McNeil-Miller to head Colorado Health Foundation

By Todd Cohen

WINSTON-SALEM, N.C. — Karen McNeil-Miller, president of the Kate B. Reynolds Charitable Trust in Winston-Salem, has been named president and CEO of the Colorado Health Foundation in Denver, effective September 1.

Allen Smart, vice president of programs at the Reynolds Trust, will serve as interim president, starting September 1, while Wells Fargo, the Trust’s sole trustee, leads the search for a new president.

With $585 million in assets, the Reynolds Trust is one of North Carolina’s largest foundations.

Formed in 1947 through the will of Kate B. Reynolds, the widow of a chairman of R.J. Reynolds Tobacco Co., the foundation focuses one-fourth of its assets on the poor and needy in Forsyth County, and three-fourths on health programs and services throughout North Carolina.

Its poor-and-needy grants total roughly $6 million a year, and its health grants total roughly $20 million a year.

The Colorado Health Foundation, with $2.3 billion in assets, awarded over $112 million in grants and contributions in 2014 to improve health and health care in Colorado.

Former teacher

McNeil-Miller joined the Reynolds Trust as president in January 2005 after working for 16 years at the Center for Creative Leadership in Greensboro, where she served as vice president for corporate resources and, for six years in the 1990s, headed its office in Colorado Springs.

She was raised in Spindale in Rutherford County, the daughter of a carpenter and a weaver in local mills. A former special education teacher and head of The Piedmont School, an independent school in High Point for children with learning differences, McNeill-Miller is the first non-banker, woman and African American to have headed the Reynolds Trust.

Making an impact

During her tenure, she says, the Trust has shifted from “a charity model and investing in activities to a change model and investing in impact.”

While it previously might have funded efforts to increase the number of people enrolled in programs to train them to manage their diabetes, or to treat people who already had a disease, for example, its investments now focus on how many people enrolled in diabetes-management programs actually lower their blood-sugar rating, or on preventing disease rather than treating it.

A key focus of its health investments is “helping people understand how to eat better, the value of exercise, movement, diet, the built environment, walking trails, as opposed to making sure people can get to dialysis treatment or could get their medicine after they already have chronic illness,” she says.

Systemic change

The Trust, which has 14 staff members, nearly double the total when McNeill-Miller joined the foundation, also has undertaken two big initiatives to give people with little or no income greater opportunities, respectively, to improve their health and their learning.

Both efforts aim to produce systemic change through community-based strategies that are designed for individual communities and count on state and national partners and “best practices” from multiple disciplines and sectors, in addition to local partners and those in health and education.

The Trust’s Health Care Division is investing $100 million to $150 million, or roughly $10 million a year, to improve health in 10 to 15 of the state’s most economically-distressed and health-distressed counties.

And its Poor and Needy Division is investing $30 million to $45 million, or roughly $3 million a year, to make sure every child in a family with financial need is ready for kindergarten and school, and meets every developmental milestone by the end of kindergarten.

That spending, which will grow over time as the Trust’s assets grow through income on investments, McNeil-Miller says, represents roughly half the funds each of the two divisions makes in grants each year.

The big challenges for the Trust, she says, will be “to sustain those efforts, learn as we go, and make appropriate mid-course corrections, and really be able to evaluate our results and tell that story, not only for our own organization, but also for the benefit of communities, legislators and other funders.”

Community focus

During McNeil-Miller’s tenure, the Trust also:

* Expanded Federally Qualified Health Clinics throughout the state to ensure financially disadvantaged residents, especially in rural areas, had access to quality health care.

* Enlisted local funders after computer problems blocked access to food assistance for hundreds of local families, an effort that led to a new coalition of local food funders to look at more effective ways to provide food to families in need.

* Established an effort during the economic downturn to provide basic operating funds to community organizations with small budgets in Forsyth County.

* Invested in major capital improvements in Forsyth County at Family Services, Samaritan Industries and Winston-Salem State University, and across the state at rural playgrounds, schools and community centers.

‘Vision and leadership’

“Karen’s outstanding vision and leadership are shaping how, why and where the Trust  invests for years to come,” Sandra Shell, senior vice president and chief operating officer for philanthropic services at Wells Fargo, says in a statement.

“Karen joined the Trust at a time that its work needed focus and creative thinking, and Karen delivered,” Shell says. “Thanks to her leadership, the Trust is making smarter, more thoughtful investments in communities with an eye on long-term impact.”

