Chapter 12: Grant-Funded Projects in the Office of Health Policy: Services for the Uninsured

Chapter 12: Grant-Funded Projects in the Office of Health Policy: Services for the Uninsured

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Description

Here, Dr. Foxhall describes initiatives supported by the institution and by federal money that are designed to reduce cancer risk among low-income individuals. He first talks about the tobacco program, mentioning the ASPIRE program designed to reach maximize tobacco avoidance/cessation in adolescents. Dr. Foxhall explained how the Office of Health Policy helped support this project. Next he talks about the project, Ask, Advise, Connect, a quit line service that services HIV patients. Dr. Foxhall notes that this is a good example of how the Office of Health Policy identifies a government program that can provide funding for initiatives relevant to the needs of at-risk individuals. He describes the individuals involved in organizing the funding mechanisms and notes where difficulties arise in the process. Dr. Foxhall explains that this is a slow and often frustrating process, but the benefits come when “you see that you help someone” and can track progress with use rates.

Identifier

FoxhallLE_03_20140311_C12

Publication Date

3-11-2014

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - An Institutional Unit; Overview; MD Anderson History; MD Anderson Impact; MD Anderson and the Texas Legislature; Education; Information for Patients and the Public; Institutional Mission and Values; Beyond the Institution

Transcript

Tacey Ann Rosolowski, PhD:

What’s another grant-funded project?

Lewis Foxhall, MD:

So that [unclear]. I think the one that we’re working on right now is one that’s funded through the—as a sharing program between the institution and the federal government, which is a waiver to the Medicaid program, which allows us to do a number of outreach programs targeting tobacco control and colorectal screening and breast screening. They will be adding some additional projects, hopefully in the near future. But this is a very significant source of funding. The outreach programs, these are things that we know work, things that we know reduce the risk of cancer, help find cancer early and reduce the risk of dying from cancer. But for low-income populations, there are very few ways to pay for that, so this has been a real positive opportunity for us to access additional federal funds that can enable us, along with our institutional funds, to reach out to low-income people around our immediate region and to be able to provide these sort of services to them.

Tacey Ann Rosolowski, PhD:

What kinds of services and how exactly do these [unclear]?

Lewis Foxhall, MD:

So there are three tobacco-related programs. One is we administer the funds and coordinate the programs that are done by our faculty members, in part, and we have a program of Dr. Prokhorov reaching out to the youth, adolescents and youth, on tobacco avoidance and tobacco cessation that he’s implemented. It’s a program project, ASPIRE, that he’s had for some time, but he gives us an opportunity to get it out to the population that we couldn’t otherwise reach.

Tacey Ann Rosolowski, PhD:

So how does that piece work? I mean, he’s doing the project. Then what do you add that expands the [unclear]?

Lewis Foxhall, MD:

We write the checks.

Tacey Ann Rosolowski, PhD:

Pardon me?

Lewis Foxhall, MD:

We write the checks. We go to jail if he defaults. (Rosolowski laughs.) So we’re involved with negotiating the arrangement with the state and with the regional organizing entity and got the program up and running, and now we administer the funds. So the institution gives us initial startup funds, and then we use those and match them with federal funds, and eventually they come back to us with new dollars that we can use to help fund the program. These are pay-for-performance arrangements, so the programs have to meet certain milestones and expectations for us to receive additional payments. So it’s a little different.

Tacey Ann Rosolowski, PhD:

I’m try to visualize how it works. I mean, where are these projects actually implemented? In high schools, junior highs, churches?

Lewis Foxhall, MD:

It’s an Internet-based outreach program, so they work with all of the above, but they reach out to where students are, primarily in schools, and connect with them to help them reduce the risk of starting smoking, or if they already smoke, to help them quit. So it’s an interesting approach. So that’s one big project, and we have a couple of others, one with Dr. Jenny Madreen [phonetic], which is Ask, Advise, Connect Program, which is helping low-income clinics to connect their patients who smoke with the quit-line services through their electronic health records. Then the other one, Dr. [unclear] has a project he’s working on in a clinic that serves a large population of HIV/AIDS patients to help them quit smoking. So they’ve got a very high smoking [unclear] in that population. So those are the tobacco projects we have—

Tacey Ann Rosolowski, PhD:

Could I ask you, because you said it’s performance-based, so how are the results, outcomes being tracked, and what does your office look for in terms of what’s the threshold that says, “Yes, we go forward”?

