Episode 4: The Importance of Promoting Prevention Forward Investments with Lauren Pennachio Director of Revenue Strategy and Partnerships with Health Leads

7:31PM Oct 26, 2022

Speakers:

Sue Watson

Marcel Harris

Robert Lee

Lauren Pennachio

Keywords:

people

money

health

funders

focused

intermediary

funding

notion

partners

investments

folks

invest

fund

community

leads

prevention

systems

health care

power

work

Welcome to People.Power.Perspectives., the podcast where we talk to the people that are working to overcome system inequities to achieve just outcomes.

Hi and welcome to this episode of People.Power.Perspectives. I'm Sue Watson and I'm joined by Marcel Harris, and where with CA4Health. We're excited to have Lauren Pennachio with us today. Lauren is the Director of Revenue Strategy and Partnerships with Health Leads. And we're really looking forward to talking to you today about the importance of promoting prevention forward investments. So before we get into that, why don't we start and having you tell us a little bit about yourself and what inspired you to work in the equity justice space?

Hi, Sue and Marcel, thank you so much for having me. And hello, everybody listening, anybody listening. I can talk about this topic all day. So I'm gonna just imagine there's a lot of you out there. Like Sue said, my name is Lauren Pennachio, she/her/ella pronoun series, I have the great privilege of being the Director of Revenue Strategies and Partnerships at Health Leads. Health Leads is as an innovation hub that seeks to unearth and address the deep societal roots of racial inequity that impact our health. And my role really focuses on the money, not just the notion of Health Leads needs money to exist as a nonprofit, I have a salary, I have rent, I have utility bills, I would like to pay those things. But really thinking about this notion that effort goes where money flows. And so we have to fundamentally think about how do we redesign how money is flowing so that we can really reach for the more just racially equitable society that I think we're all working towards. To your questions Sue on what brought me into this space. I don't know if I was brought if I got dropped in, or if I was always in it and just didn't realize it till later. It was probably a combination of all of those things. You know, I wasn't really brought to this work in the notions of inequities and injustices. It was just something that I think growing up I unknowingly was navigating and managing for my entire life. I'm a first generation college student, my Italian father dropped out of school in sixth grade, my mom was Puerto Rican, was bused to school, skipped two grades, and then walked out of high school with a GED because she needed to make money and get out of her house. Shortly thereafter, she had me. So now I know that people would use the word vulnerable and poor and displaced and high risk to describe me and my family. We were the very people that the social safety net is supposed to be reaching out to support. I certainly didn't use those words at the time growing up to describe us. I don't know that I feel comfortable using those words today, knowing them. And I unfortunately, barely knew about all of the resources and healthcare and community that were intended for us, right that were supposed to help us. And I think a lot about how different our world could have been if I did know about those things. So long way of saying when you live in a household that thinks about money every day, do we have enough? Where can we get more? How can we get more? What can we go without, it's pretty much inevitable that you think about money a lot. And I've just kind of made it my career. I will say on the professional side of the equation, I did a lot of volunteerism on grassroots fundraising, starting actually with work at the American Cancer Society and trying to get folks to understand that an investment in the American Cancer Society wasn't just for the sexy research to cure cancer, but was to help people get to their cancer appointments in the first place. There was a healthy those families because so much of their money had to go towards cancer treatment. We're talking pre ACA days, I got a great degree in cellular and molecular neuroscience and Biology from Johns Hopkins University, and I kept doing fundraising work. While I don't use that degree every day, sorry, Professor Norman. studying neuroscience gave me an appreciation for the cyclical nature of the inputs, the outputs, the agonist and antagonist that create either the systems we want or create the diseases we're trying to avoid. So I very much apply that to thinking about the world that I live in the world that I was trying to escape as a first generation college student and the world that we still exist in. So I think the combination of those things just kind of made me a Public Health and Health Equity monster a little bit.

Thanks so much for sharing that piece of your personal side. And it is fascinating. It's always fascinating to see how that can inform whether we knew it then or not where we wind up today, and and building on that with this focus on money and funding that you've been doing a lot of deep work around funding models and this idea of prevention forward investments and what is it that you want people to understand about that concept?

I want people to be angry, which is such a terrible thing to say. Okay, like hear me out. Health is multifactorial, we know that genes only contribute to like 20% of the drivers of health. That's hella old school news. That's technical terms. I want to know why we still send and center so much of our money on that 20% of what drives health. So I just want people to be a little bit more, they don't got to be as mad. I'm a baseline angry person, right? You don't have to be mad about it. But I want us to ask why we are not turning the curve on health, despite our health funding, growing astronomically year over year. If enough people ask why we can stop investing in ways to quiet symptoms and start investing in alleviating the root causes that create generations of poor health and inequitable outcomes.

All right, we're jumping into it, then. I mean, that's the core of where we see public health moving. And the idea of upstream is our funding matching where we're saying the work needs to happen. From your perspective, how does or can a shift in this focus or priority in funding and investments connect to broader movements for social justice or racial equity?

Yeah, I'd be remiss not to just name this, the unfortunate reality is we live in a capitalistic society that's founded on principles of white supremacy. I, as a realist adopt that as the unfortunate parameters or reality of the world that I'm walking within. I could do away with those things. But I used to tell my colleagues, one of my colleagues, said Lauren, find us clean money, I was like, please don't ask me to find you clean money, I'll never bring in a dime, right like we have to acknowledge. First and foremost, the very parameters we have to work within aren't ideal, they certainly aren't just, they certainly aren't founded in a way that helps to think about me as a half Latino woman, as women of color for men of color, or trans women of color, right? None of this world wasn't built for those folks. And so I want to just start by naming that, recognizing that's the case, to me, thinking about changing how money is flowing is a crucial cornerstone to making any changes in this society, I'll go back to what I always say, effort goes where money flows. And until we fundamentally redesign how money is flowing, we will never be able to sustain equitable changes in the capitalistic society that we have to accept that we live within. My team and I just did this design project to develop some core learning questions for our department at Health Leads. And one of the questions asked, how might the many systems that impact health financially and operationally sustain change that advances racial health equity, we had more than one person external to our agency tell us that this was the question that we need to answer if we're really going to cement changes and create a more racial, unjust future ahead of us and in our communities. The unfortunate reality is if we don't change this, we're not gonna see any change in the United States of America.

