12_How Bethesda, Inc. is Transforming Healthcare, One Grant at a Time with Jill Miller

Hosted by Quint Studer with special guest Jill Miller

This week Quint talks to Jill Miller, president of Bethesda Inc., a Cincinnati, Ohio-based organization devoted to transforming health and healthcare. Their focus is on vulnerable populations, the ones likely to be left behind and disproportionately impacted by events like the COVID-19 pandemic.

In this podcast, you’ll get an insider’s view as to how they effectively utilize grants to leverage assets, promote collaboration, and drive innovation with healthcare partners in various communities. They aren’t looking for quick fixes, but high-impact projects. Jill talks about their decision to invest in multi-year, multi-million-dollar projects, because they know it takes a while to get programs off the ground.

Bethesda doesn’t just focus on healthcare delivery; they have a real interest in the social determinants of health. According to Jill, around 20 percent of your health equation is tied to healthcare delivery. The other 80 percent is tied to pieces like genetics and behaviors. But at least 50 percent is tied to those social determinants of health, where you work, live, play, learn. They know that in order to transform healthcare, they can’t just focus on what goes on inside the hospital walls; they really have to look at issues beyond that and work in partnership with the community.

Jill shares about their latest focus: integrating behavioral health into primary care. Experts say that a behavioral health crisis is on the heels of this pandemic—and they’re doing all they can to prepare for it and alleviate it.

Quint Studer 0:01
Well, it is so exciting for me to have Jill Miller on the Busy Leader’s Podcast. I’ve known Jill for a little bit. Now I was I’m fortunate enough to be on the board of Bethesda Inc. and, you know, when I got on that board, I didn’t know what to expect. It’s because of my involvement with try healthcare. And, but gosh, I’ve been blessed. I’ve learned so many things of what the good work that Bethesda Inc, their foundation does in the Cincinnati, Ohio area, something that I think we can all learn from. So I want to talk about today is a little bit about the foundation and what you do. And so Jill Miller, why don’t you tell us a little bit, you’re the head of the foundation, like, is it called a foundation? Or is it? What is it? Yeah, no.

Jill Miller 0:43
We often get confused as being a foundation because we have a grant making initiative called bi three, which is to transform health and healthcare. So we give large multi year multi million dollar grants, which many foundations do as well. But we are in fact, not a foundation. It’s something that Bethesda Inc has chosen to do to really leverage its assets and fuel innovation both within our strategic health care system TriHealth. As you mentioned, Quint is Bethesda Inc is one of the co sponsors, which means that we are invested in its success and its leadership as a leader in population health, but have also chosen to be a grant maker and health. We will grant so when I look at you don’t have to be part of TriHealth in order to benefit from the dusting, is that true? That is true. So our roots are with Bethesda hospital, and Bethesda hospital is a nonprofit community hospital, and Cincinnati, Ohio. And I like to think of our work is really the legacy of the German deacons who went out in the community and serve those who otherwise would have been left behind the most vulnerable in the community. And so fast forward to today, I really think that bi3 honors their legacy. And not only sparking innovation, but also with an eye to helping those most vulnerable in the community, which has really come into play with COVID-19. And just the way it’s disproportionately affected so many people

Quint Studer 1:18
We know having worked in, in many, many cities across the country, I don’t think what’s the challenges in Cincinnati are unique to Cincinnati. And what I really liked even before covid 19, and we’re going to talk about the pivot you made with COVID-19. Even before COVID-19 you are you’re doing some things and I call it sort of like the either something that’s

determinant that’s really impacting the healthcare in the community in one way, and the other thing you’re doing is seem to be always looking around the corner with innovation and investment, to how to make things a community more sustainable. What’s better, long term because I know here in Pensacola, I’ve had them reach out to you for your work you’re doing to help mothers get better prenatal care, for example. So what are some of the initiatives that if somebody’s listening to this podcast, and they say we in our community could benefit them and not benefit from dollars, but benefit from your intellectual capital? Because you’re always really good at sharing, you’ve won a number of awards in Ohio and so on for what you do. So what are some of the initiatives you feel best about that you get Bethesda Inc has helped over the years.