Lewis Foxhall, MD:

Right. Well, as we submitted the projects for review and approval, we had to say, “This is what we expect to accomplish, and we will measure it in this particular way,” numbers of persons served or numbers of individuals who access the quit line, or number of individuals who are counseled, these sorts of things. And then we also have a second segment, which will just be starting soon, which is more based on patient satisfaction, were they satisfied with the services they received, did it help them with whatever they’re supposed to do to help them in these sorts of things, which will be a survey-type process. And then we have to report some general health-related measures from the institution as far as our clinical-type measures, which is a reporting requirement [unclear]. But—

Tacey Ann Rosolowski, PhD:

I mean, I realize some of these questions sound kind of picky, but—

Lewis Foxhall, MD:

No, no, no, it’s fine.

Tacey Ann Rosolowski, PhD:

—you know, it’s like I don’t know, and I think most people don’t know what does health policy involve. (laughs)

Lewis Foxhall, MD:

You know, this is a good example of identifying a government program and this example that can provide funding for work that we know there’s a need for, but through a mechanism that’s not common or even, I think, at first comfortable for a lot of people today. So some of it is really just trying to kind of work through the technical details and address health-related needs through funding mechanisms that are organized through these sorts of mechanisms. So a lot of it gets very technical and very, you know, arcane, but it’s just part of dealing with the federal government and the state government. I mean, this involves the regional network director, which is through the Harris County Hospital District, and then the state health and human services department and then also through the centers for Medicaid, Medicare services federal folks. And we also coordinate with our colleagues through the UT system and meet periodically with the vice chancellor’s team to be sure we’re all sort of on the same page from a UT system point of view.

Tacey Ann Rosolowski, PhD:

So what are the kinds of things that can get you off page? You know, where—

Lewis Foxhall, MD:

People not doing what they said they were going to do. You know, we have to rely on our colleagues to provide the services that they said they were going to provide. So that’s one issue. The other is just the difficulty of working in low-income settings with limited resources. You know, it’s always a lot harder than you think to do these things.

Tacey Ann Rosolowski, PhD:

What keeps you doing this? I mean, it sounds like really frustrating and just like climbing through a constant jungle of junk. And why do you keep doing it?

Lewis Foxhall, MD:

Well, every now and then you figure out you can actually help somebody, so that’s a good thing. So I think you do have to sort of take the long view and it can be frustrating, but it’s clear eventually that you’re making some difference and contributing to the improvements.

Tacey Ann Rosolowski, PhD:

What’s an improvement that really gratified you?

Lewis Foxhall, MD:

Well, you know, the mortality from cancer in this country has dropped 20 percent since I started working in this area. So it’s just a coincidence, I’m sure. It had gone up every year before that. But seriously, we track and monitor screening rates, we track usage rates for tobacco, for example, and really try to get some idea that the projects and efforts, education efforts, and other interventions that we’ve been working on are making some difference.

Tacey Ann Rosolowski, PhD:

And you find they do.

Lewis Foxhall, MD:

Yeah. So, you know, things are moving in the right direction, so that’s good. So it’s not the same as in clinical practice where you have one patient you’re working with at a time, you can see the benefits of your labors more directly, but working with populations, you’ve got a broader reach, but it’s a longer timeline to really see results.

Tacey Ann Rosolowski, PhD:

Well, that’s the beauty of having very different individuals involved in the process, because everybody brings their own gift and passion and where they want to focus.

Lewis Foxhall, MD:

Right. Exactly. So all that stuff is good.

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Chapter 12: Grant-Funded Projects in the Office of Health Policy: Services for the Uninsured

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