Purpose

A.  The Broad National Problem
The population in the United States is aging. People are living longer with chronic diseases that are accompanied by significant social and economic needs. This is a shift in the type of services healthcare organizations traditionally provided, i.e., a shift from acute disease to chronic disease. From both a health and social service perspective this represents a major shift in the volume and type of issues they are presented with, thus creating a need to do business differently in a declining economic environment.

The cost and volume of health care and social services is increasing while reimbursement for services is decreasing. Managed care/government is passing more of the financial burden for services onto the service provider.  Service providers are financially penalized for poor outcomes that may have occurred because of circumstance outside their scope of practice, e.g., health care providers are being penalized for re-admissions even though the cause of the readmission is a social or economic issue, not a health issue.  Social services agencies are being penalized for poor social outcomes when the cause is a health care issue.

The percentage of people in the United States that receive coverage through their employers recently fell to the lowest level in a decade and is still declining.

Nearly 46 million people in the United States lack health insurance.

B.  The Challenges in Terms of Catholic-Sponsored Ministries
In 2002, Health Systems Research, Inc. (HSR) was commissioned to conduct a national survey of all Dioceses in the country to determine what levels of collaboration between health and human services were being conducted.  HSR sent surveys to all Dioceses.  They then selected actively collaborating Dioceses and conducted phone interviews.  Finally, HSR conducted onsite interviews and, in Chicago, in the summer of 2002, at the first joint assembly of Catholic Health Association and Catholic Charities USA, the New Covenant published its data and recognized several Dioceses for developing national models of collaboration.   As exciting as it was to have identified Dioceses who are actively engaged in demonstrating how they can work better together rather than apart, the three year long process black-lighted how few Dioceses, relatively speaking, were working together.

In 2000, Catholic Charities USA agencies served over 10,000,000 people.  They had 51,000 paid staff and roughly 168,000 volunteers.  Another 7,335 individuals serve as volunteer members of local boards.   At the same time, Catholic hospitals, which represent the largest single group of hospital-providers in the country, recorded 15,500,000 Emergency Department visits, 5,400,000 inpatient admissions and 84,000,000 outpatient encounters.  On any given day in America over 600,000 people are employed by Catholic healthcare facilities.   On any given day, over 200,000 educators teach 7,600,000 students at all levels of Catholic education.  As staggering as these numbers are in terms of breadth and scope, and as profound the significance of the benefits they provide, they are essentially providing these services in institutional vacuums:  for the most part, the right hands do not know what the left hands are doing.

The ultimate success of our work will depend upon the extent to which we can support the challenges that the sometimes historically disparate ministries of healthcare, social service and education have in overcoming obstacles.  From our experience over the past several years, we have identified the following:

Problem #1:  Generally speaking, the poor rarely have "one problem at a time."  If they did, accessing services that respond to their needs would be simpler.  Unfortunately, more often than not, they have multiple-problems that are not only physical, but also social, emotional, spiritual, educational, pastoral, etc.  The institutions we sponsor are not organized in such a way as to be responsive to multiple needs.

Problem #2:  Our institutional histories and cultures have separated and compartmentalized us. 

Problem #3:  Geography separates us. 

Problem #4:  In the United States, according to the United States Catholic Conference of Bishops (2003), we have 63.4 million Catholics worshipping in over 19,000 parishes served by 585 Catholic hospitals and, although collaboration in both the nonprofit and for-profit worlds is increasingly seen as necessary to progress, to our knowledge, there has been no Church-sponsored effort at a national level of scope, working deliberately and intentionally to use our collective resources better on behalf of the poor.

Problem #5:  Efforts to collaborate in the past have been compromised by the tendency to disproportionately value one's own ministry over another's.   Other obstacles include:

• The potential for success of collaborative initiatives is often proportionate to the extent to which each individual organization has internally integrated it various programs and services.  To the extent it has not, integration with another organization is even more difficult.
• Individual organizations historically (and given the difficult financial times, increasingly) have asked, "What benefit will we derive from this effort?" but we believe the greater higher ground question that needs to be asked is, "What benefit can we contribute to our partners' organizations that will improve the quality of lives of the poor we serve"?
• Both health care and social services have stretched their shrinking resources to support the needs of the people that they serve. In many instances this has resulted in duplication of services within a community, fragmentation of services, inconsistency of care, and poor outcomes all resulting in an increase in the cost of doing business.
• One of the most challenging obstacles to collaboration, especially in regards to forming formal relationships that involve costs, e.g., joint venture agreements, incorporations, etc., is how differently revenues flow in health care (Medicaid, Medicare, commercial insurance, etc.) and in social services (contracts for fees-for-service from public payers, primarily county and state).  We need to appeal to funders to transcend their tendency towards categorical funding streams and be as creative as we have become in paying for services in ways that financially support the collaborations they say they want.
• We must constantly assess projects in terms of their balance of mission vs. margin.  In short, high-mission and high-margin initiatives tend to happen.  High-margin and low mission may occur with one organization but not the other.  Low mission and low-margin tend to distract us and not come to fruition.  By far, the most common combination, though, are high-mission and low-margin initiatives: most collaborations fall into this category and is part of the reason our work is so challenging.
• We believe that organizational entropy, without the stimulation of an outside source such as Ministering Together, will be to return to the historical, hierarchical vacuums that have been each organization’s status quo for years.   Ministering Together will keep the collaborative vision in front of everyone.
• One of the greatest hurdles to successful collaboration is that the health care, parishes, and human service systems have vastly different organizing principles.  Finding a common organizing principle is challenging.

C.  Our Objectives
Our intended outcome is to expand our participation in a broader church ministry of caring and healing that will enable us to use our resources more effectively and have greater impact on the people we serve.   As a result of our national survey conducted in 2001, and through our ongoing communication throughout the country, we know that less than 50% of our Dioceses are presently involved in some form of collaboration between its hospitals, human service providers, and educational facilities. 

Problem #1:  Generally speaking, the poor rarely have "one problem at a time."  If they did, accessing services that respond to their needs would be simpler.  Unfortunately, more often than not, they have multiple-problems that are not only physical, but also social, emotional, spiritual, educational, pastoral, etc.  The institutions we sponsor are not organized in such a way as to be responsive to multiple needs.

Objective #1:  We will increase ease of access to our network of health, social, pastoral and educational services for everyone we serve, but, particularly for the poor.

Problem #2:  Our institutional histories and cultures have separated and compartmentalized us. 

Objective #2:We will develop and promote a curriculum of insights and strategies, based upon what we have learned over the last five years from select Dioceses that have successfully developed collaborative initiatives, e.g., Orange County, Cleveland, Albany, and Tampa.

Problem #3:  Geography separates us. 

Objective #3:  Greatly reduce the problems that are inherent wide spread geographical locations in supporting collaborative initiatives.

Problem #4:  In the United States, according to the United States Catholic Conference of Bishops (2003), we have 63.4 million Catholics worshipping in over 19,000 parishes served by 585 Catholic hospitals and, although collaboration in both the nonprofit and for-profit worlds is increasingly seen as necessary to progress, to our knowledge, there has been no Church-sponsored effort at a national level of scope, working deliberately and intentionally to use our collective resources better on behalf of the poor.

Objective #4:  We will increase the numbers of Dioceses who initiate and maintain deliberate, ongoing efforts to collaborate by over 20 percent of the 195 Dioceses in the United States by the end of 2007.  

Problem #5:  Efforts to collaborate in the past have been compromised by the tendency to disproportionately value one's own ministry over another's.

Objective #5:  We will reduce obstacles to collaboration that have historically gotten in our way.