Placing Bets in a Complex Environment: One Foundation’s Approach to the Opioid Epidemic

Across the globe, foundations grapple with how to tackle complex, cross-sector societal problems. A major effort by the California Health Care Foundation to reduce opioid-related morbidity and mortality, launched just as opioid use was becoming understood as a problem that could reach epidemic proportions, presents an instructive case study of impact. Starting in 2015, the foundation placed several “big bets” on initiatives aimed at stopping overdose deaths and preventing new addiction. That early investment had dramatic returns, laying the groundwork for scaling pilot projects statewide as hundreds of millions of dollars in government funding became available to address the crisis. This article, based on review of foundation strategy, data on investments and results, and interviews with foundation staff, partners, and grantees, identifies key strategic elements that contributed to impact: bridging across sectors, resources beyond dollars, and co-creation with grantees. It also highlights lessons learned for foundations working to address this and other complex social issues

Healthcare Hot Spotting: Variation in Quality and Resource Use In California

This Issue Brief presents analyses of data available through the HEDIS by Geography tool, accessible at https://hbg.iha.org. The tool allows users to display and compare measures of both quality of care and use of health care resources throughout California. Rates can be displayed by product line and geographic area -- from as granular as a ZIP code to as extensive as statewide averages. Two main themes are highlighted in this brief: Health plan products that rely primarily on integrated care delivery networks, such as HMOs and Medicare Advantage, generally have higher quality scores without using more resources. Resource use and health care quality vary widely throughout the state

Foundation Evaluation Startup: A Pause for Reflection

· This article reports on the accomplishments, challenges, and lessons learned in creating a new Department of Research and Evaluation at the California HealthCare Foundation. · Different tools were developed to address each of three key areas: performance assessment, organizational learning, and program evaluation. · These new processes and tools have been wellreceived by both staff and the board, and have become increasingly important as resources become more scarce, making understanding and maximizing the impact of investments even more critical. · Fostering a culture of evaluative inquiry in a fast-paced, payout-oriented environment is a significant challenge – program staff often feels pressured to move on to development of the next project without pause. · Careful attention to designing new efforts to ensure that they yield value from the perspective of participants can mitigate this challenge, as can clear endorsement from foundation leadership

Using Contingent Choice Methods to Assess Consumer Preferences About Health Plan Design

Introduction: American insurers are designing products to contain healthcare costs by making consumers financially responsible for their choices. Little is known about how consumers will view these new designs. Our objective is to examine consumer preferences for selected benefit designs. Methods: We used the contingent choice method to assess willingness to pay for six health plan attributes. Our sample included subscribers to individual health insurance products in California, US. We used fitted logistic regression models to explore how preferences for the more generous attributes varied with the additional premium and with the characteristics of the subscriber. Results: High quality was the most highly valued attribute based on the amounts consumers report they are willing to pay. They were also willing to pay substantial monthly premiums to reduce their overall financial risk. Individuals in lower health were willing to pay more to reduce their financial risk than individuals in better health. Discussion/conclusion: Consumers may prefer tiered-benefit designs to those that involve overall increases in cost sharing. More consumer information is needed to help consumers better evaluate the costs and benefits of their insurance choices.Patient-preference, Willingness-to-pay