By: Kristina Swanson, CCPM Grants Manager
What is the best way for an accountable care organization (ACO) to manage grant applications and do post-award grants management? Like many organizations, Maine-based ACO Community Care Partnership of Maine (CCPM) often faces what is commonly referred to as the “make or buy” decision. Do we use our staff and resources to take on an initiative internally, or do we outsource the work to a vendor or contractor?
For several years after its incorporation in 2015, CCPM opted to outsource its grantmaking processes to a contractor who was tasked with identifying, applying for, and managing grant projects. While this approach was successful to an extent, there was limited capacity for grant writing and at times a disconnect between CCPM’s internal, day-to-day operations and its outsourced grants management function. Predictably, this resulted in overly complex and often disjointed post-award management.
In 2020, after a few years of outsourcing grant functions, CCPM decided to bring grantmaking in-house by employing a full-time Grants Manager. This has been a highly successful endeavor filled with lessons learned that may be beneficial to ACOs and other similar entities looking to stand up internal grants infrastructure.
In this blog post, CCPM will share insights from a year of grantmaking. We describe lessons learned about staffing an in-house Grants Manager position, coordinating project and proposal development processes, and managing funded projects. We address the following questions:
GRANTS MANAGER POSITION
I was hired as the full-time Grants Manager for CCPM about a year ago. CCPM added an in-house designated grants staff position to function as a member of the CCPM team and:
I came to CCPM with 20+ years of experience in grant development and management and no professional experience in health care. I believed that, with the CCPM team’s support, I could learn about the ACO’s work relatively quickly, while decades of grants expertise would enable thorough vetting and completion of grant proposals. This theory has proved to be accurate, as we submitted many proposals over the past year that were successfully funded. While this didn’t come without its challenges, it has been a very rewarding past many months – after all, learning new things is a big part of what makes grant work so much fun! Supporting me along the very steep learning curve are the members of CCPM’s stellar clinical and quality team, operations team and support staff, members of leadership, and leaders among CCPM’s member organizations.
GRANT DEVELOPMENT PROCESS
Identifying Opportunities
It is helpful to develop a set of tools, resources, and strategies to navigate the thousands of grant programs offered through federal, state, and local governments and private foundations. The needs of our ACO and members are many and varied, and we’ve found it essential to focus grantmaking efforts around our strategic priorities while remaining open to amazing opportunities that may fall outside of those parameters.
Project Lead and Applicant Lead/Grant Recipient Model
CCPM is not a nonprofit organization and is therefore not an eligible applicant for many public and private grant. In situations like these, one of our member organizations serves as the lead applicant and fiscal manager on each grant. Additional CCPM members (and sometimes organizations external to the ACO) are identified as project partners. Projects are often structured to allow CCPM to carry out centralized functions that support members: i.e., curriculum and workflow development. Project partners are then tasked with implementing the clinical procedures and workflows developed centrally. There’s some complexity in implementing this model – discussed in more detail in the Managing Multiple Grant Partners section, below.
Tools – Grant Search, Partnerships
Most grants managers are familiar with the standard online grant search tools – grants.gov, state grants offices, and foundation directories. In my first weeks on the job, I met with grants staff in CCPM member organizations that have designated positions. They generously shared additional resources for grant searching, including newsletters, listservs, and funder websites. I developed agreements with the two largest member organizations to give notice about funding opportunities that we will pursue, so that we can keep an eye out for opportunities to collaborate and avoid duplication.
Resources – Grants Team
CCPM formed a Grants Team that meets weekly to establish strategies and priorities for grantmaking, vet specific grant opportunities, develop potential grant project ideas, and build out project details. The team includes me, of course – the grants manager – as well as representation from CCPM leadership, operations, and our clinical and quality department. It’s been crucial to have the perspectives of those working directly with clinical staff to assess partner organizations’ need for and capacity to carry out projects; and it’s important to have operations and leadership represented to align projects with strategic priorities, link projects with external partners and resources, and to expedite decision-making to move forward with time-sensitive grant proposals.
Strategies: Aligning Organizational Priorities with Grant Searching and Project Development
CCPM’s strategic direction includes developing and expanding clinical service lines for our member organizations. Over the last year, we focused grant searches and project development on this priority. While there were viable grant programs in other areas of interest to the ACO, such as research and workforce development, focusing on service lines provided manageable parameters in the expansive world of grant opportunities. The grants team developed several project ideas and matched these to grants. As a bonus, aligning grantmaking with strategic priorities enabled grant project development to seed other work throughout the organization.
CCPM developed a process to present prospective grant proposals to the board of directors for approval, notify member organizations, and select project partners. This progression – from grant search to grants team to board to members – ensures that all projects are thoroughly vetted, and all voices are heard as proposals are considered.
Grant Project and Proposal Development Processes
Grant Support for Members
As a benefit of ACO membership, the grants manager is available to member organizations to assist with grant-related tasks, including searches, consultation on opportunities, writing, and proofing grant proposals. One of my first tasks was to survey members and learn about their organizational priorities and grantmaking needs. While we’ve issued many reminders about the availability of this service – including monthly newsletter notices and board meeting presentations – only a small percentage of our members have taken us up on the offer. This coming year, we’ll survey members again to learn more about their needs, and we’ll develop resources to support them as needed.
CCPM-Led Grants
CCPM is unique among ACOs in its collaborative decision-making processes, and equitable and highly participatory governance structure. CCPM’s board consists of a member of senior leadership (most often a CEO or COO) from each member. Board approval is required for all grant proposals initiated by CCPM and where CCPM is the project lead.
