Achieving Financial Sustainability: A Connected Community of Care’s #1 Goal

By Keith C. Kosel, PhD, MHSA, MBA

 

Show me the money!” No one old enough to have seen the 1996 movie, Jerry Maguire, will ever forget that memorable phrase. That simple but powerful phrase could apply to every person who punches a clock for a living and just about every business, including community-based organizations (CBOs) and Connected Communities of Care (CCC). For CCCs and other non-profits, a parallel but no less powerful phrase, “No margin, no mission,” also rings true― just ask Sister Irene Kraus of the Daughters of Charity National Health Care System, who is credited with giving health care the phrase. The question is, how do we satisfy these two complementary statements?

When we consider funding for a CCC, we usually speak of seed funding― those dollars provided by a grant or other type of external funding award to establish a new entity or program. Initial planning, design, development, and implementation typically fall under the heading of seed funding. But once the new entity or program is operational and the seed funding is expended, then what? How do we sustain the CCC’s operation? Unfortunately, for most non-profit organizations, that’s when they first seriously ask themselves the question, just before the money runs out and the entity and/or program is placed in immediate peril of failing. This state of hyper-anxiety could have been avoided with some simple sustainability planning initiated very early, during the initial planning phase of the project.

The time to think about how operations will be sustained is not after the entity or program is implemented, but before the first meal is served, the first patient seen, or the first service delivered. For many, especially those new to starting a going concern, this might seem like odd advice and that’s completely understandable. When you are planning, designing, developing, and implementing a new entity or program, you typically have your hands full with a myriad of activities such as hiring team members, decision-making, checking progress, and achieving milestones, revising plans, etc. The last thing you are thinking about is where to get money to keep things going, especially since you have the seed funding check in your pocket, providing a false sense of financial security. But to that initial list of must-dos, you have to include looking beyond the implementation phase to evaluate where the next paycheck will come from and how you will obtain it. To be sure, this is difficult for most organizations to do, but it is essential for the long-term viability of the entity or program like a CCC.

Before we look more closely at the two key elements of financial sustainability – 1) what funders are looking for, and 2) sources of supplemental funding― it is vitally important to state the obvious, which is that sustainability involves far more than just accessing funds. We often talk about operational sustainability, meaning those factors other than money that are essential to keep the organization functioning. Succession planning immediately comes to mind. What happens if the person leading your CCC abruptly leaves or has a major health episode (e.g., heart attack, cancer diagnosis, complications from COVID-19)? We also speak of political sustainability, such as what happens if a new administration takes office and isn’t as favorably disposed to your entity or program as the prior administration? Ever wonder why tech giants and the big Wall Street banks and brokerage firms give money to both parties? That’s political sustainability in action! While all these other types of sustainability are no doubt important, for most non-profit CBOs and CCCs, finding funds to continue operations is, without exception, their greatest concern. Because of that, I will focus my comments on financial sustainability.

Of the two key elements of financial sustainability referenced above, understanding what funders are looking for and ensuring that your new undertaking can deliver “the goods” is paramount to sustaining a CCC. Today more than ever, funders (e.g.,  philanthropic organizations or civic entities, including state and federal grant makers) expect organizations seeking funding for ongoing operations to be able to demonstrate―through valid, demonstrable data― that the programs and services they are delivering are making a difference. No longer are philanthropic organizations willing to simply write a check to non-profit start-ups with the admonishment to “do good with it.” Among other things, given the increasing competition among non-profits for funding assistance, funders are increasingly seeking proof that the new entity, program, or service is making a demonstrable and meaningful difference in the community or among those being served. While this certainly seems like a reasonable expectation, it often catches start-ups by surprise, setting in motion a chaotic chain reaction of panic and grasping at any funding opportunity- even if it’s not related to the core strength of the start-up, that might provide funds, and then more panic when/if that opportunity fails to materialize. To prevent this situation in your CCC, you must BOTH plan for ongoing funding and put your organization in the best possible position to demonstrate that you are making a real difference. So how do you do that? Very simply, you deliver on your promises and generate results that matter.

