A little disruption every once in a while (and, sometimes, even a major shock) can be a good thing

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by Rick Ybarraincentives

Every day in health care settings across the country, payers, providers and patients make decisions that impact service delivery and patient outcomes. The struggle continues as the health care system goes through, in some cases, radical transformation. The health care field seeks to improve the assessment, diagnosis and treatment of various health conditions, including mental health, that result in good quality care and positive health outcomes.

Once again the conversation circles back to “the stick or the carrot.” Which is the strategy (or set of strategies) that will effectively change provider behavior resulting in improved quality of care, improved health outcomes and decreased costs?

According to a recent blog posted Tuesday, July 15, the Commonwealth Fund’s blog authors Mark A. Zezza, Anne-Marie J. Audet, M.D. and Dominique Hall announced a new and exciting portfolio of work in the Breakthrough Health Care Opportunities program. “Incentives 2.0: A Synergistic Approach to Provider Incentives” explores the use of strategies to influence provider decision-making and promote higher-value, outcome-based health care.

The authors remind us that financial incentive strategies such as pay-for-performance programs have had limited success in improving outcomes and controlling costs. It is important to note that a wide range of factors influence providers’ choices, beyond financial rewards or penalties, including intrinsic motivation and medical professionalism, organizational influences and policy advancement.

The initiative will be seeking insights from diverse fields of study such as economics, psychology, nursing, social work, sociology, and the management sciences in order to identify influences, understand how they affect behaviors, how these influences interact with each other, and develop ways to use them to optimize health system performance. A huge undertaking indeed!

Some examples of approaches that might result from this work include:

  • Redesigning financial incentives so they are more meaningful to providers. Psychological research has shown that people tend to spend more effort avoiding losses than achieving gains of comparable value. For example, Massachusetts General Physicians Organization has found it effective to give upfront financial rewards to providers, with the potential to return some of the funding if performance standards/measures are not met.
  • Leveraging providers’ innate desire to do a better job. Psychological research also demonstrates that nonmonetary motivators, such as peer comparisons, may actually strengthen providers’ inherent desire to perform well. The introduction of quality report cards for cardiac surgeons across Pennsylvania had a four times larger effect on surgeons’ performance than profit incentives.
  • Creating an organizational environment that promotes high performance at the provider level. The link between strong organizational culture and top performance is well demonstrated. One study found that hospitals with a clear mission, highly involved senior management teams, and non-punitive approaches to problem-solving had lower 30-day mortality rates for heart attack patients than did other hospitals.

The initiative seeks to create a “model” or “guide” for how to combine various influences in ways that can lead to a real breakthrough in performance.

Four projects are highlighted showing how innovators are working to design provider incentives that drive high-quality and achieve high-value care – and most importantly, contribute to improved health outcomes.

The program aims to identify opportunities and make changes in health care that can have large-scale impact. At the end of the day, that’s what it’s about, right?

I have always said that true health care reform cannot happen without payment reform. There are many pilots underway across the US examining value-based payment versus our current volume-based payment system, an approach that is perpetuated by the current fee-for-service reimbursement system. We must disrupt the status quo and look towards other payment models that hold providers accountable for high quality and positive health outcomes. The authors remind us that “In any industry or field, a little disruption every once in a while―and, sometimes, even a major shock―can be a good thing.”

Updates and lessons learned from these programs will be available on the CMWF website throughout the year. Stay tuned! More to follow….


Video: What do grant makers look for in proposals?

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by Rick Ybarra

Today, The Chronicle of Philanthropy posted a video titled, Foundations Reveal What They Look for in Grant Proposals. The video was taken during the Council on Foundation’s recent annual conference in Washington, D.C. It is a brief, inside perspective by grant makers representing the Walmart Foundation, Ford Foundation, Berks County Community Foundation, the Marie C. and Joseph C. Wilson Foundation, and the Minnesota Council on Foundations. The video captures “pearls of inside wisdom,” discussing the characteristics that make a grant proposal advance in the funding consideration process. The elements cited are what many foundations look for during the proposal review process.

For grant seekers who run at a frantic pace, this may be the best 1 minute, 36 seconds you’ll ever spend!


Announcing the New Hogg Foundation Podcast!

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podcast artworkby Ike Evans

We are excited to announce that the Hogg Foundation has launched a new monthly podcast! Into the Fold, the brainchild of the communications team here at the foundation, is our newest attempt at creating a niche for candid conversations around mental health. We have just recently completed our pilot episode, an interview with LaQuinton Wagner, a youth consultant for Texas Network of Youth Services, a Hogg Foundation grantee. He spoke with eloquence and insight on the subject of transition-age youth, a key area of concern for the foundation.

