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Lessons from the ObamaCare Rollout Fiasco for Grant Writers

Regardless of one’s politics or policy preferences, it’s painful to watch the ongoing Affordable Care Act rollout fiasco.* Developing is obviously a complex undertaking. One thing lost in the cacophony over the botched rollout is that many large scale IT projects fail to launch successfully, with being the most widely publicized example this year.

We recently wrote some proposals for an electronic health record (EHR) development project on behalf of a California hospital. When scoping the project, our client told a story about a very large Los Angeles hospital that spent several years and $34 million rolling out an EHR system that its doctors refused to use. This well-known hospital failed to involve the docs—the users, in other words—in system development and the whole system had to be trashed.

Since President Obama and his team—or the L.A. hospital—presumably didn’t set out to create a debacle, there are lessons to be learned for anyone involved in complex project development, including grant writers. Perhaps the most of obvious is to make sure that one person is in charge. This echos Steve Jobs’s insistence on a Directly Responsible Individual (DRI) (to use the Apple-speak) for all projects. That ensures that one person has their head cut off in the event of failure, and beheading tends to focus the mind. If your agency is going to be serious and successful in grant seeking, either hire a competent staff grant writer or consultant and hold them responsible for getting job done.

For nonprofits, which often have fairly chaotic, or, to be less pejorative, “egalitarian” management structures, this simple strategy is frequently overlooked in proposal writing. Without a DRI, proposal planning meetings are likely to drift, with the management team espousing great, but vague, thoughts and the worker bees afraid to say they don’t understand what is wanted. Frequently their fears are well-founded, since nothing concrete has been specified by management.

The result is typically conflict and confusion, which results in a poorly written, incoherent and/or technically incorrect proposal, if the proposal gets finished at all. Most of our clients are astounded when we scope a project in an hour-long phone call and produce a more or less on-target first draft without any angst or finger pointing. Some details may be wrong, in which case they’re fixed in the next draft. It’s really not hard, because we assume the role of a DRI, get the job done, and don’t make excuses. We ask direct questions to elicit specific answers to the five Ws and the H that are central to proposal development or any information gathering effort. When in doubt we let the RFP dictate the proposal, instead of trying, probably futilely, to dictate the program to the funder.

* Otherwise known as “Obamacare.”

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Health Care Innovation Awards Round Two: ObamaCare, the Gift that Keeps Giving for Grant Seekers and Writers

Another week, another huge ACA / ObamaCare RFP announced. This time it’s Health Care Innovations Awards Round Two. There’s $900,000,000 up for grabs, with grants to $25,000,000. These eye popping numbers are big enough to seize the attention of even this grizzled grant writer.

The purpose of this very attractive RFP is to:

The second round of Health Care Innovation Awards will fund applicants who propose new payment and service delivery models that have the greatest likelihood of driving health care system transformation and delivering better outcomes for Medicare, Medicaid, and CHIP beneficiaries in four Innovation Categories.

This string of policy buzz words doesn’t really say anything other than that applicants are supposed to do something that will somehow lower undefined health care costs born by public insurance programs, while at the same time magically improving undefined outcomes. This is great news for applicants because almost anything can be proposed. It’s even better news for grant writers, as we can wax eloquently in health policy mumbo jumbo while spinning grant Tales of Brave Ulysses (I used this quote before, as well, but it just seems so damn perfect here). Speaking of quotes, I’ve cited the late, lamented Senator Everett Disksen before, but it applies here too: “A billion here, a billion there, and pretty soon you’re talking about real money.” This program is another example of the talk about sequestration and budget deficits having little effect on actual federal grant funding: the grant spigot is on at ObamaCare and it’s a gusher.

Every type of applicant is eligible: nonprofits, IHEs (Institutions of Higher Education, otherwise known as “colleges or university” but in bureaucrat-speak), Indian tribes, businesses and your Aunt Martha, as individuals are eligible applicants. Think of it as another Oklahoma Land Rush of grant opportunities.

As faithful readers know, I’ve been writing grant proposals since dinosaurs walked the earth and I can’t remember another grant program that has had so much money available, so little direction, and so broad an eligible applicant pool.

If your organization or your Aunt Martha have any bright ideas on improving Medicare, Medicaid and/or CHIP service delivery and costs, you should not let this opportunity pass. The deadline is August 15, so, for a change, there’s plenty of time to plan the project concept and write the proposal. A word of caution, however: a mandatory letter of intent to apply must be submitted by June 28. LOIs are easy to draft, so you should work most di di mau on the letter to reserve your place at this incredibly tasty grant trough.

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Another New Federal Grant Program Emerges: PPHF – 2013 – Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Exchanges

Despite sequestration and budget worries, the Feds are churning out a new grant program every month or so; today, let’s consider this tasty if poorly named treat from the Centers for Medicare and Medicaid Service: “PPHF – 2013 – Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Exchanges.” The trade name for this FOA is “Health Navigators,” and it is the first of what should be a tsunami of federal and state FOAs designed to help clueless Americans understand how to access the cornucopia of subsidies and benefits glittering like tiny jewels in the 25,000 pages (so far) of the byzantine Affordable Health Care Act (“ObamaCare”) regulations.