N.C. diabetes ‘epidemic’ costs billions, Harvard finds; broad-based solutions urged

By Todd Cohen

RALEIGH, N.C. — Diabetes rates in North Carolina have nearly doubled in 20 years, reflecting a rapidly growing “epidemic” that costs billions of dollars in medical spending and a less efficient workforce, a new report from Harvard University says.

Diabetes is now the seventh-leading cause of death in the state, where the disease is far more prevalent than in the U.S. overall, the report says. And among African Americans and American Indians in the state, it is the fourth-leading and third-leading cause of death, respectively.

Economic impact

“This growing threat to the health of North Carolinians is also a threat to the state’s economy,” the report says.

At its current pace, it says, diabetes is on track to cost the state’s public and private sectors over $17 billion a year in medical expenses and lost productivity by 2025.

“With such high stakes, the state must take significant steps to address the disease from every angle,” the report says, including collaborative, coordinated efforts to attack known risk factors for diabetes for the population overall, and to improve the quality of care and access to it for all individuals living with the disease.

The report calls for “multipronged changes to the state’s healthcare, nutrition and physical activity landscapes,” including better access to healthy food and education programs; better access to medical and lifestyle interventions; improvements in the built environment; and new legislation and diabetes-related task forces.

1 in 10 Americans

In the U.S., diabetes affects nearly 26 million children and adults, or 1 in 10 Americans, and is the main cause of death for over 71,000 Americans a year, according to the American Diabetes Association. By 2050, if current trends continue, as many as one in three Americans will have diabetes, which now generates $245 billion a year in costs.

Type 2 diabetes, which accounts for nine in 10 diabetes cases, is a disorder of the body’s metabolic system that is characterized by high blood sugar, with obesity believed to be the main cause of the disease in people genetically predisposed to it. People who develop type 2 diabetes can lose up to 15 years of life, the report says.

Broad-based change

Funded through a grant from the Bristol-Myers Squibb Foundation and released last night in Raleigh, the report from the Center for Health Law and Policy Innovation at Harvard Law School is the result of research and over 90 interviews with policymakers, government agencies and nonprofits involved in North Carolina’s response to diabetes.

The report, “2014 New Carolina State Report: Providing Access to Healthy Solutions (PATHS) – The Diabetes Epidemic in North Carolina: Policies for Moving Forward” calls for a broad range of approaches to tackle diabetes. Among those recommendations:

* Promote “team-based, whole-person models” to deliver and finance diabetes care.

* Increase access to diabetes prevention and self-management programs.

* Expand telemedicine programs and access to durable medical equipment and insulin.

* Improve behavioral health services for people with diabetes.

* Increase economic and geographic access to healthy food.

* Increase opportunities for physical activities, and nutrition and cooking education.

* Expand programs for early childhood, school food, nutrition and wellness.

Focus on prevention

Allen Smart, vice president for programs at the Kate B. Reynolds Charitable Trust in Winston-Salem, says investment in efforts to reduce diabetes has focused on treatment of the disease, and on prevention of its complications, not on prevention of the disease itself.

The big challenge in fighting the disease, he says, will be to find ways to “engage communities, not just people in the health world, around some of the fundamental causes of diabetes that are really fueling this escalation.”

The Reynolds Trust, the state’s biggest private funder of diabetes programs, has invested roughly $10 million over the past five or six years to address the disease.

Just this week, the Reynolds Trust announced it is giving nearly $200,000 to the YMCA of  Western North Carolina to expand a diabetes program for McDowell County that has served 196 adults, helping them reduce their weight by 10.9 percent, on average.

Still, Smart says, “if I had $10 million to invest today in effective diabetes prevention programs in North Carolina, I wouldn’t have a place to put that money. There’s not enough evidence-based prevention work that’s been accepted that we feel confident works.”

Brad Wilson, president and CEO of Blue Cross and Blue Shield of North Carolina, the biggest health insurer in the state, says diabetes “is taking an increasingly heavy toll in our state on patients and families, citizens and taxpayers, and hospitals and other healthcare providers, and this has a direct impact on both the health of our customers and the cost of health insurance.”

The good news, he says, is that “common-sense, collaborative strategies can significantly reduce the impact of diabetes on the health and pocketbooks of North Carolinians, and on the costs to organizations that serve them.”

[Note: This article is a joint project of Philanthropy North Carolina and, with financial support from Blue Cross Blue Shield North Carolina.]

Reynolds Trust counts on partners to boost health, learning

By Todd Cohen

WINSTON-SALEM, N.C. — The Kate B. Reynolds Charitable Trust in Winston-Salem has joined a small but growing number of foundations that are turning to partners from a broad range of disciplines and sectors to give people with little or no income greater opportunities to improve their health and learning.

