Healthcare Grants: Are they worth pursuing?

1. Healthcare Grants:Are they worth pursuing? Doris T. Barta, Director Telehealth Services Partners in Health Telemedicine Network St. Vincent Healthcare

2. Challenges in writing healthcare grants • Competition is greater – less grant opportunities • TNPG grants – funded 80 1 year ago; 5 this year • A lot less money – with high expectations for achievement • $200k/year versus $500k/year • More emphasis on outcomes (e.g. evaluation) and less focus on need

3. Office of Rural Health Policy Grants

5. I. Funding Opportunity Description 1. Purpose This announcement solicits applications for the Telehealth Network Grant Program (TNGP). The primary objective of the TNGP as noted in Section 330I(D)(1) is to demonstrate how telehealth programs and networks can improve access to quality health care services in rural, frontier, and underserved communities. TNGP networks are used to: expand access to, coordinate, and improve the quality of health care services; improve and expand the training of health care providers; and/or expand and improve the quality of health information available to health care providers, and patients and their families, for decision-making.

6. INTRODUCTION The St. Vincent Healthcare Foundation is submitting this Telehealth Network proposal to provide pediatric outreach services to rural and frontier Montana communities. We request the following administrative funding priorities: (b) provision of clinical mental health services; (d) network of rural health care providers whose sites are located in frontier areas; (e) participation of a HRSA-funded community health center; and the following legislative preferences: (a) the applicant is a faith-based organization and (b) will provide pediatric mental and preventive health services through this project. St. Vincent Healthcare (SVH) is one of the two largest healthcare providers in Montana, and is located in the state’s largest city, Billings. SVH is home to the Partners in Health Telemedicine Network (PHTN), a partnership of healthcare sites in Montana, Idaho, and Wyoming, which offers telemedicine, teleconferencing, and continuing medical education to member sites.

7. Montana Has Critical Gaps in Pediatric Care 178 Montana Pediatricians 73% of Pediatricians in Montana are located in 5 urban communities – all of which are on two freeways that cross the state

9. Healthcare is hard to access in most of the state’s counties, and pediatric care is nearly non-existent in rural/frontier Montana. In-state transfers of emergency care cases to urban areas such as Billings are frequent and expensive. Numbers of pediatric outpatient ER admissions at St. Vincent (children admitted to the ER, treated, and released without hospitalization) from outside Yellowstone County are significant. The chart below shows numbers of pediatric patients from outside our county who are admitted to the ER, treated, and released without an overnight stay. This indicates numbers of children who could be served in their local area, without the stress and expense of travel. By enhancing rural communities’ access to pediatric specialty services through telehealth consults, we will help our rural communities keep more pediatric cases closer to home – providing the most cost effective and appropriate level of care – where and when needed. Finding a way to keep more pediatric cases in-state and closer to home—treated locally, where possible, or, for cases requiring more intensive care, sent to larger medical centers in state – is better financially for the state, the children and the parents.

10. Criterion 2: RESPONSE (maximum 16 points) This Criterion is comprised of two parts: a. Goals and Objectives (maximum 8 out of 16 points) - The application will be evaluated based on the extent to which the project Goals and Objectives: • Facilitate collection of data on the impact of telemedicine on improving health care outcomes (e.g., improved access, productivity, dollars saved) as well as improved quality of clinical services (e.g., reduction of medical errors). • Correspond to identified problems, needs, and community demand. • Are achievable, measurable, time-limited, and clearly stated. • Are compatible with the applicant organization’s goals and objectives, including quality of care, and cost-effective delivery of services. • Responds to TNGP program goals. b. Benefits (maximum 8 out of 16 points) - The application will be evaluated based on the extent to which the project benefits: • evidence of effective results in terms of quality of care, efficiency, and cost savings. • Relate to the project’s goals and objectives. • Are quantifiable, and justify the costs (both equipment and human) of the project. • Are assessed by the applicant to monitor project effectiveness. • Evidence the project’s value to the community and most effective use of technology

11. Writing Goals and Objectives:What Funders want to see Goal: What is the problem, and what would the world look like if you solved it • What do you want to accomplish Objectives: How will you address the problem Evaluation: How will you know if it worked?

12. Activities: What steps do you have to take to get there? • Think through the objectives and activities that will help you reach your goal, and start jotting down your budget needs as you go. • Your goals, objectives and action plans become your work plan.