Even with all of the other kinds of communications technology out there, the human voice continues to hold its own as an eerily effective tool for reaching, informing, and educating an audience. We’re still making up the rules as we go, but our overarching aim is to create audio content that’s easy to get and that presents conversations that are worth listening to. Episodes will be hosted and produced by Ike Evans, public affairs specialist.

We’re taking some of our inspiration from other mental health organizations, as well as other UT departments, who are showing that podcasting can be an inexpensive way to present engaging or informative content to a sizable audience. The hope is that once we get the hang of the format, it will come into its own as a primary means of capturing the human implications of our program areas, i.e. highlighting the challenges and achievements of our grantees in a way that is interesting, informative and appropriately provocative. Along the way, there will also be ample opportunity to enlighten the public about our grantmaking process, and even to delve into the past and present lives of Hogg Foundation staff.

Any and all feedback is appreciated!

For ® iTunes users, you can download podcast episodes here.




Into the Fold Pilot Episode: LaQuinton Wagner







More outcomes please!

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closelook by Rick Ybarra

 On June 3, I posted on Hogg Blog, Measure Activities or Measure Outcomes? And the Answer is . . . based on Jason Saul’s May 28th piece in The Chronicle of Philanthropy highlighting the difference between activities (or outputs) and outcomes. Well, our friend Jason has upped the ante again with a follow-up blog post from June 16 titled, 4 Tips for Measuring Outcomes Instead of Activities. It sparked some interest from the field. But he noticed some uncertainty on how to go about measuring outcomes. In this follow-up blog post, Jason offers a few tips:

  • Aim at the right outcomes. The “right” outcomes are those you can credibly claim to produce. It must be believable that your organization makes a substantial contribution to producing the outcomes it lays claim to. Got it!
  • Use existing research. We’ve heard and often used, “No need to reinvent the wheel.” Same goes with data.Often you don’t need to start from scratch. Since most nonprofits use strategies that have been implemented or studied, there is a wealth of research available. Check!
  • Consider indirect measurements. He validates that many programs are working toward achieving ambitious outcomes that take a long time to produce and thus, are impractical to measure as a whole. Community-based organizations can demonstrate their impact by utilizing indicators that may not directly measure their outcomes but that help predict how likely an intervention will produce the intended outcomes. Great point!
  • Focus on measuring what matters to funders. The most useful information you can offer your supporters is the expected return on their investment.  Think about how effectively you can produce the outcome that matters to them (the funder). Rather than providing the number of hours students are tutored, retention rates, and volunteer involvement (all activities or outputs), he suggests making a more compelling data-supported case that you are 80 percent likely to produce an intended outcome, like getting students in a promising program to be proficient in math. Makes sense!

Jason closes with that there is no one perfect way to calculate efficacy, but measurement that shows value (outcome/impact) will pay off more than data about activities (outputs). A word to the wise…

Eliminating Health Disparities through Culturally and Linguistically Centered Integrated Health Care: Consensus Statements, Recommendations, and Key Strategies from the Field

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by Rick Ybarra and Dr. Octavio N. Martinez, Jr.

We are excited to share with you a manuscript just published in the Journal of Health Care for the Poor and Underserved (May, 2014) highlighting the Hogg Foundation’s work with the Office of Minority Health resulting in a seminal report titled “Eliminating Health Disparities through Culturally and Linguistically Centered Integrated Health Care: Consensus Statements, Recommendations, and Key Strategies from the Field.” This report is the outcome of an expert consensus meeting sponsored by the United States Department of Health and Human Services Office of Minority Health, which was convened to formulate consensus statements, recommendations and key strategies for implementing integrated health and behavioral health care with the aim to improve the overall health status for traditionally underserved populations.

Much has been reported in peer review and non-peer review publications about the benefits of integrated health care: treating and coordinating the health care of persons with both physical health and behavioral health conditions. However, very little has been reported to date regarding integrated health care as a strategy to reduce health disparities. We hope this article offers health care leaders, providers, researchers, payors, and policy makers practical recommendations that hold promise for improving access, treatment, and health outcomes for racial and ethnic minorities.

Journal of Health Care for the Poor and Underserved, Volume 25, Number
2, May 2014, pp. 469-477 (Article)

Published by The Johns Hopkins University Press
DOI: 10.1353/hpu.2014.0100


Measure Activities or Measure Outcomes? And the Answer is . . .

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bullseyeby Rick Ybarra

The Hogg Foundation for Mental Health has been intentional about focusing on outcomes. In conversing with many non-profits, it is a concept they still find quite challenging (and I must admit I’m still working on it myself). Jason Saul’s blog in The Chronicle of Philanthropy on May 28 titled, “Measuring Up: Advice for evaluating a charity’s work” is a great read, explaining the difference between activities (or outputs) and outcomes and offers an “A-ha! moment” in discriminating between the two. As funders, we often hear about stories from nonprofits about activities they are conducting. Often the intent is not clear. Does the organization answer the most important question: “Why?” Why do they conduct this activity? What do they hope to achieve? Do they understand the intended purpose or goal of what they are trying to achieve?