While that sounds simple enough, it’s what causes most new start-ups, including CCCs, to fail. Having an idea to improve the health and well-being of individuals in the community is simple, but making it happen is much more difficult. Here we are talking about ensuring you can demonstrate to potential funders that you have established realistic stretch goals and supporting objectives for your CCC or one of its programs and that you met those goals and objectives. Have you identified validated measures to track and evaluate performance and do you have a system for helping you collect and analyze the requisite data? Finally, is your program doing what you expected it to do and have you documented every step of the way? These elements are not easy to accomplish. It takes astute planning, a knowledge of the field and immediate market to know what is demanded and valued, and an obsession for tracking all the essential moving pieces. If you can do all of this and your program or service performs as expected, then you will be well on your way to securing the ongoing funding necessary to sustain your operations. As indicated, this is much easier said than done and it is where most new organizations or programs go wrong. Even when your program or service performs to perfection, failing to capture and document that performance (a very common problem among start-ups) can put you squarely behind the eight-ball.

Next, fast forward to results, which have been documented and are turning heads. This means that the funds should just start flowing in, right? Well not exactly. First, you will need to find a funder that believes in you and your data. That’s often not as difficult as it might sound. Start with those you know best― the organizations that provided your seed funding. Assuming the organization that provided your initial funds also funds ongoing projects (some funders do not) and you have solid results, find out if they would be open to continuing to support your work. If they do not, reach out to other funders that know you, assuming your program or service fits within those areas they fund. It is well-known among those in the funding game that funders prefer to fund those they know and those that have consistently delivered the goods. The risk to the funder is considerably less if they know where the money is going, how it will be spent, and if the awardee has a good track record of fiscal responsibility and program results. This is equally true whether you are talking about local philanthropic funders or state and national governmental agencies―building a strong relationship with your funder and delivering result is a proven winning formula.

If the organization that provided your seed funding does not fund ongoing operations, or for any other reason it may be difficult to approach your initial funder or other funders that know you, then you must begin your search for another funding entity. While this process can take some time, especially if you are new to the funding game, it is not that difficult to identify organizations with funding opportunities that may be open to hearing about your results and receiving a proposal. There are numerous information services that identify funding opportunities across the country that can be accessed for free (e.g., www.grants.gov for government opportunities, www.ruralhealthinfo.org for rural opportunities) or for a fee through a subscription arrangement (e.g., www.grantwatch.com and www.grantstation.com), to name just a few. These services cover a wide range of funding opportunities from governmental agencies to local, state, regional, and national philanthropic foundations and can serve as a good way to locate organizations that fund the type of work you do. While there are many professional firms that will do this searching for you for a fee, which is often quite steep, with a little time and perseverance you can do the searches yourself.

At the end of the day, achieving financial sustainability for your new CCC is not that difficult so long as you remember to begin to plan for the need early on during your initial start-up period and, most importantly, you generate solid, demonstrable, in-demand results that funders are eager to pay to support.

About the author

Dr. Keith Kosel, Executive Advisor at Parkland Center for Clinical Innovation (PCCI) and is author of “Building Connected Communities of Care: The Playbook for Streamlining Effective Coordination Between Medical and Community-Based Organizations,” a guide that brings together communities to support our most vulnerable. At PCCI, Keith is leveraging his passion for – and extensive experience in – patient safety, quality, and population health by focusing on understanding Non Medical Drivers of Health and the impact of community-based interventions in improving the health of vulnerable and underserved populations.

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Parkland program helps pediatric patients with asthma management

Asthma a top cause of sickness in Dallas County children

DALLAS – It’s difficult to keep Sir Moreland of Mesquite indoors. Like most 12-year-old boys, Sir loves spending time outside with his brother and friends. Playing baseball and basketball is his favorite thing to do but right now his focus is flag football.

“This is the first time I’ll be playing for a team,” said Sir. “I’m scared, nervous and excited.”

Playing sports was not always easy for Sir. At age 5 after running outside with friends, Sir began struggling to breathe and was rushed to the Emergency Department at Children’s Hospital. His mother Sheniqua Turner, 36, had no idea the symptoms her son was experiencing at that moment were due to an asthma attack. He was hospitalized for three days.

“I knew of some kids who had asthma, but I’d never seen an asthma attack firsthand,” said Turner. “I didn’t know what was going on. I was really nervous and didn’t know what to do.”

According to physicians at Parkland Health & Hospital System, asthma symptoms vary from person to person. The most common include shortness of breath, chest tightness or pain, coughing or wheezing and episodes that worsen with respiratory viruses like the flu. These symptoms tend to appear when exposed to triggers like pet dander, dust, pollen, air pollutant, mold or even cold air.  For some, the symptoms might not necessarily be conspicuous, such as a mild, prolonged cough.