15. Any questions so far . . .?

16. Criterion 3: EVALUATIVE MEASURES (maximum 18 points) The effectiveness of the method proposed to monitor and evaluate the project results. Evaluative measures must be able to assess 1) to what extent the program objectives will be met and 2) to what extent the outcomes can be attributed to the project. • Evidences the experience and/or ability in evaluating health care outcomes attributable to the telehealth program (e.g., improved quality of care, productivity and efficiency, expanded access. • Addresses the specific data planned for collection, the specific data collection strategies and tools to be used, the types of analyses to be performed on the data, and provides baseline data for those clinical services and/or diseases addressed for this proposed project. • Will be able to collect and provide dataon costs, utilization, patient and practitioner satisfaction, improved health care outcomes, reduction of medical errors, and network organizational factors such as staffing, administration, etc. • Has developed a plan to carry out evaluation activities and provides resources for evaluation activities. • Indicates how assessment data might be used to modify the project as appropriate. • Evidences experience in dissemination of technical information to a wide audience.

17. How will you know if it worked? • How will you measure your results? • How will you demonstrate that the grant project caused the results? • Applications will be reviewed based on the strength of the approaches used to measure success in achieving project goals, objectives and outcomes. • Many applicants do not have this expertise in house, and are hiring an outside evaluator

18. The Evaluator will be responsible for process and outcome evaluation, selection of valid and reliable measures, development and testing of new measures as needed. She will also participate in monthly meetings with the Project Director and the Advisory Group as needed. Baseline data will be used where available. The Evaluator will prepare and deliver quarterly and annual reports that will be available to the Advisory Group and the Network of Providers. The consistent sharing of information regarding the program activities will allow for changes in development and/or implementation of program activities dependent upon the results of evaluation information presented. Quarterly meetings will assure ample opportunity for program adjustments should the need arise. The Evaluator will also assist the Project Director to disseminate results through local publications, refereed international publications, and national presentations. In summary, the external Evaluator’s role will be to monitor progress, measure successes, ensure fidelity of the project, and assist or take the lead role in disseminating results. Tools used to assess the goals and activities: We are using standardized tools for patient outcomes (e.g., clinical and behavioral measures) and will be designing brief tools to estimate cost, describe reasons for telehealth consultations, count the number of telehealth consultations, and so forth. The tools for this project will use nominal, ordinal, interval, and ratio levels of measurement. Each tool is described in the Evaluation Plan below. In addition, data will be collected to confirm process outcomes, such as compliance with the terms of the proposal and timely execution of project objectives. Evaluative strategies including both outcome and process objectives are incorporated into the table “Evaluation Plan,” which follows this section.

21. Criterion 4: IMPACT (maximum 13 points) – The extent to which project results may be replicated nationally; the extent and effectiveness of plans for dissemination of project results; and the sustainability of the program beyond the Federal Funding. Specifically, this Criterion is comprised of two parts: a. Project Impact and Information Dissemination (maximum 5 out of 13 points) • Serves as an experienced model for telehealth networks that provide specific, quantifiable and measurable outcomes for: 1) quality of care; 2) efficiency; 3) cost savings; or 4) the integration of the telehealth information system into the electronic health information systems (e.g., electronic medical record) used by the applicant and network members. • Plans and strategies for marketing, promotion, and information dissemination b. Sustainability (maximum 8 out of 13 points) How the project will be sustained during and after federal grant funding: • Plans to measure the contribution of the project to the goals of each project partner and how these goals contribute to the long-term success of the project. • Has integrated the project into its strategic plan, core business, and clinical practices • Documents how cost-savings to be realized and measured, as applicable. • Evidences acceptance of partner financial responsibility, participation and commitment • Outlines a realistic plan for sustainability • Evidences local community/provider involvement

23. Criterion 5: RESOURCES/CAPABILITIES (maximum 25 points) – The extent to which project personnel is qualified by training and/or experience to implement and carry out the projects. The application will address the capabilities of the applicant organization, and quality and availability of facilities and personnel to fulfill the needs and requirements of the proposed project. This Criterion is comprised of three parts: a. Network Experience/ Network Member Sites including, as applicable, Network Partner Rural Spoke sites and Hub site(s) and Network Organization (maximum 9 out of 25 points) b. Project Management and Work Plan (maximum 11 out of 25 points) c. Clinician Acceptance and Support (maximum 5 out of 25 points) Applicants failing to submit verifiable information with respect to the commitment of network partners [i.e., all Partner Rural Spoke sites and Hub site(s) at the time of application will receive 0 out of 25 points. Existing Network Experience/ Network Member Sites and Network Organization Project Management and Work Plan Clinical Acceptance and Support