ObamaCare is roaring at us from the distance and is supposed to arrive at the station on January 1, 2014. Without getting too far inside baseball, the subsidies and Medicaid expansion at the heart of ObamaCare are supposed to provide health insurance for millions of uninsured Americans. These programs are structured as a series of state-run Health Insurance Exchanges. Somewhere along the way, however, only 16 states actually opted to set up their own exchanges, with the balance deciding to join the Federally-facilitated and State Partnership Exchanges.

The new Health Navigators program has $54,000,000 up for grabs for nonprofits in the 34 states without Exchanges. If you’re in a state with a proto-Exchange, like California or New York, don’t worry—they’ll issue their Health Navigator FOAs.

In the federal program, however, here’s a section that should warm the cockles of the stone-like heart of even the most jaded nonprofit Executive or, in my case, grizzled grant writer:

Section 1311(i) of the Affordable Care Act requires each Exchange to develop and implement Navigator grant programs. This funding opportunity announcement (FOA) is open to . . . serve consumers in States with an FFE or State Partnership Exchange. As health reform implementation continues, consumers will need to understand new programs, take advantage of consumer protections, and navigate the health insurance system to find the most affordable coverage that meets their needs. Exchange Navigators are intended to assist consumers in those areas.

Health Navigator grantees will be responsible for ObamaCare outreach and education to uninformed populations—which is just about anybody in America, since nobody understands it. Maybe a few health policy wonks do.

If there is any nonprofit Executive Director reading this post who doesn’t think their agency could run a Health Navigator program, call me, because you’ve missed one essential aspect of human service providers: virtually all nonprofits do some kind of outreach and education. This makes the Health Navigator program an exceptionally great opportunity, and perhaps the best in recent memory, for getting “walkin’ around money“—a grant concept we’ve written about before.

Although the Health Navigator FOA clearly presents a very attractive grant opportunity on the street, with its promise of walking around money for vaguely defined and impossible-to-measure activities (just the kind we love to write proposals about and our clients love to operate), the real reason to apply now is to be on the ground floor of this emerging class of grants. As I noted in my recent blog about another new grant program, Face Forward, it is always a good idea to apply for the first funding round of any new grant program.

In the case of the Health Navigators FOA, this general principle is even more important because ObamaCare has created an entirely new class of service delivery organizations—”Health Navigators”—which is presumably going to provide never-ending grant competitions.

This reminds me of about 20 years ago, when the HIV/AIDS crisis was in the full bloom of its first major publicity salvo and a mounting public outcry. The Feds responded with Ryan White Act grants. The agencies that originally received Ryan White and similar HIV/AIDS grants formed what we termed an “AIDS Mafia” that slurped up all the available HIV/AIDS grant funds.

If your agency was not in the local AIDS Mafia, your chances of getting grants was very low. The same thing happened about 18 years ago with HUD McKinney Act Homeless Assistance Grants (and we’ve written about the knock-on effects in “HUD’s Confusing Continuum of Care (CoC) Program Explained“). As with Ryan White, it soon became obvious that if you weren’t part of the Homeless Mafia, your agency would not be likely to get HUD homeless grants.

I think the same will be true for Health Navigator grants: if you want to get your organization’s snout into the ObamaCare trough, make sure you apply for this first Health Navigator funding round. When you get funded, your agency will instantly become an expert! In grant writing, I sometimes refer to programs like this as grant herpes: it’s the gift that keeps on giving.

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The Affordable Care Act (“Obamacare”) Is Legal — For Now — And Its Implications for Grants

Subscribers to the Seliger Funding Report (our e-mail newsletter) have seen the numerous RFPs related to the Affordable Care Act, and loyal blog readers have probably noticed our numerous posts on the issue. Unless you’ve been living in a media-free environment for the last couple of days, you’re also aware that the Supreme Court found the Act to be Constitutional. If it had not, the fate of the numerous discretionary grant programs authorized by the Act would be as uncertain as the fate of the peripheral characters in a horror movie.

But that’s not the end of the story.

It’s plausible that Mitt Romney will win in November, and it’s probable that Republicans will take the Senate, with the House a possibility; if that happens, it’s also plausible that Obamacare will be repealed, replaced, or significantly modified. Such changes would likely impact the dozens of discretionary, competitive grant programs that are larded throughout the Affordable Care Act. Even if these new grant programs are left more or less intact, many could face rescission anyway. Rescissions are rare, but certainly not impossible, and the Affordable Care Act will present a juicy target rescission-minded members of Congress.

Still, it will be more tempting to ax future spending without taking already allocated money away, and Federal grant making agencies know this. So we should see a gaggle of Affordable Care Act RFPs issued between now and November, as Federal agencies work to make sure they have as many grantees on the ground as possible, who will squawk if their grants are rescinded. Last week’s Funding Report included the Personal Responsibility Education Program; this week, DHHS released the Establishment of the Affordable Care Act’s Health Insurance Exchanges program (for which only states are eligible)—and next week we might see even more.