After her son’s discharge from the hospital Turner immediately followed up with Sir’s pediatrician at Parkland who educated the worried mother about asthma and potential treatments. She left with a personalized action plan to help manage Sir’s asthma.

“I had to learn all his triggers,” said Turner. “I think that’s the reason he hasn’t had an asthma attack since. He’s doing really good now.”

About 6 million children in the U.S. ages 0-17 years have asthma, according to the Centers for Disease Control and Prevention. The 2019 Dallas County Community Health Needs Assessment (CHNA) identified asthma as a leading chronic disease among children, particularly in children residing in ZIP codes located in the southeast of Dallas County. Parkland providers have launched a new program to educate parents and other caregivers and stress the importance of having a personalized action plan to help manage the disease.

“It’s a significant problem. Children would visit their nurse at school because they didn’t have their asthma under control,” said Cesar Termulo, MD, Associate Medical Director at Parkland’s Hatcher Station Community Oriented Primary Care health center. “At times their case would be too severe, and they would need to be taken to the hospital. The majority of these children were not being seen by a primary care doctor to help manage their asthma.”

To help families dealing with the condition, six ZIP codes in Dallas County (75210, 75211, 75215, 75216, 75217 and 75241) were identified to target with interventions to improve children’s asthma control through Breath for Life & Learn for Life, a collaborative effort between Parkland and multiple organizations to address asthma in the community.

Parkland Center for Clinical Innovation (PCCI) instituted an educational text messaging program that focuses on upstream interventions to engage and improve patient care in identified ZIP codes such as patient symptom and medication adherence monitoring. The text messaging program allows for two-way communication. For example, the parent may receive a text message asking, “How is your child’s asthma today?” If the response is the child is experiencing some difficulties, PCCI will notify their provider who may recommend the parent to seek care. The data-driven model assists with care prioritization by referring patients to their primary care physician for asthma management when indicated. If they do not have a primary care physician, they are referred to Parkland to establish a medical home for primary care to include asthma medical management.

PCCI’s asthma risk-prediction model remotely monitors background electronic data of high-risk asthma children.  These children may be referred to their primary care physician.  If the physician requires additional information, the child can be referred to Dallas County Health & Human Services (DCHHS) for a home visit.  DCHHS reaches out virtually to assess their current asthma status and identify environmental factors at home.   Based on their findings, DCHHS community health workers recommend changes to the home environment to reduce exposure to asthma triggers.

“The pediatric asthma model retains a good prediction ability and provides additional clinical insights not previously available using claims data only,” said Aida Somun, PMP, MBA, Chief Operations Officer at PCCI. “With the addition of electronic health records data, our asthma model can be used for all children irrespective of insurance status, thus expanding the benefits of our program to more vulnerable children with asthma.”

Positive Breathing, an organization with a mobile bus that has been outfitted to perform advanced asthma spirometry screening, will also provide outreach into the hard-to-reach sectors of the community and refer patients who are symptomatic.

There are plans for Dallas Independent School District to also refer students with asthma who do not currently have a primary care physician.

“The goal is to reduce avoidable asthma-related visits to the ED and hospitalizations through community outreach,” Dr. Termulo said. “We can make a huge difference.”

Sir says he feels “really good” now that he has his asthma under control. “I don’t have to worry much about it anymore. I can run as fast as I can.”

“Asthma is a real monster, but it’s possible to overcome it. It’s all about educating yourself,” said Turner.

If you live in one of the targeted zip codes and would like to enroll in the asthma text messaging program, please text @asthma to 844-721-0839. For Spanish, please text @asma1 to 844-721-0839.To find out about services at Parkland, go to www.parklandhospital.com. For more information about the 2019 Community Health Needs Assessment go to www.parklandhospital.com/chna .

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Dallas Morning News: Big data, big impact: How Dallas researchers and providers are targeting vaccines to fight COVID

Dallas Morning News:

Big data, big impact: How Dallas researchers and providers are targeting vaccines to fight COVID

One census block northeast of downtown had over 4,100 unvaxxed residents. In a smaller block in the southern edge of Dallas County, 94% were unvaccinated.

Big data is making a big difference in the fight against COVID-19 in Dallas, and the potential promise goes well beyond the pandemic.

Parkland Center for Clinical Innovation, a nonprofit research and data analytics company, is helping providers target their outreach efforts to the most vulnerable residents. PCCI tracks real-time data on vaccinations and COVID-19 cases, and overlays it against underlying health conditions and socioeconomic factors.