Nearly two years ago, the Reynolds Trust launched a $100 million, 10-year effort to improve health in 10 to 15 rural North Carolina counties, including some of the poorest in the state.

Known as “Healthy Places NC,” the effort is rooted in the idea that state and national partners and “best practices,” as well as local partners in addition to those in the health field, are critical to creating community-based strategies that are geared to individual communities and more likely to succeed.

“It requires a constellation of partners and evaluation, in state and out of state, to transform community health,” says Allen Smart, director of the Trust’s Health Care Division.

In January, Smart was given the additional job of vice president of programs, overseeing both the Health Care Division, which has a statewide focus, and the Trust’s Poor and Needy Division, which focuses on Forsyth County.

The Health Care Division is responsible for 75 percent of the Trust’s $22 million in annual grantmaking, and the Poor and Needy Division, directed by Joe Crocker, is responsible for the remaining 25 percent.

With $550 million in assets, the Trust is one of the largest philanthropies in the state.

The organizational restructuring is designed to take the strategic approach and lessons from Healthy Places NC and integrate them into the work of the Poor and Needy Division, particularly a new initiative that will focus on preparing children from birth to   age five to enter kindergarten.

Known as “Great Expectations,” the effort aims to enlist partners not just in the field of education but also from throughout the community, including parents, community leaders and those in fields such as health care, social services and child care.

What is needed, Smart says, is “everything that makes a more supportive environment that allows kids to be thriving by the time they go to kindergarten.”

The level of funding both for Healthy Places NC and for Great Expectations will grow for each of the first five years, and then will level off at 50 percent of the annual grantmaking, respectively, for the Health Care and Poor and Needy divisions.

To help integrate into the Poor and Needy Division the strategy of “multi-sectoral stakeholders” that the Health Care Division has developed, the Trust now is looking for a program coordinator to handle a range of key administrative functions for both divisions.

To fill the new position, which replaces a two-year post-graduate fellowship, the Trust is looking for someone with at least 10 years experience.

Critical issues such as health and learning represent complex challenges and require integrated solutions and a broad range of perspectives, Smart says.

For Healthy Places NC, for example, “state and national partners are bringing best-practice work to these communities that either weren’t aware of them or couldn’t afford them,” he says.

The initiative also is “bringing new people into the mix in these partnerships,” he says.

“In health care, we’ve really determined that to improve the health status of a community, institutional stakeholders have to be involved who are not in health care,” he says.

“To improve health care, you can’t just talk about doctors and nurses and the health department and the hospital,” he says. “You also have to talk to the school board and the planning commission, who have a hand in the health of the county.”

Partners from multiple sectors also are important because “your issue is not just owned by the people who work at it every day,” he says. “We’re trying to create community ownership over the larger program.”

Just as many adults are not as healthy as they should be, many children, particularly those who are financially disadvantaged, are not as prepared as they should be to enter kindergarten, Smart says.

The solution is “not just engaging child care, but all sorts of people, such as the housing authority, for example, or the communities those kids are in,” he says. “Multi-sector thinking will definitely be embedded in the Poor and Needy Division as it is in our health care work.”

Hospital mergers spawning new philanthropy

By Todd Cohen

HIGH POINT, N.C. — The Triad is poised to get over $100 million in new philanthropic assets, thanks to the pending combination of hospitals in High Point and Alamance County, respectively, with health care systems in Chapel Hill and Greensboro.

As part of its strategic alliance with High Point Regional Health System, UNC Health Care will provide $50 million to establish a new community health fund in High Point.

And as part of its partnership with Alamance Regional Medical Center in Burlington, Cone Health in Greensboro will provide $54 million to establish a new community foundation in Alamance County.

“It’s huge for Alamance County,” says Tracey Grayzer, director of marketing, community relations and development for Alamance Regional Medical Center.

While details of the two mergers still are being worked out and both deals are subject to regulatory approval, the new philanthropies they will create are expected to focus on the broad area of health and on some or all of the geographic regions the High Point and Alamance health systems serve.

Both new philanthropies will be grantmaking entities only and will operate separately from and in addition to both systems’ current foundations, which will continue to raise money to support their local hospitals and patients.

The existing High Point Regional Health System Foundation, for example, will continue to raise funds solely for capital, technology and patient care service needs at High Point Regional Hospital, says Denise M. Potter, vice president of the foundation, public relations and marketing for the system.

