Health Policy Institute of Ohio (HPIO)

1. Health Policy Institute of Ohio (HPIO) Updated materials originally presented to interested foundations in late February, 2003

2. How the Project Arose • The Health Foundation of Greater Cincinnati’s Board felt it was time for us to do more policy-oriented work • We began a process of talking with health policy officials, researchers and funders across the state • Several themes arose, and a number of researchers, officials and sister foundations encouraged us to look at forming a policy institute; a proposal was written

3. What We Found: Policymaker Issues • Because of term limits, legislators have lost the history and their knowledge bases about Medicaid • Lobbyists are the only source of information, and their information always supports their causes; no independent sources • State officials are hard-pressed to generate information and analyses • In-state studies not ready when needed • More Medicaid coverage decisions have been delegated to the state

4. What We Found: Researcher Issues: • MEDTAPP (program of Medicaid & Board of Regents) is funding only a few projects • Most research is clinically-oriented rather than policy-oriented • Most researchers working on Medicaid and the uninsured are isolated • This work has low priority and prestige in academic departments – partly because it is poorly funded • Little research reaches legislators

5. What We Found: Ohio Health Policy Research Centers • UC: Institute for Health Policy & Health Services Research • U of Akron: Institute for Health and Social Policy • Federation for Community Planning • OSU: Center for Health Outcomes, Policy & Evaluation Studies • CWRU: Center for Urban Policy & Social Change

6. What We Found: Health Advocacy Issues • It is hard to get good information out of the state system • Important issues do not get attention because there is no way to back them up • Most advocates do not have the ability to do analytic work directly

7. What We Found: Foundation Issues • Most health & community foundations do not act to influence state policy – but policy is critical for sustainability of local programs • No coordination of policy efforts among health foundations • Policy efforts are isolated; hit-and-miss for priorities, and last-minute

8. What is Different About Our State • Ohio is one of four states that have multiple urban centers • No single city dominates the state

10. What is Different About Our State • Ohio is one of three states that have multiple urban centers • No single city dominates the state • Our cities differ in their cultures • No statewide health grantmaker

11. Work in Other States • At least 1/3 of states have, and 11 states plan a health policy center • Three foundations in Colorado just announced creation of a center • They did substantial research prior to acting, and we have borrowed liberally

12. Three Models for Health Policy Centers • Subsidiary of a health foundation • University-based center • Independent center

13. What We Are Proposing An independent center that works to improve the health of all Ohioans through research, analysis and communication about vital health concerns affecting the state, with particular emphasis on the Medicaid, uninsured and underinsured populations, and issues of public health in Ohio

14. What is Different About Our Proposed Center • More emphasis on communication with and education of policymakers • Less emphasis on data warehousing or clearinghouse functions (we can link to existing sources in Ohio) • Multiple local funders joining to fund a state policy center as a way to advance regional interests through state-level interventions

15. Success Issues • Quality of HPIO leadership: • Competent with research, economic analysis • Non-partisan, no political agenda • Communication and relationship skills to interact with policymakers

16. Success Issues • Stable funding during start-up (or we won’t recruit well and money issues will distort the work selected) • Board that represents the state, but has no vested interest (i.e., no income to them or their organizations from changes in state policies)

17. Work of the Institute: Health Policy Research Agenda for Ohio • Generate through state-wide inclusive process • Working closely with ODJFS Ohio Health Plan (Medicaid), Ohio Department of Health and others • Attuned to issues likely to arise and to closing gaps in useful information

18. Work of the Institute: Reports • Informational Brochures (2/year) • Such as Ohio Medicaid Basics • Issue summaries (12/year) • Translate studies done across the state into materials understandable by policymakers • White papers (3/year) • In-depth research or analysis

19. Work of the Institute: Reports • Biennial district and local reports • Bringing abstract issues into focus in a legislator’s district • Report to the Community • The Center’s annual report (but done biennially)

20. Work of the Institute: Meetings • Legislative Briefings • Research Conferences & Roundtables • Public meetings for setting policy agenda • Media Briefings

21. Governance • The Board will consist of appointees of the Founders during the starrt-up years • Broader participation will be engaged through advisory groups convened by the Institute

22. The Ohio Health Policy Advisory Group… to develop consensus about state policy research issues & priorities The Institute will convene:

23. Ohio Health Policy Researchers Advisory Group… to develop researchers to share work to simplify work to enhance health policy work in Ohio The Institute will convene:

24. Scientific Review Advisory Group... to review the Institute’s scientific activities and to oversee a formal evaluation process in Year Four The Institute will convene:

25. HPIO Benefits for Ohio: • Decisions affecting Medicaid & uninsured will be more data-driven • Hare-brained solutions may wither sooner • Contentious issues will be examined more thoughtfully, with better understanding of consequences • Opportunities for reform will be used

26. Useful Information fromOhio Medicaid Basics Publication by the Health Foundation of Greater Cincinnati and the George Gund Foundation - as an example of potential HPIO output and impact (Report available at www.healthfoundation.org/publications)

27. Medicaid Enrollment

28. Medicaid per member, per month costs

30. Medicaid Expenditures

31. How does Ohio compare? Ohio’s per member per month (PMPM) costs for most Medicaid-eligible populations are at or below national averages

32. Other Things Being Equal,Decisions about Medicaid coverage will balance: • Covering the optimum number of people • Providing the optimal services • Maintaining Ohio’s financial integrity • Promoting family & community self-sufficiency, self-determination, & health

33. Health Policy Institute of Ohio: Benefits for Foundations • Permits foundations to inform policy based on what they learn from their local projects • Research and analysis can help foundations choose and focus projects for best impact • Source of health outcome studies and indicators for evaluating own work

34. Health Policy Institute of Ohio: Benefits for Foundations • Source of expertise for getting certain types of projects done • Allows Ohio health grantmakers to collaborate • Will keep us out of crisis-driven and fragmented policy work • Permits state-level interventions that we have not used up to now

36. Discussion