That creates “a vulnerability index” and other tools that allow officials to assess which areas face the greatest risks — not just at the ZIP code level but in areas as small as census blocks…

– Click the link below to read the full story –

Dallas Morning News_Big data, big impact_ How Dallas researchers and providers are targeting vaccines to fight COVID

DCEO Healthcare: Info Envy: Dallas County’s Public Health Data Is Among the Best in the Country

One of Dallas’ top media outlets, D CEO Healthcare, ran a story on the reaction to PCCI, IHI and the Cincinnati Children’s Hospital Medical Center publishing an article in the New England Journal of Medicine on PCCI’s herd immunity program for Dallas County:

“Dallas County is home to some of the best COVID-19 data in the country. So when Steve Miff met with experts from Cincinnati Children’s Hospital Medical Center to publish his recent paper in the New England Journal of Medicine about herd immunity, he found that his out-of-town colleagues were jealous of the depth and breadth of information.” 

Go here to read the full article: https://www.dmagazine.com/healthcare-business/2021/09/info-envy-dallas-countys-public-health-data-is-among-the-best-in-the-country/

MSN News: DFW hospital beds filling up with COVID-19 patients; Delta making it harder to reach herd immunity

MSN News:
Across the state, more than 23,000 new positive COVID-19 cases were reported. And the Delta variant, which is responsible for most of the new cases, is making it harder to reach herd immunity.

The problem is that the Delta variant has put the state further back from herd immunity, but also moved the goal line further out.

Steve Miff is the CEO of Parkland Center for Clinical Innovation and says we are around 76% right now, but the state, with Delta, needs to get in the mid 90s to achieve herd immunity.

Click the following link to read the full story:

https://www.msn.com/en-us/news/us/dfw-hospital-beds-filling-up-with-covid-19-patients-delta-making-it-harder-to-reach-herd-immunity/ar-AAOt46k

DCEO Healthcare: How Today’s COVID Data Informs Tomorrow’s Public Health Measures

In a story in the DCEO Healthcare, PCCI research says Dallas County will need 95 percent immunity, explains how several factors are extending vulnerability to the virus, and teaching us about the next one.

The battle against the COVID-19 virus steals the headlines, but another war is being waged under the surface. Data analytics professionals and public health officials are constantly fighting to stay ahead of the massive amounts of data generated by the pandemic. In Dallas, PCCI leads that effort and develops lessons for future pandemics.

Click this link to read the full story:

https://www.dmagazine.com/healthcare-business/2021/09/how-todays-covid-data-informs-tomorrows-public-health-measures/

Dallas Morning News: PCCI reports Upwards of 95% of Dallas County residents need protection against COVID-19 to reach herd immunity

According to a report in the Dallas Morning news, PCCI data indicates that upwards of 95% of Dallas County residents need protection against COVID-19 to reach herd immunity. Herd immunity refers to the condition in which a population is indirectly protected from infection because enough people are vaccinated or have natural immunity to a disease.

Click this link to read the full story:

https://www.dallasnews.com/news/2021/09/17/upwards-of-90-of-dallas-county-residents-need-protection-against-covid-19-to-reach-herd-immunity/?outputType=amp

 

 

 

Parkland and PCCI’s suicide screening program show who is most at-risk in Dallas County

By Jacqueline Naeem, MD, PCCI’s Senior Medical Director

By Kimberly Roaten, PhD, CRC, Parkland Health & Hospital System’s Director of Quality for Safety, Education, and Implementation

The month of September is designated as Suicide Prevention and Awareness Month, offering an opportunity to bring awareness and support to mental health organizations and individuals in Dallas who are helping those in need. An initiative led by Parkland Health & Hospital System (PHHS) and Parkland Center for Clinical Innovation (PCCI) reveals important information about suicide risk among Dallas residents.

While national and international efforts to prevent suicide are ongoing, the problem continues to grow. Over the last decade, healthcare systems have seen a rise in the number of individuals with psychiatric needs and suicide risk. As outlined by the American Foundation for Suicide Prevention (AFSP), suicide and suicide attempts continue to plague the healthcare sector:

  • Suicide is the 10th leading cause of death in the US
  • On average there are 130 suicides per day
  • In the US there were an estimated 1.38M suicide attempts in a single year

Many individuals who die by suicide have had contact with a healthcare provider in the weeks and months prior to death, but often this contact is with primary care or emergency medicine providers who may not identify the risk. With the aim of stemming this problem, PHHS implemented a proactive suicide risk identification and prevention program in 2015 which includes screening all patients ages 10 and older for suicide risk regardless of their presenting problems. Approximately 40,000 screenings are completed per month and over 4 million screenings overall. The Universal Suicide Screening Program at PHHS is an example of how meet and exceed The Joint Commission National Patient Safety Goal 15.01.01, targeting suicide risk and has yielded important data about the prevalence of risk in healthcare settings.

