Colorado Health Foundation Makes Rural Communities a Priority: Q&A with Karen McNeil-Miller

by Beth Blevins

Karen McNeil-Miller has worked for nonprofit organizations her entire career: first, as a schoolteacher, then, as an administrator at a private school for children with learning complexities. She then worked at the Center for Creative Leadership for 16 years. It was at the Kate B. Reynolds Charitable Trust, which she joined in 2004 as president, that McNeil-Miller began to focus on rural communities — a focus that she attributes, in part, to growing up in a rural town in North Carolina. Now at the Colorado Health Foundation (CHF), where she has been president and CEO since September 2015, McNeil-Miller is helping turn some of the foundation's human and financial resources to rural communities. In addition, she has been a member of the Rural Health Philanthropy Partnership from its outset in 2013. Recently we discussed what her goals are for CHF, particularly for rural communities in Colorado.

What does the CHF do, and what makes it unique?

Our goal and our emerging vision is that everyone, everywhere in Colorado has the opportunity for their best health.

We are a statewide health foundation. We look at the usual suspects related to healthcare and the broader health landscape. For the healthcare aspects, we are looking at access to care, quality of care, and insurance — getting as many Coloradans insured as possible. We're beginning to move into behavioral health in a broader way than we were before. We're also looking at things outside the clinical setting, such as healthy behaviors. And we're starting to focus more on the social determinants of health, with a particular focus on child and adolescent health. Our goal and our emerging vision is that everyone, everywhere in Colorado has the opportunity for their best health.

One of the first things you did as CEO of CHF was to conduct a Listening Tour around the state last year. Why was that important?

There were several things we accomplished. First, it provided a way for me to get to know the state in a way I couldn't get to know it by just living in Denver. My working knowledge of Colorado was weekend trips here and there. I needed to understand the state and all the different cultures and personalities that exist in the state.

I also wanted to start spreading the message that our belief is that we're all in the health business. I wanted to start having those conversations in communities to say that it's not just doctors in the health business. If you're a schoolteacher, you're in the health business because there's a direct correlation between education level and health outcome. If you're in the housing industry, you're in the health business. So I was trying to make the connection with government, with Chambers of Commerce, with residents in general to think about the decisions they make and the health benefit that they could have.

In a heavily rural state like Colorado, when you're coming from Denver, you can't go to a rural community and tell them what they need.

In a heavily rural state like Colorado, when you're coming from Denver, you can't go to a rural community and tell them what they need. And so I wanted to help get the message out: "We are not coming to your community with an agenda other than to help you with yours. If you develop community will and you've determined that X is no longer acceptable in your community — whether X is substance abuse or low-performing schools or seniors not getting medications — we want to bring our resources there to help you."

We advertised the sessions in the local papers, so that normal, everyday residents would come to these meetings to learn about issues in their community that they may not have known about or may not have known they had any opportunity to impact.

What did you learn from the Listening Tours and what were the biggest benefits?

We wanted to find out what was on the minds of communities around health. There were two questions I asked: "What assets do you have for residents to get healthy?" and "What barriers exist that keep people from getting and staying healthy?"

[In 50 town halls,] every one of them said that substance abuse, mental health, and behavioral health were at the top of the list.

The biggest surprise to me was that in every town hall that we did — and we did 50 town halls — every one of them said that substance abuse, mental health, and behavioral health were at the top of the list.  I wasn't surprised to hear it, but I was surprised to hear it everywhere. That led the Foundation to say, "We've got to engage in these issues in a more robust way than we are now."

We found some differences between rural and urban communities. In urban, when they talked about lack of access to care, they weren't talking about availability of doctors — there might be doctors everywhere, but there might not be doctors who take Medicaid. In rural communities it was, "We don't have a doctor." The doctor might be 30 miles away, and there might be no access to public transportation.

Different regions in the state have different personalities. So while the headlines might be the same, the context might differ. There's the farming region personality, the eastern plain personality (where they feel left behind), the resort communities, the cattle land, the Southwest — all of these are unique and different.

For the past 10 years, CHF has released an annual Colorado Health Report Card, along with subsequent data spotlights based on the Report Cards. The most recent of these data spotlights, Rural Health: Innovating Out of Necessity, was issued in January. How is the Report Card typically used and why was there a need for a data spotlight on rural health?

The main report is used heavily by nonprofits to help guide their goal setting, judging where they want to go next. Legislative aides pore over it to help legislators make decisions about healthcare and beyond. Because it's large-scale population data, which doesn't change a lot over time, we use it to look for trends. For example, "Are we getting better in senior care, or child and adolescent care, or are we getting worse?" It helps us set a broad strategic direction and then it helps us do some tweaking. Underneath all those major categories there are specific targets and data, and it may lead us to funding opportunities in one or more particular areas if something promising shows up. Or if it looks like something is dropping off, it may spur some activity in those areas.

We go behind the numbers of specific data points in the Report Card through a series of data spotlights. The most recent one focuses on rural health in Colorado. We looked at how healthy those communities in Colorado are, but also sought out stories about how they are innovating to solve complex issues related to health. That piece will become both an internal and external educational tool for us.

We are really invested in understanding how issues play out in different communities.

Our strategy up until now, not intentionally but by default, could easily leave out rural communities. Oftentimes rural communities fell through the cracks. So now we're going to put a laser focus on them. We are really invested in understanding how issues play out in different communities. We're assigning staff members to territories. It's their responsibility to know the lay of the land in that territory, in terms of health and social determinants, and to know who are the government agencies and the nonprofits, and what partnerships are forming in that area, and where we can be of assistance. We need to understand the context a lot better in order to be better grantmakers, and to better focus where our policy efforts should be. As a result, we hope, our policy efforts may be county-level as opposed to statewide.

Why are you involved in the Rural Health Philanthropy Partnership, a national collaborative of rural funders?

Philanthropy is learning more and more that we have to engage in partnerships with other foundations, philanthropic organizations, public entities, and with the private sector.

Partnership is critical for us. Even with all of our resources — and we're the third largest health funder in the country — what we have to bring financially is still a drop in the bucket. We don't have access to everything we need to know about rural communities. The partnership is helping us know what is happening within our state, across the country, what other people are trying, what's working in different environments, what's not. And it can help us understand where there are places we can go to lead an effort, or maybe there's a great effort already underway that we can learn from and be a support. Philanthropy is learning more and more that we have to engage in partnerships with other foundations, philanthropic organizations, public entities, and with the private sector. We have to build a strong network that doesn't fall apart when one entity or another drops out.

What are the challenges — and the opportunities — you've found in rural Colorado?

Households in rural Colorado earn about $48,000 annually, $10,000 less than the average urban households. Between this income gap, higher unemployment, and more lower-paying and seasonal jobs, rural Coloradans have some big hurdles to overcome. There isn't enough fresh, healthy food or access to local pharmacies or affordable child care. These are critical drivers of how health takes shape. Without better access and economic opportunity, those Coloradans don't have the same opportunities to be healthy as those living in more urban parts of the state.

From a philanthropic perspective, we want to learn more from communities about their needs, but also their ideas and innovative approaches to solving these complex problems.

Yet, some of Colorado's most enduring health challenges — poverty, unhealthy options, and lack of access to healthcare — are being addressed in rural communities with really creative solutions. From a philanthropic perspective, we want to learn more from communities about their needs, but also their ideas and innovative approaches to solving these complex problems. We're looking to more deeply engage in these communities to do just that.

Opinions expressed are those of the interviewee and do not necessarily reflect the views of the Rural Health Information Hub.