Jill Miller 3:33
So as you mentioned, Quint, what I’m most proud of is that more babies are alive today because of the work of bi three. And that started back in 2013. And I think one thing we try to keep our eye to is the opportunity to connect different people in the community that otherwise may not collaborate. So during our grant process back in 2013, we had a proposal from Cincinnati Children’s, which is a phenomenal pediatric hospital in Cincinnati. And trial actually has a number of collaborations with them on the healthcare delivery side. We had TriHealth that is one of the hospitals that delivers the most babies. And you had a number of community organizations. And one common theme was everybody’s desire to reduce infant mortality, which was one of the highest in in the country and Cincinnati. And so when we received several proposals from different entities, we pulled everybody together and said okay, clearly this is a community health issue. Everybody has interest in. Let’s work together and figure this out. And so, you know, I look at as an example, we started in the Avondale community, which is a neighborhood that’s primarily African American, and they had an extreme preterm birth, which is the leading cause of infant death every 26 days or We started. Fast forward three years after this effort got underway. There was zero extreme preterm births for several years. And so that really gave us hope that in bringing various partners together, no one could have achieved that result on their own. And collaboration is hard. And I think sometimes that word is thrown around a lot. Oh, yeah, we collaborate or we partner. But true collaboration and true partnership is really hard. Right? There is a lot of challenges and a lot of barriers to it. which speaks to just the importance of strong leaders being a part of an initiative like that.

Quint Studer 5:39
I think what happens to having been involved with this type of not the what type work you’re doing, but just trying to bring various not for profits together, it’s almost like they get worried they’re gonna lose something. Like, I’m gonna lose a position or if we consolidate things, where will I be? or How will this influence my fundraising? I need my own identity. So yeah, I think it’s, it’s easier said than easier said than, than done. Yeah. That’s remarkable. Because here in Escambia County, we have that same issue. And that’s why I was so glad we could talk to our people about that. So what about what are some of the grants that bi until a little bit then? So bi three, is the grant making arm of Bethesda Inc, right?

Jill Miller 6:22
Yes, bi3 is our grant making arm to really fuel innovation and transform health and healthcare. So we have our IT systems change, which is why we give large multi year multi million dollar grants, because we recognize that a lot of planning, implementing learning, it takes a lot of resources and time and effort to get something new, off the ground and underway, right. And what we really try to encourage people both TriHealth and nonprofit agencies we work with is, you know, while we set out to achieve certain outcomes and certain results, don’t let that blind us as we work along the way to other opportunities that might present or learnings that we gained that may change where we thought we were gonna go, you know, three years is a long time. So we’re really, we’re always trying to push on our partners. And I’m really proud that we’ve really adopted this trust based philanthropy approach, which means we don’t just write a check and go away. We’re really a thought partner, we lean into people, you know, challenge them, but help them think about solutions. So it’s fun, it’s fun to be a partner.

Quint Studer 7:36
I think too, you help people that say, invest in some innovation, they couldn’t invest in without bi three, because you know, I know and health care, particularly, you know, margins are pretty tight, reimbursement is changing, that they might just not have the money, even though they have the goal, the mission, they just don’t have the money to, let’s say put things aside. I mean, Jill, even when I was with the Studer group, it was sometimes hard for people to even envision taking their leaders off site for two days for training, how do I get the money? And we would try to say, Well, if you don’t get your skills better with the leaders are always going to have this issue. There was a whole the chicken and the eggs. So I think you’ve been so helpful to health care providers in your area of giving them, like you said, some dollars to innovate a little bit, why don’t you talk about some of your bigger projects, and you’re been involved and then in the world of innovation?

Jill Miller 8:32
Sure. So TriHealth, which is our strategic partner. And you know, we’re in a unique position to be able to fuel innovation in healthcare delivery, because of our strategic partnership with TriHealth. So I’m really proud of what we’ve done to integrate behavioral health into primary care. I think that I agree with the experts who say that a behavioral health crisis is on the heels of this pandemic. And as you know, Quint, and healthcare, behavioral health services is not reimbursed at a very good rate. And so while it’s an important need and health and health care, it’s not a moneymaker for a health care system. And in fact, most of them lose money and in behavioral health, but nonetheless, trials recognize the need and so we’ve, we gave $3 million to trial to really feel integrating behavioral health into primary care that put a behavioral health consultant inside primary care, so that when patient, presents with issues, the primary care physician can provide a warm handoff to the behavioral health consultant who can work with that person. And I will say that physicians have considered that a tremendous resource and try health is in the process of figuring out how can we sustain that even if it’s kind of a blended payment approach?

