“The idea of the wellness trust is to create a pool of money that can effectively address the social determinants that are making our families sick and the vast disparities in health and access based on which ZIP code you live in,” Jim Mangia, CEO of a network of 10 community clinics in south Los Angeles, told journalist Rob Waters.
I’d never heard of a “wellness trust” until I stumbled upon Mangia’s engaging Q&A with Waters, who blogs about health and science over at Forbes. Mangia is part of a coalition of labor and community groups trying to establish a wellness trust with funding obtained via a state law that mandates that a certain percentage of profit made by hospitals be spent on community benefits. Here’s Mangia:
“If you look at where the money is in healthcare, it’s with hospitals, health plans and insurance companies. So if you’re going to reorder the priorities of a healthcare system in a particular area, you have to use the resources of the system’s wealthiest elements. The issue is: Are these community benefit dollars actually being used for community benefits? I think some are and some aren’t. We’ve done research and know that cities and counties have some power to decide how those community benefits are spent. It’s through that process we think we can create this trust.”
It’s like a scaled-down version of the national health reform idea championed by the Center for American Progress and the Brookings Institution several years ago, which called for establishing a whole new federal agency to take over the job of delivering preventive health services to all Americans without regard to insurance status. To pay for it, the proposal called for consolidating what Medicare, Medicaid and public health already spend on prevention, with further funding from new taxes on booze and sugary soft drinks.
We all know how receptive Congress is to creating new taxes and bulking up the federal bureaucracy. So it’s perhaps no surprise that we have no federal Wellness Trust. But as Mangia point out, health and wellness trusts are attracting serious attention at the state and local level.
The Prevention and Wellness Trust Fund of Massachusetts is the most ambitious effort I’ve come across. The Boston Globe reported that the Trust will have $60 million to spend over four years on grants to communities, health care providers, regional-planning agencies, and health plans providing preventive health services. The money comes from a tax on insurers and an assessment on some larger hospitals, who aren’t too happy about it.
“While we support the concept of a public trust fund, we have long felt that this is something that should have been funded by the state, not through an assessment on insurers and employers,” a health insurance trade group spokesman told The Globe.
The Massachusetts Hospital Association said it is “opposed to the imposition of surcharge assessments on hospitals and will continue to advocate that the additional cost of implementing the bill not be placed upon providers who are already underpaid by government payors and working diligently to lower costs.”
Others see a lot of potential in the Massachusetts model. “The implications go far beyond reduced costs,” say the authors of a scholarly white paper on the Massachusetts program. “The Trust provides a framework for marshaling a state’s multitude of resources — hospitals, doctors, community health-care centers, universities, local schools, and food assistance organizations — to improve the long-term health of the entire population. As the potential of the Trust begins to be realized, a closer look at the key policy makers and officials making it work can suggest a plan for the rest of the country.”
It’s clear that money will be a battleground in these efforts. Advocates in Massachusetts originally wanted a steady stream of ongoing funding for primary, community-based prevention activities. What they got instead was a one-time assessment to fund an experiment that puts a lot of emphasis on demonstrating a return on investment.
Will four years give prevention projects enough time to achieve savings? Will the Los Angeles coalition succeed in getting a trust off the ground? Will other states launch efforts as ambitious as the one in Massachusetts? I think it’ll be worth keeping an eye on the evolution of the wellness trust idea this year.