In the last year, CCPM partnered with several member organizations and submitted four proposals, two of which were funded – the Maine Cancer Foundation Lung Cancer Screening and Early Detection Project and the Harvard Pilgrim Health Care Pre-Visit Planning project. (While a 50% success rate for grant awards doesn’t seem impressive, it’s a standard average, and above average for new funders). In addition, having a grants manager on staff gave CCPM the capacity to responded to an invitation by the Maine CDC to implement an expansive Cardiovascular Health Project.
For each proposal, we develop a timeline with tasks and persons responsible that includes markers for draft reviews, feedback, decision-making, and approvals. We’ve learned that it’s important for all project partners, including front-line workers, to be involved up front with developing projects and proposals. They know best how funded projects will work on the ground.
Capacity Assessment
It’s essential to do organizational capacity assessments when developing projects and proposals. Grants can bring in significant resources for exceptional projects, and there is often a temptation to “go big” and try to do everything. When the possibilities offered and deliverables required by grant funding don’t match with actual organizational capacity, you may end up with “pie in the sky” projects that can’t be managed or completed as planned. Below are some of the considerations to be included in a capacity assessment. Some organizations document decision-making about each grant opportunity in a chart like this:
| Grant Project Capacity Assessment | |
| PROPOSAL | Do we have adequate time to develop a thorough and competitive proposal before the deadline? Will all project partners be involved in developing and approving the proposal? Do all project partners support the proposal development timeline? Are there others who should be involved in decision-making and proposal development? |
| PROJECT | What are the project deliverables for each project partner? activitiesoutcomesdata measures What will each partner be required to contribute to produce project deliverables? personnel: staffing, time (daily, monthly, or weekly)other resources: technology, space, supplies, equipment Does each partner have the resources and capacity necessary to produce the project deliverables? Will the grant funding provide sufficient resources to each partner to produce deliverables? |
| POST-AWARD MANAGEMENT | Does each partner have the capacity (time, expertise, resources) to manage and produce grant deliverables? financial management: expense tracking, invoicing, personnel trackingpersonnel: staffing, hiring, supervision, project oversight and managementother resources: technology, space, supplies, equipment Does each partner have the capacity to sustain the project beyond the grant funding period, if required? |
POST-AWARD: MANAGING MULTIPLE GRANT PARTNERS
When I first came on board last year, we weren’t sure how funders would respond to our unique project model. We submitted several grant proposals in a short period of time for projects with similar timelines. Two were funded, each with four partner organizations, and CCPM entered a service contract for a third project that involves 10 partners. Starting three new projects at the same time proved to be a heavy lift for CCPM’s small but mighty team and participating member organizations. We’re still in the process of developing and adapting meeting schedules, documents, and other communication and organizational tools to manage the project activities and grant financials.
Project Meetings
“I’m spending more time in meetings about the grant than I am on implementing the project.” Point taken. CCPM’s Director of Care Management and Quality was attending way too many meetings as we sorted through the activities and data measures associated with the new projects. We adjusted and streamlined our meeting schedules, both internally and with project partners. Form follows function: we aim for meeting schedules and formats that most efficiently address the issues that need attention. Internally, we meet as necessary to track grant activities and data-gathering for reports to funders. The clinical/quality staff have regularly scheduled meetings with each project partner to guide the implementation of project activities. To clarify financial tracking and invoicing processes, I met individually with each lead organization’s grants and financial management staff, and with each project partner’s financial officers.
Project Tracking
We developed financial spreadsheets for each grant to track grant income, expenses, and invoicing. The clinical/quality team developed spreadsheets for each project to track each partner’s tasks, deadlines, and persons responsible. The activities are aligned with specific project milestones to be reported to the funders. The team has implemented a system that puts responsibility for reporting progress on the partner organizations, to encourage accountability and ownership of the project.
Partner Accountability and Compliance
My friends’ two-year-old son recently took to blurting out a word he’s been hearing all too often – “COVID, COVID, COVID!” We all feel the strain of the pandemic, and it’s hit our member organizations – most of them small community health centers in very rural areas – especially hard. Already burdened with workforce retention issues, the opioid crisis, and the ongoing challenges of geographic isolation, these small-town heroes continue to face the pandemic with resilience. They are on the front lines in their communities for COVID-19 prevention, treatment, education, and vaccination. There is not a lot of extra time and energy to develop new projects.
We recognize the need to develop a clear process to address accountability and compliance for grant project implementation. We’re focusing first on preventing non-compliance by doing thorough capacity assessments prior to committing to submitting proposals, as described above, and making clear action plans for project deliverables. To address lack of follow-through in funded projects, our aim is not to be punitive, but to clearly define obstacles and implement supports. The process is still in development and will include steps for communication, actions, follow-up, and consequences for non-compliance.
GRANTS MANAGER ADAPTABILITY
A grants manager who is fortunate enough to have extra time to work on special projects can be a unique asset to the organization. Most grants managers have broad skill sets that include project development and management, budget development, financial management, personnel management, networking, multi-disciplinary partner coordination, meeting facilitation, and of course writing. Organizations may make good use of these assets by assigning projects for grants managers to do between deadlines.
Conclusion
Employing a Grants Manager has benefitted the ACO by adding cohesion to grant development procedures, supporting thorough vetting of grant opportunities and members’ capacity to participate, and systematizing post-award grants management. We’ve found that these processes are key to successful grantmaking:
Support Member Organizations
Advance CCPM Priorities
Streamline Grants Management Processes
GOING FORWARD
CCPM’s grants management goals for the coming year are designed to fully support our member organizations, advance organizational priorities, and streamline grants management processes for currently funded grants. We continue to seek grant resources to fund innovations and best practices to support our ACO members in providing excellent health care throughout the state of Maine.