essay Creating Age-Friendly Health Systems
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The Role of the John A. Hartford Foundation and Lessons for Issue-Based Movements
Faith Mitchell, Terry Fulmer, Kedar Mate
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Many philanthropic foundations aspire to “move the needle” on an issue of central importance to their mission or purpose. Yet despite this aspiration, and often despite consistent and substantial investment, many struggle to do so. One notable exception has been the John A. Hartford Foundation (JAHF), which, through the Age-Friendly Health Systems (AFHS) initiative, has transformed the lives of millions of older adults throughout the US by establishing standards for better care in health systems.

The goal of AFHS is to improve outcomes for older adults in a variety of health care settings by building upon previously identified successful practice models. The initiative is designed to use large-scale approaches to help health systems change how health care is delivered, operationalize the essential elements of good care, and better integrate community-based supports and services within the health system and across the continuum of care. Since 2017, AFHS has been housed at the Institute for Healthcare Improvement, working in partnership with JAHF, the American Hospital Association, and the Catholic Health Association of the United States.

Today, AFHS has gained the attention of federal policymakers. In August 2024, the Age-Friendly Hospital measure, which will ensure improved standards of care for millions of older Americans, was approved for 2025 by the Centers for Medicare & Medicaid Services, the largest payment provider for older adults in the US. Achieving a major policy change akin to this proposed measure has informed every step of the AFHS initiative and given leaders and participants alike a tangible, collective goal to reach for.

This case study identifies the following seven factors that have contributed to the success of AFHS as an issue-based movement:

  1. Long-term commitment: a commitment to the issue clearly demonstrated by consistent funding over multiple years, if not decades (i.e., keeping your eyes on the prize).
  2. Leadership: executive-level engagement by the primary partners and formal connections made with other leaders with experience and expertise in the issue area.
  3. A “sticky” evidence base: ensuring that changes that have been tested and implemented are based on evidence that is scientifically valid, and that those changes can be “packaged” in a way that anyone can understand.
  4. Recognition: publicly visible validation by a trusted authority that lends to a sense of belonging to something larger than just the efforts of one person or organization.
  5. Networks and scaling up: creating formal links between organizations that use and generate collective knowledge about the problem they are trying to solve.
  6. Focus on policy: clear understanding that the “prize” one’s eyes should be kept on is specific policy changes that embed changes into standard and routine practice.
  7. Relationships: cultivating the strong and trusting relationships between funders and implementation partners that are imperative for successful movements.
Research and Evidence Health Policy Research to Action Tax and Income Supports
Expertise Nonprofits and Philanthropy Health Care Coverage, Access, and Affordability Medicare and Medicaid Aging and Retirement
Tags Foundations and philanthropy Health care systems and managed care plans Health care laws and regulations Health outcomes Medicare
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