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Demonstrating the Value of Health Care Coalitions for Meeting Preparedness Requirements

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
March 2, 2018

As the U.S. Congress considers the reauthorization of the Pandemic and All-Hazards Preparedness Act, U.S. hospitals work to manage a shortage of medical supplies brought on by the inadequate response to hurricane damage in Puerto Rico, and the U.S. combats a particularly virulent flu season, the need for stronger health emergency preparedness infrastructure seems clearer than ever. The federal government has enacted policies to promote such infrastructure, including a regulation from the Center for Medicare and Medicaid Services which requires health care facilities to meet multiple preparedness requirements. Karl Schmitt is the former Chief of Disaster Planning and Readiness at the Illinois Department of Public Health and current health care coalition development consultant who maintains that creating independent, non-profit health care coalitions is key to making America more resilient against such threats. He also argues that health facilities will not be successful in meeting the requirements of the rule without these coalitions.

Part of the U.S. response to the 9/11 terrorist attacks was the creation of the Public Health Emergency Preparedness (PHEP) program and the National Bioterrorism Hospital Preparedness Program (NBHPP). The inadequate response to the natural disaster of Hurricane Katrina led to the development of the original Pandemic and All-Hazards Preparedness Act and the creation of the Office of the Assistant Secretary for Preparedness and Response (ASPR) in the U.S. Department of Health and Human Services. One of ASPR’s first acts was to restructure the NBHPP into the Hospital Preparedness Program.

Since 2012, the HPP cooperative agreement has been designed to encourage the development of independently governed organizations, through a legally established nonprofit or a quasi-nonprofit operating under a fiduciary agency. It is ASPR’s intent that these organizations be neutral, governed outside the influence of organizations in the highly competitive health care space. The most common fiduciaries for coalitions are nonprofit hospitals, local health departments and other nonprofit entities. Schmitt offers a number of reasons for using sub grants to nonprofits rather than running the HPP and coalitions through state offices, including the ability to receive donations and fees for services.

The primary challenge is people being asked to build these organizations are not organizational development experts. With few exceptions, they lack understanding of the importance of proper organizational structure, how to provide governance that is inclusive and legally justified, and the breadth of public affairs. Schmitt offers several recommendations to those working through this process. He argues that the bottom line is creating value by providing information through workshops, demonstrating credibility through tax-exempt status and proper oversight, building brand identity through participation in community activities and offering true inclusiveness in decisionmaking. All, in Schmitt’s view, will be essential for fiscal sustainability.

Schmitt also notes that the CMS rule, which became effective in November 2017, will compel health care facilities to reconsider coalition participation. The CMS rule requires facilities to meet a variety of preparedness standards in order to receive Medicare and Medicaid funding.  “When the CMS emergency preparedness rule came down, there was a new federal regulation that said if you want funding from Medicare and Medicaid, you need to meet this new regulation on preparedness requirements. And it says thirty times in that document that they strongly recommend that providers seek the counsel and assistance of coalitions to reduce their administrative burdens and implementation costs. So November 2017 that became enforceable, and these institutions are scrambling to find their healthcare coalitions, which are, too often, not ready to help them. We are at a critical point for everyone,” Schmitt said.

Schmitt also notes the value of coalitions can become quickly apparent. “What if you put together a multidiscipline board at their first [coalition] meeting and ask would you all put $200 on the table each if the coalition could meet the requirements under the CMS rule to do the regional risk assessment, your regional table top, your regional full-scale exercise?”  Schmitt notes that while facilities may initially balk at such a request, they are likely to reconsider when they realize how much it will cost their facility individually. In Schmitt’s view, facilities’ decisions to participate will come back to the value added.

“They do it because they get valuable service in return,” Schmitt reiterates. “That’s what needs to happen. And then when the grant gets cut again, members are more likely to contribute additional dollars to keep the services. You are getting them to incrementally buy in by proving value, and when you can prove value, people will pay for value.”

The news offers us daily reminders that a major health threat is on-going possibility. The U.S. government has put in place a number of policies to mitigate this risk, although they are consistently underfunded. Now health care institutions are being asked to demonstrate individual responsibility for health preparedness while at the same time forming collective coalitions to meet these challenges as a team. Karl Schmitt argues that both the individual and collective efforts depend upon demonstrating the value of health care coalitions. Government officials and the general public must also be convinced of the value of collective health security to guard against future emergencies.


Author: Nathan Myers is an associate professor of Political Science at Indiana State University. He primarily teaches courses in the Master of Public Administration program. Myers is also a member of the Indiana State University Center for Genomic Advocacy. His teaching and research interests include organizational behavior, public health policy, and biotechnology policy associated with genomic research. He can be reached at [email protected] 

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