26. Criterion 6: SUPPORT REQUESTED (maximum 15 points) – The application will be evaluated based on the extent to which the budget, including the cost projections, and budget justification: • Is realistic and justified in terms of the project goal(s), objectives, and proposed activities. • Documents that the budgeted costs are realistic, necessary, and justifiable to implement and maintain the project, including the human and technical infrastructure. • Documents a realistic, necessary, and justifiable full-time equivalents (FTEs) and expertise necessary to implement and maintain the project. • Is complete and detailed in supporting each line item and allocating resources. • Documents demonstrable experience with regard to technical costs of hardware and software, and telecommunication charges. • Conforms to the use of grant dollars permitted by the grant program.

27. Budgeting

28. The budget and the narrative should tell the same story! You should be able to read the text and estimate the cost You should be able to review the budget and understand what is being done.

29. What is an allowable cost? Know your funding source • They will publish what they fund and what they do not fund • Some federal funding sources will not cover operating costs, but will allow you to include that in your match (RUS) • The ORHP funds both operating costs and equipment (equipment can only be up to 40% of the project budget) • Funding sources can and will change their priorities

30. In-kind and matching requirements • In-kind contributions: the “stuff,” time, and material you bring to the grant • Hard match: the cash dollars you set aside from your budget toward the grant

31. Budget Development • Many times the Funding Source will give you a sample budget form to follow • Make sure you provide a thorough budget – don’t leave the reviewer guessing • Make sure you provide a detailed budget and a detailed budget narrative

32. Sample Budget Personnel Funding In-kind Total Source Project Director 15,000 15,000 30,000 Travel Billings 1000mi/ @ .51/mile 250 260 510

33. Planning for sustainability • Avoid building salaries into grants • Can the project sustain itself? • Can your budget absorb the costs?

34. Criterion 7: ASSESSING TECHNOLOGY AND INTEGRATING ADMINISTRATIVE AND CLINICAL SYSYTEMS (maximum 8 points) – The extent to which the application demonstrates knowledge of technical requirements and rationale for cost-effective deployment and operation. • Have the ability to integrate administrative and clinical information systems with the proposed telehealth system. • Will utilize “open architecture” (interoperable) technologies or demonstrate why proprietary solutions are preferable. • Will integrate the proposed system into each provider’s normal practice. • Employs technologies that are upgradeable and scalable. • Justifies the technology as the optimum and most efficient technology to meet the identified need. • Explain how the project will ensure the privacy of patients and clinicians using the system and the confidentiality of information transmitted via the system, including compliance with Federal and State privacy and confidentiality, including HIPAA regulations. • Evidence knowledge of telecommunications transmission services available in the project service area, and justify the deployment at each site considering the range of choices available.

35. This project will provide fifteen rural spoke sites with the peripheral equipment to support the telepresentation of pediatric patients to urban pediatricians and pediatric specialists. Based upon currently available technology, this equipment will include the following peripherals, which are easily incorporated into the selected codec: • TR-1/EF Telephonic Stethoscope, which consists of a Chest Piece Assembly, a standard audio Headset, a wall-mount power adapter and electronics Module containing amplifiers, filters, CODEC, UART and RS232 interface. The power adapter, Chest Piece Assembly and Headset are detachable and can plug into the electronics Module. The electronics Module is capable of operating as a transmitting unit sending digitized auscultation signals fro the attached Chest Piece, or as a receiving unit accepting the digitized auscultation signals, converting them to analog audio and presenting them to the attached Headset. This stethoscope will provide the ability to assess heart and lung sounds. • AMD 2500 General Exam Camera, which is an analog camera that combines power zoom (1-50x), auto focus, freeze frame capture, and electronic image polarization in one diagnostic device. It provides fluorescent lighting feature with auto white balance and output signals of composite and S-Video. This equipment allows for the presentation of patients when the Polycom codec is not adequate, and operations are easily presented and coached for unfamiliar users. • AMD 2015 ENT/Otoscope with Pediatric Adapter, which is a tool that combines the functionality of a high performance otoscope and an oral exam scope in a single diagnostic device. It contains pneumatic otoscopy for easy assessment of outer-ear canal, ear drum and middle ear. It permits excellent imagery for lower sinus and upper throat examinations and connects to the AMD-400 camera platform (included in the purchase). This device with the pediatric adapters allows for the full examination of the ear, nose and throat.

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