Through collaboration with Parkland Clinical Leadership, PCCI has applied data analytics to understand insights from Suicide Screening Program data, which can be used to identify opportunities to improve the current care pathway. Identification of previously undetected suicide risk leads to timely assessment by a health care provider and connection to appropriate services and resources.

Importantly, analysis of data from the program revealed that 2.3% of individuals who have an encounter for a non-psychiatric complaint endorse suicide risk factors (2,735 pediatric patients and 65,000 adults), underscoring the importance of proactive screening and assessment in all patient populations. Patients who are at risk are assessed, provided with brief evidence-based interventions, and then referred for appropriate ongoing care.

Parkland and PCCI are identifying important ways to prevent suicide and self-directed, but everyone can work together to prevent suicide. Knowing the warning signs and how to find help are two important steps in addressing this critical issue. National Suicide Prevention Month is a wonderful way to raise awareness and improve advocacy. If you are someone you know is struggling with suicidal thoughts or suffering and in need of support, there are excellent resources in North Texas including AFSP’s North Texas Chapter. Our collective efforts can help those at risk.

(Are you in Crisis? Call 800-273-8255 or text HOME to 741741.)

 

PCCI Publishing: New England Journal of Medicine – Examining PCCI’s approach to determining COVID-19 herd immunity in Dallas County

The New England Journal of Medicine/Catalyst published an article authored by members of PCCI, the Institute for Healthcare Improvement and the  Cincinnati Children’s Hospital Medical Center that examines PCCI’s approach to determining COVID-19 herd immunity in Dallas County.

The article, “Rethinking Herd Immunity: Managing the Covid-19 Pandemic in a Dynamic Biological and Behavioral Environment,” was published under its “Innovations Care Delivery” section. The authors of the article share how a detailed understanding of local pandemic conditions is necessary to create focused, tailored responses. While achieving high levels of vaccination is important, exclusive focus on national vaccine targets de-emphasizes the complexities of Covid-19 population immunity. Herd immunity is dynamic and depends on the transmissibility of each new Covid-19 strain, the effectiveness of previous immunity due to previous infection and vaccination against these strains, and human behavior in local communities.

The authors developed a potential framework for enumerating and estimating community-wide immunity to Covid-19 with use of data reportable to local county public health authorities. Using data from Dallas County, Texas, they describe the interplay of vaccines and infection in terms of Covid-19 population immunity, the effect of variants on the ever-changing threshold for herd immunity, and how better access, algorithms, and use of real-time local immunity data could lead to more effective local population protection.

To view the article click here:

https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0288

Or to view it as a PDF, click here.

https://catalyst.nejm.org/doi/pdf/10.1056/CAT.21.0288

 

PCCI Published: Building a Vulnerability Index of Biological and Socioeconomic Risk Factors to Combat COVID-19 Spread

In mid-2021, PCCI experts, along with co-authors from William & Mary published an article in the DESRIST 2021: The Next Wave of Sociotechnical Design pp 22-33, outlining how PCCI developed a COVID-19 vulnerability index that was used by Dallas-area health officials to identify populations in Dallas most at-risk.

DESRIST 2021: The Next Wave of Sociotechnical Design pp 22-33

ABSTRACT:
In early 2020, many community leaders faced high uncertainty regarding their local communities’ health and safety, which impacts their response to the pandemic, public health messaging, and other factors in guiding their communities on how to remain healthy. Making decisions regarding resources was particularly difficult in Dallas, Texas, USA where local communities face stark differences in Non Medical Drivers of Health, such as availability of fresh foods and environmental pollution. We use an action design research approach to develop an index to assess vulnerability, which incorporates both long-term COVID-19 community risk measures and ongoing dynamic measures of the pandemic. Community and public health officials utilize the index in making critical policy and strategic decisions while guiding their communities during COVID-19 and in future crises.

AUTHORS
Thomas Roderick, PCCI, Yolande Pengetnze, PCCI, Steve Miff, PCCI, Monica Chiarini Tremblay, College of William and Mary, Rajiv Kohli, College of William and Mary