Quint Studer 9:56
Well, that’s beautiful, you know, so I started on behavioral health and I will say, what you’ve done is just everybody listening, everybody in health care, but say we’ve got to learn more. Because what I find is this, the patient goes to the doctor and the doctor might give them a referral. But then the referral is, how do I get in? Can I pay that gap, and all it takes is a small little gap for the person to who was ready to seek mental health services, to figure out a reason not to. And because I’m sort of every week trying to help somebody in Pensacola getting into the Mental Health Network, and it’s a hard thing to do. So I just think that’s absolutely, absolutely brilliant. On what is the grant process, because you have another thing I like about what you’ve done is you have a pretty solid system of how to do it.

Jill Miller 10:49
So our grant process has developed through the years. And what I like to say is we stay fluid. And, you know, I’m dedicated to continuous improvement. So always looking for opportunities to make it better. But typically, given the size grants, our process is pretty intense. So we start by inviting people to submit an idea, we don’t want them to go through the great lengths of filling out a long proposal, right? Unless we feel there’s merit to the idea, and it aligns with our priorities. So once an organization submits an idea, and we feel like it’s a good one, we’ll invite them to submit an intense online proposal, which as I mentioned earlier, what are the outcomes? What are we trying to achieve? How are we going to sustain it? And so based on those types of criteria, we rate them. So what is the feasibility and the capacity of the leadership to pull off this idea? What is the potential to sustain? Is there talks among payers that this might be reimbursable? What is the ability to measure outcomes and not just outputs, which is different? And then how do we spark systems change. So based on those ratings, we can rate the proposals and then depending on the dollar amount that we’re able to award, we’ll pick the best ones, but I will, again, emphasize the importance of leadership in those projects. And as a leader of continuous improvement, when COVID-19 hit, we recognized, we might need to do things a little bit differently. And so recognizing that, you know, there was a lot of need associated with housing, those social determinants of health, right housing, domestic violence, food, health and health care services that we pivoted. And so instead of inviting, or making people fill out an intense application process, we said, Tell us what you need, you know, what are your needs? What are you facing, and so what we continue to hear is just this need for funding to build the capacity to be able to deliver their services virtually this virtual world we find ourselves in. And so a lot of nonprofits and even the good Sam pre Health Center and the faculty Medical Center, you know, a lot of organizations don’t have the resources to just put in place to be able to, to offer their services virtually, and much less do the people that they’re trying to reach have the resources, they need to be able to access the services. And so we had the idea of let’s commit at least a million dollars, we ended up awarding 1.6 million to 37 different nonprofits, to really provide those resources needed. And we didn’t limit it to the big, the big orgs. Right, that would be the easy way to just cut some big checks to the bigger organizations. But we included grassroots organizations, because we know during this time that those are the organizations that communities really trust and rely upon. And so we gave a number to grassroots organizations and really prioritized people of color, rural communities, and others disproportionately affected by COVID-19.

Quint Studer 14:07
That’s pretty obvious, philosophically, as you move toward what the community needs that you’re, you know, you adjust to the community needs. But I noticed it’s really been a maybe it’s always there. Of course, I’m new to the board a couple years, but you’ve seemed to really grab things like population health, keep people healthy, dealing with those social determinants, as you’ve talked about quite a bit, and inclusion and diversity. And is that something when do you adjust as the community just because you have a real deep seated interest in that being on your board? Tell me tell me what drove the i three to get so engaged in those areas, because even though I know their need their need in every community, but doesn’t mean that they’re getting the attention that you’re giving them?

