8 Ways States Can Save the Hospital Preparedness Program

8 Ways States Can Save the Hospital Preparedness Program

Failure to spend down allotted grant funds, a hyper focus on buying stuff, and failure to show program effectiveness are a ticking time bomb for the National Healthcare Preparedness Program (NHPP). Fortunately, the clock on the NHPP, formerly known as the Hospital Preparedness Program (HPP), has not hit zero.

Yes, there's still time for the states to feed and nurture their healthcare coalitions to better health. There's still time to save the NHPP.

“It is amazing the difference between a coalition that ‘gets it’ in terms of sustainability beyond the grant and just spending the dollars,” commented Keith Dowler, Emergency Manager for Inova Health System’s flagship 850+ bed hospital and Level I Trauma Center in the National Capital Region. Dowler made the comment in response to my article 3 Reasons Congress Will Kill the Hospital Preparedness Program. And Dowler knows a thing or two about effective healthcare coalitions, as he was formerly Assistant Director of the Near Southwest Preparedness Alliance (NSPA) in Virginia.

For a coalition of its size and its urban/rural make up, the NSPA is by far one of the most progressive healthcare coalitions operating nationally. I’d say they ‘get it.’ And they'll be operating no matter what happens in 2017.

“Stuff versus education has always been challenging- when did building and maintaining a capability stop with purchasing equipment,” Dowler said in reference to our propensity to focus on stuff. “For the ones who do get it and are using ASPR funds as seed money to expand and grow, 18 months from now will be just another fiscal calendar close out and not closing doors.”

Ouch! Well said, Keith. So how does a healthcare coalition help individual healthcare providers move from stockpiles of stuff to “building and maintaining” regional healthcare system preparedness capabilities?

It starts with their State’s strategy, program implementation, and oversight – and the State's political will to fight the good fight.

The transition to healthcare system preparedness from hospital preparedness has been challenging for many states. Some more than others. As I’ve written about recently, state funding strategies are a key factor driving success – and failure. But all is not lost. There is time to make significant progress before Congress makes a decision on the NHPP.

During my work, I’ve seen what success, struggle, and failure looks like nationally, so I’ll now share what I’ve seen that can help states help themselves, their healthcare coalitions, and their citizens.

  1. Fund a reasonable number of coalitions: States that have exorbitant numbers of healthcare coalitions dilute per coalition funding to the point that none have adequate resources to be effective. See How Many Healthcare Coalitions Are Too Many.
  2. Be cautious using local governmental entities as sub grantees: In most counties and municipalities, grant funds fall under the same ordinances and policies as general revenue, which can bring procurement and hiring to a crawl. Further, mission creep often causes NHPP funds to be directed to capabilities not found in the Healthcare Preparedness Capabilities: National Guidelines for Healthcare System Preparedness. And let's not forget that healthcare moves at the speed of the private sector.
  3. Directly fund healthcare coalitions, not facilities: States that deliver funding around their healthcare coalitions choke their ability to deliver desired regional efficiencies. The vast majority of states using this model are funding only their hospitals directly, which leaves their coalitions with few resources and little discretion in implementing cross-sector, cross-discipline regional priorities.
  4. Deliver sub grants to coalitions quickly: Coalitions that receive funds in August are less likely to go into panic spending mode than those that get their funding in December. States that must negotiate and process sub grants to 4, 6, 8… healthcare coalitions deliver funding months faster than those that sub grant to 120 facilities plus 8 coalitions.
  5. Deliver advanced funding: Parlaying off number 4, few coalitions have matured to the point that they are generating unrestricted funds that can carry them from June 30 to December. Even if states deliver sub grants quickly, say August, but expenses can only be paid as reimbursements, how are they to pay staff? That is, if they do not have a charitable sub grantee with deep pockets.
  6. Retain 25% or less for state operations: Unlike public health, where state health departments provide important services to citizens and local health departments; direct healthcare services are predominantly delivered in the private sector. ASPR ‘recommends’ that no more than 25% of NHPP funds be retained by the state, but…
  7. Stop approving stuff: Stuff is a necessary component of preparedness, response, and recovery. But without a sound organizational foundation and associated communications, inventory, and logistics systems, the stuff has limited reach.
  8. Support organizational development: State health departments are not experts in organizational development and nonprofit management. And with few exceptions, neither are the emergency management coordinators for the healthcare providers who make up a coalition’s membership. Whether a state’s coalitions are quasi-nonprofit, nonprofit, or a nonprofit with a 501c3 designation, they need a new toolbox.

The bottom line is this: states need to get the most money possible in the hands of their healthcare coalitions as fast as possible, whether that be direct or through a proper sub grantee. The longer the funds are trapped in state and local bureaucracies, the more likely coalitions will be forced to make ineffective, last minute spending decisions – on stuff.

Consulting firms that provide regional assessment, planning, training, and exercise services, and those that help coalitions work through governance, strategic planning, and other organizational development challenges are critical to the successful implementation of effective sustainable healthcare coalitions.

The challenge is that, unlike stuff, service oriented projects cannot be delivered overnight, and without them coalitions will continue to struggle. And struggling healthcare coalitions tend to be less effective, are more likely to have unspent funds at the close of the grant year, and are more likely to panic and want to buy a bunch of unnecessary stuff at the last minute.

And then the state has to say, “no, we’ve got enough stuff!” The coalition then responds with, “here, take our unspent money back.” And then, of course, ASPR says to the state, “why the heck do you all have so much carryover. These unspent funds are killing the program!”


Stay Tuned

So, I’ve laid out the three reasons Congress is likely to kill the NHPP in 2017, and I’ve given the states eight strategies to reduce the chances of it happening. Next week, I’ll dig into what healthcare coalitions need to do to live another day

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Karl Schmitt, MPA

Karl Schmitt, MPA

Karl is the Passionate Founder & CEO of bParati. He is on a mission to build a national network of effective, sustainable healthcare coalitions. More...

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Karl Schmitt, Passionate Founder & CEO, bParati

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