For nearly 20 years, The Nicholson Foundation has worked to improve the health and well-being of vulnerable populations in New Jersey. The Foundation recently announced that it would commit its last grants through the middle of 2020 and close its Newark office at the end of 2021. We spoke to Jan Nicholson, President of the Foundation, about the organization’s mission and legacy.

The Nicholson Foundation’s strategic approach has been to transform service delivery systems to better serve vulnerable populations. You’ve looked for partners here in New Jersey. Can you tell us how that model works?

Well, our partners have been instrumental. The way we work is through partners who are serving both vulnerable populations in New Jersey, or who bring expertise or experience here. And we work in collaboration with intermediaries, such as the Quality Institute, the Center for Healthcare Strategies, Rutgers Center for State Health Policy, and the New Jersey Primary Care Association. Government is often our partner because government defines the framework. We have worked with the state departments of Health, Human Services, Children and Families and Education.

It’s often thought, “Why would anybody give a grant to government? Government is the one with money.” But government works on a budget and does not always have the latitude to take money that’s already been budgeted for something and divert it to a new idea…We’ll also look for ideas or expertise to bring to New Jersey from out of state. For example, Project ECHO, which is out of New Mexico. Partners are the key way we work.

You have worked with many grantees and distributed $137 million to support projects and another $13 million in direct technical assistance to grantees. What do you see as the key attribute of successful grantees?

Our most successful grantees have been established organizations. They have leadership, the staff capability, policies, and procedures. We’ve tried working at the grassroots level and found that nascent, albeit promising, organizations just aren’t ready. A second thought is that successful grantees must be good at collaboration. I think it’s a learned skill, if not a talent, to collaborate well. And an underappreciated, but important, attribute of successful grantees is the ability for the staff to write well. Writing is entwined with thinking and we have found that organizations that are able to define plans clearly in writing are the most likely to execute well. You parse it and search for the right words, you hone your thinking, you get much crisper in your mind about what you mean.

An approach that has worked well for us is to identify potential grantees and start out with a planning grant to test the water. This might be $5,000 or $10,000. And if that planning grant goes well, then we move on to a full implementation grant. And we let grantees know that our commitment will be for only two years and this requires that grantees bake in plans for sustainability from the start.

The Nicholson Foundation funded the Quality Institute’s Medicaid 2.0 Blueprint for the Future, which has led to the creation of the Medicaid Policy Center. Can you tell us why you funded this Medicaid policy work?

We move when and where we see opportunity. In the case with Medicaid, we knew that New Jersey’s gubernatorial election in 2017 was going to result in a new administration that would be motivated to move quickly on reforming aspects of the Medicaid system.

Therefore, the Quality Institute and The Nicholson Foundation started planning a year ahead of time to examine the system and propose needed reform. And we gathered a group of policy people, government service providers, a wide array of experts who started meeting to think about this … and the Quality Institute was the leader of this collaborative thought process.

And now comes the Medicaid Policy Center, which we hope will establish a structure to keep the reform process going because things need constant rethinking. As for the fundamental question of why we funded this work, it gets to the heart of our mission for improving the health and wellbeing of vulnerable populations in New Jersey. Medicaid is the principal funding stream for health care for vulnerable populations. We wanted to get going on Medicaid reform in New Jersey and just had to wait for the right moment politically.

The original Medicaid ACO’s are now regional health hubs. What do you hope for the future of these organizations as they move on in a sustainable way?

I am hoping that these hubs will continue to be central players in revitalizing public health at the community level. To digress for a moment, the journey of these organizations from ACO’s to hubs illustrates our approach to grant making, where we try to stay light on our feet and adjust according to what is and isn’t working. The State effectively turned away from ACO’s when they looked to the insurance industry for managed care. Now, we’ve got these effectively organized coalitions of major providers in a market—Camden, Trenton, Newark, and Paterson—that don’t have the ACO mandate, but represent an opportunity. We’re hoping that they’ll take on important localized issues to improve health and wellness.

Do you have some words of advice to people working to improve health and wellness in New Jersey?

First, ride the wave. You can get so much further when there is public interest and political receptivity toward change than you can where there is not. And right now there’s a wave of support, interest, and receptivity in health care.

Then I would say number two, before you jump into action, know exactly what your goals are and how you’re going to achieve them. This means writing a business plan. Defining objectives and benchmarks. That sounds easy. It is not, but it gives you a map for making your journey and then you can do it so much more expeditiously. The third thought I have is, “Steal good ideas.” Find out what’s working elsewhere. And stand on all the shoulders you can find.

And then my last thought is just a comment. And this is something I genuinely feel. The policy people and service people in the health care field are exceptionally smart with knowledge broad and deep. And I have met so many health care people who are completely giving in their desire to help others. I’m in awe of this. And we are in a time when efforts are yielding results. So, I would say to everybody that you’re engaged in truly important work, you’re getting results, and you all deserve to feel exhilarated.