Jill Miller 14:55
So, because Bethesda Inc has been the CO sponsor of TriHealth for many, many years and has always been in the health care delivery piece. What we’ve really educated the board around is just that 20% of your health equation is tied to health care delivery. The other 80% is tied to a pieces genetics, of course, and behaviors. But at least 50% is tied to those social determinants of health, where you work, live, play, learn. And so if we’re going to transform health, we can’t just focus on what goes on inside the hospital walls, we really have to look at issues beyond and in the community and work in partnership with the community. And I just think as a as a mom myself and raising two girls, take housing, for example, if I didn’t have my home, I don’t know how I make life work. I don’t know how I make sure that they get a good meal before they go to school, or they have clean clothes to wear, or how I get to work, right? I mean, it just just taking that one social determinant of health and the last thing and you take away my home, and how do I get to my appointments and transportation, I mean, it just doesn’t work. So I think to really transform health, you have to, to work on all of those things.

Quint Studer 16:14
And I think I think that the virtual learning, for example, talking to people that are teaching virtual learning, there’s a gap between those kids that have certain types of home life, there’s a gap between people that have certain type of technology. And you can go into one and each child has their own computer and they’re all room, you’ll go into none other one, there might be one computer for the entire family, the internet connection might not be the greatest. I think this achievement gap is going to even be more challenged now because of COVID-19 than it has been has been before. Tell us about COVID-19. Because you’ve stepped up and provided some extremely creative support to even people at TriHealth. Um, tell us a little bit about what you’ve done in that arena.

Jill Miller 17:02
Yeah, so Mark Clement, who is the CEO of TriHealth came to me early on in the pandemic and said, You know, this is going to have devastating effects to our community, but also our healthcare system and some of our workforce. I mean, when you take a $2 billion healthcare system, and an overnight it becomes a $1 billion healthcare system, because you cancel elective surgeries and really have to focus on those with COVID are preparing for patients who are going to need it, that changes things. And so it was really important to him that team members have access to support during this time, whether that’s retraining for different departments if their positions are eliminated, or for those who couldn’t find something in try health but wanted to do something outside providing them with Career Services. So we gave $1 million to TriHealth to stand up the team member Support Center. And and that helped with childcare. I mean, you name it, which has been a tremendous resource. And now even it’s getting into how do you support the workforce, as you talk a lot about Quint is moving from not just stress, but many healthcare workers are experiencing trauma. And so how can the team member Resource Center help people with with those, that the effects of this crisis as well,

Quint Studer 18:21
Well Jill, one of the things that you did with by helping TriHealth is they created sort of a toolkit for their workforce. And what’s really neat about that is I was speaking to a number of colleges, an AUPHA, which serves people, faculty that’s teaching healthcare administration. And I just mentioned this toolkit. And with that mark gave us permission to utilize that tool kit from Trihealth. So there are 69 colleges now utilizing a Trihealth toolkit for their faculty. I’m Caravan Health, who serves lots of small little rural hospitals that just don’t have any access to these types of resources. Mark’s allowed them now to have access to the Trihealth toolkit. So you know, it’s really neat that you’re helping people all over the country, and I know talking to your board, that they really seem to like the fact that when they can do something that can impact people even beyond the Cincinnati area. So thank you for doing that, because it’s really making a huge impact. I know when I saw it, I only saw it because I’m on the board of TriHealth. And I immediately said, Man, this is something that I wish I would have thought of, but I’m an imitator. I’m not an innovator. I’m an imitator. So So I grabbed on and so thank you for doing that. You know, when we talk about your leadership journey and what you’ve learned as we come sort of to the close here, and you’ve seen leaders and so on, you mentioned two things in a pre call that I thought were pretty interesting. You mentioned the power of pause. That’s one of the things that that you’ve learned. It’s sort of interesting. Sunday, I was at something that I was they asked me to speak at, in spirituality. And I sort of mentioned that I can sort of tell how spiritual I am, is how well I’m doing with pause. And the meat pauses the difference between what I think and what I do. And sometimes my pause is so small, it’s hardly noticeable. Sometimes it’s a little bigger. When you mentioned the power pause is something that that’s been a big impact in leadership. What do you talk about when you say that?

Jill Miller 20:29
This three second rule, um, you know, it’s something I’m, I work out every day, but you often find, I think, and I think everybody can relate to this, you’re in a conversation and someone says something, and you really hold on to that point, right? Because you want to comment on that point. And that person might continue for a few more minutes. And you haven’t really heard what they’ve said after that point, because that’s what you’re focused on responding to it’s it’s this active listening, right. And so what I found is two things, I find that the three second rule helps me with is one to really just take a moment to check my own implicit bias. Because if you’re human, you have implicit bias. And I think that that’s an important point to raise today as, as our country is in this racial justice, fight for for everyone is to really pause and check your own implicit bias, so one that helps with that, too. And just to take a moment to think about what the person said, how you want to respond. And it’s, it sounds short, but when you’re in it, it’s it can feel long at the same time. So I just think that it’s something that I’m committed to working on.