That foundation raises $1.5 million to $2 million a year in new income, plus $1.5 million in annual pledge payments, she says.

The existing fundraising foundation at Alamance Regional Medical Center will receive $1 million from Cone Health in addition to the $54 million Cone Health is giving to create the new foundation.

The existing foundation operates just over two-dozen patient funds, spending over $300,000 a year for support for patients, such as for prostheses, wigs for cancer patients, fuel expenses so patients can get to appointments, and rent for cancer patients whose treatment may consume all their income, says Grayzer.

The two new foundations will be the latest in a trend that began in 1973, when the first “health legacy” foundation was formed. Since then, nearly 200 similar foundations have been created throughout the U.S., most of them during the 1980s and 90s, and their ranks keep growing as an increasing number of hospitals and health organizations merge or shift to for-profit status, according to the Foundation Center.

Allen Smart, director of the health care division at the Kate B. Reynolds Charitable Trust in Winston-Salem, says the financial impact of the two new foundations would be significant, increasing the flow of philanthropic funds by roughly $2.5 million a year in each of their communities.

Key decisions still must be made for both new foundations about their geographic reach, funding focus and board makeup, decisions that Smart says will help determine their impact.

Some health legacy foundations, for example, focus on a narrow service area, such as the county in which a merged hospital is located, while others focus on a multi-county region the hospital serves.

And while many health legacy foundations focus on health, others address a broad range of issues such as education, economic development and the arts.

The new foundations also could name to their boards individuals who now serve on the boards of the existing hospital foundations, or they could opt to recruit new board members, a decision that Smart says could influence the initial selection of grantees.

“If the people are primarily associated with the hospitals, that says how open they might be to new thinking or new ideas,” he says.

Whatever the details of their focus and makeup, Smart says, the two new foundations will have a big impact in a state in which he estimates health-related giving from North Carolina foundations, other than hospital-related foundations that raise money for their own hospitals, totals about $100 million a year.

He also expects the merger trend to continue in the state and create more health legacy foundations.

The big wave of health legacy foundations were created from the mid-1980s through about 2000, a period when nonprofit hospitals were purchased by big for-profit chains or merged with other systems.

North Carolina has seen only a few of those health legacy foundations, including The John Rex Endowment in Raleigh and the Cape Fear Memorial Foundation in Wilmington, as well as Triangle North Healthcare Foundation, which was created through the merger of Maria Parham Medical Center in Henderson with Duke LifePoint Healthcare.

Most remaining stand-alone hospitals in North Carolina are nonprofits or publicly owned, Smart says.

“As more get sold to for-profits or other systems, there would be more of this new philanthropy in the state,” he says. “There has been little of this activity in North Carolina. I forecast more.”

Reynolds Trust boosts rural health clinics

WINSTON-SALEM, N.C. — Triad Adult and Pediatric Medicine in Guilford County is getting $51,275 to renovate a home for reuse as a satellite location in Rockingham County for a home community health  center.

And the Free Clinic of Rockingham County is getting $19,450 to renovate new office areas and an educational room, and to buy furnishings, computers and printers.

The two rural health clinics are among nine in some of the state’s poorest counties that are getting much-needed equipment and improvements to their facilities, thanks to a $1 million grant the Kate B. Reynolds Charitable Trust in Winston-Salem awarded last year to the Raleigh-based N.C. Rural Center.

The funding, which will be used for new treatment rooms, a new x-ray machine, an insulin cooler, a wheelchair-accessible van and other improvements, is being provided as part of a larger initiative known as Rural Hope that aims to stimulate economic activity and job growth in the health-care sector while improving the availability and quality of health-care services in rural communities.

Rural Hope, which has received about $5 million is a collaborative effort that includes the Reynolds Trust and Rural Center, as well as the Appalachian Regional Commission, N.C. Office of Rural Health and Community Care, and the Golden Leaf Foundation.

Allen Smart, director of the health-care division at the Reynolds Trust, says that while it can be tough to differentiate funding requests from different health-care agencies, the collaboration has provided an effective way to “get some collective thinking about the capital needs of health-care providers in rural communities.”

That is becoming increasingly important, he says, because rural health-care providers are trying to “ramp up” with more space, more equipment or simply different space in anticipation of changes in the health-care system scheduled to take effect in 2014 that are expected to generate more demand for service because more people will be eligible for Medicaid and thus for services they have not sought in the past.

The Rural Hope effort also has found that many rural-health providers often are housed in physical space that simply needs to be renovated or replaced, Smart says, needs that must be addressed to meet rising demand for services from people who are not insured.