I now have a greater understanding of why the nonprofit world is used to measuring outputs instead of outcomes. Measuring activities is much easier, way easier in fact, and nonprofits have limited time to dedicate to measurement. But with so much attention to reporting of outcomes due to possible sanctions, incentives/pay for performance, etc. measuring activities isn’t going to help nonprofits demonstrate their value and secure more funding.

Think about it: If a funder asks, “You say your program makes a difference in the lives of the people you serve? How so? Can you show me?” Well, can you?

When organizations measure program efforts — number of persons served, teaching, training, meals provided, and so on — they’re measuring activities. Outcomes, on the other hand, are the results of those activities: changed awareness, behavior, condition or status. Saul’s blog post offers some practical examples of outcomes.

So the take-away here is when we start by identifying the outcome, we can consider the most efficient and effective ways to achieve that outcome (either through an activity/strategy or a set of activities/strategies).

In light of today’s budget reductions impacting many nonprofits, it is mission critical for organizations (yes, yours too) to measure and evaluate the outcomes of the programs that the organization administers and believes in. It’s not a bad thing to learn that perhaps your program is not as effective as you believe. That’s what we refer to as “strategic learning.” Understanding the outcomes of your program can help you course correct — or reevaluate the change you made — to see if you can achieve a more positive outcome.

Lastly, if you have good outcome data from your program, share it with the world. Telling your story and sharing your program outcomes will demonstrate to your community, and particularly to your funders/donors, how important your work is. It can also lead you to successfully solicit additional donations and win competitive RFP awards, thus raising more revenue so you can make a greater impact. In closing, I leave you with a famous Warren Buffet quote: “Price is what you pay. Value is what you get.

Wellbeing: A Bottom Line Issue for High Performing Organizations and for our Health Care System

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by Rick Ybarra

Ok, I’ll admit it. I read the Harvard Business Review. I am fascinated with business models, new concepts, innovations and the cutting edge in business science. I also see how these concepts and applications can easily transfer to our health care industry. Private businesses and markets are faced with multiple challenges; they seek new, innovative solutions to become (or maintain themselves) as high performing organizations. The health care profession is faced with the same types of challenges: delivering the highest quality services and fostering the new skill sets required to produce better health outcomes, greater patient satisfaction, and reduced cost. Business is applying new knowledge, technologies and principles to address their organizational concerns and we can learn some things from the private sector experience.

In an article posted in the May 2014 edition of the Harvard Business Review, IBM asked CEOs to identify the most important leadership traits needed today. Their answer: collaboration, communication, creativeness and flexibility. Not only does leadership require these skills; they are required from our workforce. Employees in today’s workplace need to be comfortable with change; learn as they go, and learn often from others’ experiences. Driving the need for these skills is the complexity of demands and challenges that organizations face and there is no better example than today’s health care system in transition. The aim is to provide the highest quality of services and foster an engaged and committed workforce to deliver those services.

Only recently are organizations recognizing the need to create an environment and culture in which these behaviors can thrive. “The most successful organizations are now turning their attention to employee wellbeing as a way to gain emotional, financial and competitive advantage,” notes Tom Rath, Gallup’s leader of workplace research and co-author of the bestselling book “Wellbeing.”

Wellbeing is systemic and holistic, integrating many dimensions, including the physical, cognitive and psychological needs of people. It’s also about building an organizational culture of wellbeing.

So how do you build a culture of wellbeing? CEO Jim Hackett of Steelcase states that in his experience the past 19 years, he has discovered that work is inherently a social endeavor, and that when you understand that the purpose and emotional health of high performing organizations centers around people who make up the organization, you can take performance to a much higher level. He concludes that creating places and spaces that provide for the wellbeing of people at work is critical for success. It’s that simple. And that powerful.

Not a surprise, right? We talk about fostering an organizational culture that promotes wellness and wellbeing. The time is now for action. We must not forget, first and foremost, that we are in the “people” and “relationship” business. No widgets being manufactured; it’s about the building of relationships and the delivery of the highest quality health and behavioral health services with a laser focus on people getting better. Yes, we have technologies or tools we use: psychopharmacology, assessment tools, evidenced-based practices, recovery orientation and the like, but people are the ones to put these tools into practice to help support persons with chronic physical health and behavioral health conditions. People helping people.

So I have no doubt you’ll be hearing and reading more about wellbeing as we venture down the path of systemic and organizational change in the new health care landscape. To achieve the Triple Aim, the people seeking health care will need the very best from those providing health care services, and employees delivering health care services will need the very best from leadership. Fostering these new skills will lead organizations to value the wellbeing of employees. Now that’s smart business and medicine!