November 22, 2016 - With the release of the 2017 Healthcare Preparedness and Response Capabilities by HHS and ASPR, the role of healthcare coalitions appears to have finally hit its stride.
The focus is finally on results – and it hasn’t come a moment too soon.
In the 2012-2016 budget cycle, the focus was largely on coalition development. This guidance, as is typical for a program the magnitude of HPP, experienced its fair share of revision and course correction over the five-year cycle. Healthcare Coalition Development Factors (HCCDA) were created, tweaked and then largely abandoned at the end of the cycle. Development certainly occurred, but it may have been hampered by an amorphous answer to the question “What does a coalition do?”
The 2017 guidance evaluates coalitions on their ability to finally deliver on what has been promised all along – protecting the healthcare system through the enhanced ability to coordinate and communication healthcare needs during disaster.
The guidance is largely built around a capstone exercise called the Coalition Surge Exercise. Conducted with the participation of all coalition members, this exercise involves a facility evacuation and tests the ability of the coalition to assist healthcare facilities and improve outcomes.
In the end, there are several important takeaways in this new guidance. Here are my top three:
Objective data – For the first time, coalitions are going to measure their effectiveness in delivering upon their goals in an objective and repeatable way. This will allow coalitions to demonstrate their value to their members, compare themselves to one another, and track improvement in these data points over time.
Performance-linked funding – The guidance clearly allows for future funding decisions to involve the objective data noted in #1. This should allow high-functioning coalitions to receive greater funding to further their good work while incentivizing less polished coalitions to improve their reach and effectiveness.
Increased interagency focus – In the 2012-2016 HPP program’s HCCDA factors, coalition establishment, governance and development was primary and integration with EMS, Public Health, and local emergency management was a distant second. In this new guidance, EMS, Public Health and Local EM are elevated alongside Acute Care Hospitals as designated Core Members of the coalition. The downstream implications of this remain to be seen but for now it’s safe to say that these partnerships are here to stay.
While the above are certainly big improvements in federal guidance that will help coalitions take their work to the next level, the guidance also leaves a bit of uncertainty around a topic that many have been wondering about for some time – the manner in which funding gets pushed down to the coalition level.
The first two measures that will be used to evaluate awardees and coalitions in this new cycle involve how much money is passing from the awardee (often the state public health office) to the coalitions and how fast it is getting there. Reading between the lines (at the risk of making an error, no doubt), it appears rumors that ASPR has been somewhat exasperated with inefficient awardees seem to be supported by these measures.
I lead a healthcare coalition in Southwestern Virginia called the Near Southwest Preparedness Alliance. We have been very fortunate to exist under an awardee partnership (Virginia Department of Health and the Virginia Hospital and Healthcare Association) that has been a faithful and efficient steward of ASPR funds. In fact, this relationship has been paramount to the success of the HPP program in Virginia and regional coordinators like me have reaped the benefits of a strong and communicative relationship in this regard. My travels across the country, however, demonstrate that this is not the reality in every state. It appears that ASPR has noticed as well.
That brings me to the big question – will ASPR look to bestow preparedness funding directly to coalitions in the absence of a capable awardee? Will they push funds directly to healthcare systems in the absence of a strong coalition? What effect might this have on states like Virginia with a strong and effective awardee-coalition relationship already in place? The guidance leaves these and other questions open to interpretation.
Time will tell, folks. Time will tell.