally, most of these revelations below have come through key Philanthropy Northwest conferences and convenings. Please note that these are revelations, and we’re trying to learn from them and have them impact our work, but MSHF has quite a ways to go.
- We have to be addressing the capacity of the organizations, coalitions and our partners in the work at the same time we’ve giving grants and helping facilitate the work to specific outcomes.
- If we’re not addressing the health disparity experienced by select demographic groups, we’ll never make substantive progress for the whole population.
- The community and those affected by the prominent health issues have to help to drive the systems change — at the leadership level, in the research and in implementation.
- An asset based approach is more productive, but we’re easily mired in what I call “the misery index.” All parties bring something to the table.
With the exception of a natural or manmade disaster, there’s no such thing as a “philanthropic emergency.” We can take ourselves and our work too seriously, and that can get in the way of the work itself.
Elizabeth Ripley is CEO of the Mat-Su Health Foundation, joining us this month for our virtual roundtable with healthcare conversion foundation leaders.