Quint Studer 21:43
Well, we’ve learned that from you, too. I mean, I just take, you know, I was went to your board retreat, and you had Vincent Brown, doing a thing on diversity inclusion, of course, we’ve hired him here. He starts in January, his company to help us with bias, inclusion, really scrub our company to say, are we are we there? Or where do we need to be? And not only with keeping talent, but attracting new talent? So, again, you’re always, I think, looking around the corner, I repeated since I tried that pre call with you, by the way, and I have given you credit, I was talking to what 126 students on a zoom call. And they were asking about things. And you mentioned something that was pretty interesting. You said, you use the words live at the edge of your comfort zone. Now, what do you mean by live at the edge of your comfort zone?

Jill Miller 22:34
That edge that’s your growing edge, right, the pushing myself to do new things. So every job I’ve ever had, I’ve never done before. And that’s not a comfortable place to be to go into a job that you’ve never done before. But I’ve always just taken that on as an opportunity to learn to really throw myself in to talking with different people and new experiences. And so every day, you know, how do you It’s like when you work out, right? You push yourself to the point where it doesn’t feel so good. But later on, it feels good. And so I think that that’s something you can do in your professional life as well is just push yourself, push yourself where you’re not comfortable. I’ve always wanted to be a really great public speaker. And as you know, Quint, like that takes work. And I’ve worked with coaches, and I’ve put myself out there and uncomfortable situations or places to speak. Because if you don’t do that you never grow as a person and you never get better.

Quint Studer 23:34
I think too, you know, somebody asked me if I worked, if I were you, Jill Miller, and they asked me What does Bethesda do, I would say we save lives. And because that’s really what you do, do unless I’ve gotten to know you these last couple years, whether through population health, whether it’s through the prenatal care. Um, I think that that’s what you do. And the other thing that I love that not only do you live at the edge of your comfort zone, but you push your board to be at the edge of their comfort zone. And I say that because we’re gonna have people on this podcast, and I’m gonna certainly encourage not for profit leaders to lead this to listen. On board development is very difficult, particularly in a not for profit setting. They don’t have skin in the game per se like financial stakeholder. They employ you, per se. But man, I will tell you that being a board member, first of all, you work you’re bored quite quite hard. You know, I’m really I mean, you’re expected to be there you’re expected to work and so on. And the other thing is, you’ll push the board. I mean when we had that board retreat, it was a it was out of the comfort zone type board retreat. And I really admire you for finale when you say you live on the edge of comfort zone. You push our people around you on the edge of the comfort zone, I mean you push Trihealth to make that you push the whole entire area of Cincinnati to look at prenatal care, you look at the whole entire community in Ohio that you serve, to look at social determinants, I mean, because you have such a wide path, and that’s one thing I was really impressed with is, you might start something to a try, you know, but pretty soon, it’s like, a whole entire communities involved. It’s not just a Bethesda initiative, or TriHealth. Diversity Inclusion is huge in your community. So I just think what you do is truly, truly remarkable. And I just want to thank you for allowing me to be on your board and from learning from you, because I’ve got stuff here on how to do grants better, and you’re helping our community and prenatal care. You’ve helped me a ton in diversity inclusion. In fact, you know, we brought people that you have introduced me to, to talk in our community to speak at EntreCon. And I hope people that are listening, reach out to you because one thing I will give them information is, um, you know, you’re not out to just make the testing better, you’re out to make the world better. And I thank you for that. Jill.

Jill Miller 26:05
Thank you, Quint. I’m honored to work with you. And have you on the board and honored you asked me to speak today. And I would sum up what you just said is just I’m really passionate and put my heart and soul into this work. And I do want to be a difference maker and a change agent and sometimes I you know, push people to where they’re uncomfortable, but I appreciate that you and that board, trust me to lead you into new spaces and try different things.

Quint Studer 26:39
Well, thank you.