During the initial strategic planning process for specific programs, RWJF staff conduct a survey of existing programs and players in the area, including government and other foundations. During this process, RWJF also commonly learns of innovations by specific programs, other foundations, and federal agencies. Staff then evaluate whether program goals may benefit from the involvement of other stakeholders. At the most basic level, there must be common ground on the approach, priorities, and goals to justify interaction.
The approach RWJF takes depends on a staff evaluation of the costs and benefits of interaction. Staff weigh the merits of a variety of possibilities. Strategies range from funding advocacy efforts to affect federal policy, to supporting communication to improve programming and avoid duplication, or even developing deliberate, complementary programs to enable each organization to focus on their comparative advantage.
The benefits to interaction can be substantial: knowledge sharing, minimized duplication, and even leveraging of additional funding. While deeper interaction can amplify these benefits, RWJF often decides that less formal or no involvement is the most efficient path. Previous RWJF efforts have revealed that initial enthusiasm over obvious benefits of interaction can obscure the high costs of deeper relationships. One respondent stated: The more formal the nature of the relationship, the harder it is, the longer it takes, and the more complicated it is. There is a continuum of how formal relationships are, and building relationships requires very careful development and understanding of rules and roles, either through memoranda or contracts, which is challenging. For us, it is not worth the time to develop formal relationships unless it is long-term and involves significant resources. Transaction costs are huge.
Given the costs of interaction, previous successful relationships have sought to simplify processes and address administrative hurdles. For example, RWJF sometimes responds to extensive federal financing rules and regulations by funding a specific project component, like a demonstration program or conference, with other funders sponsoring other components. Over time, RWJFs experience with federal agencies has allowed it to develop patterns or recognized routines of interacting, leading to less costly interactions. Even when both sectors have a common logistical framework, RWJF considers the marginal costs of further interaction for each project, since collaboration can lengthen the planning process and constrain project and institutional innovation.
In addition to considering the logistical difficulties with any interaction, RWJF takes care to avoid impairing what staff members believe are the Foundations own structural advantages compared to government. RWJF has the freedom to fund innovative and risky projects that are insulated from political pressures that might make it difficult or impossible for a government agency to conduct certain kinds of policy research, such as an examination of sexual practices or tobacco policy. In addition, foundations often have more flexibility with their resources than the federal government, although this may be changing as RWJF makes more multi-year, mission-focused grants.
Given their overlapping programmatic interests, RWJF has interacted with the U.S. government in a number of ways. Some recent initiatives include:
- The Cash & Counseling Demonstration and Evaluation: a collaboration with U.S. government that began as a partnership with ASPE to improve long-term care services for frail elders and individuals with disabilities. The collaboration, which arose from shared policy motivation for the initiative, had a well-defined and relatively narrow focus on the problem, and benefited from the influence of internal program advocates within ASPE and RWJF. Both the Foundation and ASPE committed to the demonstration approach, which facilitated collaboration. Jointly they created a national program office to manage the decision-making process, facilitate communication among partners, and provide technical assistance to grantees. The team developed coordinating and monitoring mechanisms involving regular management team conference calls and the use of inter-agency transfers to enable other government funders to participate. The Centers for Medicare and Medicaid Services (CMS), while not a formal partner, was also involved, approving state Medicaid waivers and later eliminating the requirement that states needed a waiver to offer the Cash & Counseling option (Knickman and Stone 2007).
The initial Cash & Counseling Demonstration and Evaluation (1995-2005) has been followed by two additional phases: (1) the Cash & Counseling Replication Initiative, which also involved funding from the Retirement Research Fund and the DHHS Administration on Aging (AoA), which began in 2003 and ended in 2008, and (2) the National Resource Center for Participant-Directed Services (started in 2008) which is currently being funded by a consortium of sponsors that include RWJF, Atlantic Philanthropies, AoA, CMS, and the Department of Veterans Affairs.
- The Nurse Funders Collaborative: a complementary interaction with the federal government convened by RWJF to identify ways of addressing the nursing shortage and related health care issues. The Collaborative meets quarterly and includes 10 federal government entities and 90 foundations and corporations. Participating government entities, all within DHHS, are the Health Resources and Services Administration, the National Institutes of Health, the Agency for Healthcare Research and Quality, the Administration for Children and Families, AoA, the CDC, CMS, the Office of the Secretary, SAMHSA, and the Indian Health Service (Davis and Napier 2008). One goal of the Collaborative is to better coordinate initiatives designed and operated by participating entities.
- The National Priorities Partnership: a group of 28 national organizations from the public and private sectors, convened in 2008 by the National Quality Forum to improve health care. The partnership is supported by RWJF and facilitates supplementary interaction with the federal government. It includes diverse stakeholders with influence over major portions of health care delivery such as health care and quality improvement organizations, various DHHS agencies (Agency for Healthcare Research and Quality, CMS), and associations that represent consumers, health professionals, health plans, community health centers, and other related businesses. The partners have agreed to a core set of priorities and goals and to take action to achieve safer, more affordable, and effective care, yet each operate independently, seeking to avoid redundancy.