Right to the core of it. You know, no dancing around the edges. That's I love talking to you, Lauren.

I am only one person. I'm always this person, unfortunately.

Yes. And so then if we connect that dot, are there more dots that you would connect to traditional public health efforts? So if we kind of hone in a little more into the space that we're in?

Yeah. I don't know how much time we have. I do know how much time we have, it's not a lot. I will say this about particularly the traditional health space for a lot of my career was focused on is health care, right. And health systems. Right now, I think traditional health efforts need to take their right sized place around the community health table so that we can pursue this notion of public health and adjusted more equitable way too much funding and power is needed in that traditional health system. And again, that system has demonstratively not improved health for decades. I'm not saying people aren't trying, I've got a lot of colleagues who are wonderful doctors and doing wonderful things in public health who within health systems, but what I'm saying is we need to practice some take space and make space so that we can really create some change to make that very tangible. As an example, my team and I did an analysis of 18 Center for Medicaid and Medicare Innovation Waivers that are coming down the pike. We know that these waivers and health care and health care partners into a total Tailspin because they're trying to discover what's the next leading edge on how we're going to pay for health care who's going to be able to get paid for health care and how healthcare gonna get paid for of the 18 that we looked at this past year 14 use the term social determinants of health, which is a nice proxy for an acknowledgement of health is multifactorial. Only eight are specific on ways that they want social determinants of health integrated into the waiver and only six of those 14 use the word equity in proposal if that doesn't demonstrate both the Tailspin that these waivers create for these healthy ecosystems and also just demonstrate that we're putting too much money in power and an agency that doesn't even use the word equity as a standard. I don't know what is a good proxy for those.

Thanks those tangible examples, and I know this is just one of many, are so helpful to see the systems at play, and then the impact it has on those of us doing the work. And maybe you can share some other challenges that you see with the way funding is currently provided by the majority of funders and the approach and what challenges that leaves for those who are trying to access that funding.

Sure, I'll stay centered on back on that traditional health system for another second or two. First and foremost, in the last 10 years, the health systems obsession with what's called the high needs high cost playbook makes me nutty. There is nothing inherently preventative about focusing on the people that are utilizing health care system services too frequently. And if you're too sick, and costing us too much money as a result, I'm not saying My grandmother was one of those people, she got a lot of great treatment, I'm glad that she had the privilege and access to do so I'm not saying we shouldn't focus on those populations. I am saying why are we so majority focused on an application of the high needs high cost playbook, there's nothing inherently preventable. All we're doing is getting good at answering this fast revolving door, we're not stopping the door from revolving going back to that for alleviating systems are not addressing root causes parallel. And then if we look at health care investment, particularly in social determinants of health, intervention, focus, the CMMI level and it's a broader statement and state contracts level, we know that a majority of those investments are focused on making referrals for people who enter their services to agencies outside and in communities. So what's happening is health care is creating systems and infrastructure and resources to say, Oh, you don't take your prescription because you're hungry and don't have food at home, go to the food bank, well if effort goes where the money flows, how are they funding the food bank so that they can actually give that person that they just made a referral to the food that they need. And I can say this was I statements for a long time Health Leads was doing these sorts of referrals within health care to try to get health care to acknowledge and act on social determinants of health. So we've seen firsthand the impact of what we're doing is investing in pumping people out of health care and back into community and investing in infrastructure that pump people out but not investing nearly enough, if anything in several instances of what happens outside do they have somebody they can talk to to do the legal aid to do the rental assistance to provide the food to provide the domestic violence shelter and safety of that this isn't just not good enough, it's actually harmful for people for this community agencies, and also for their providers and healthcare who care and want them to get the things that they need. I'll step outside of healthcare because I've got words for private philanthropy, too. I really love working in private philanthropy, because I think with so much positional and financial privilege, if anybody's going to be able to get to stick their neck out and make changes, My money is on the private philanthropists because they're holding, they're held accountable to nobody, but really themselves and some IRS tax codes around how they're allowed to spend their money. I'm really excited that private philanthropy is excited about the notion of collaboration and multi agency effort. What I am not excited about is funders, being super excited about those things, and giving us $100,000 to find four very specific partners that they think we need to partner with, and then make seismic change within two to three years. I'm cool with the energy, I can vibe with the energy in the intention. But I think we really need to do more around helping people move from intention to action and give us the money to actually do the co-design actually find the right partner to invest in planning so that we make the most of the investment as a collective, both needing the time to do that. And also time is money. If I need six months to plan before I can start to see an impact. I think those six months should be funded, especially if we're trying to contend with the turnover and the burnout of those of us frontline and social safety net.

We're in this moment where equity is the overarching word, whether it's in the nature of the work, what we're asked to do in the work we're funded to do and how many philanthropic funders are looking into their own structures to see how do they represent that better differently and how they do their work. And I wonder if there are models or approaches that in your collection? have information that you're lifting up in this as things to aspire to, or that may work better than how things operate today.

I certainly feel like I've been doom and gloom so I can love on people for a little bit with that request. I'll use I statements for a second Health Leads has just this immense privilege to lead a multi sector collaboration focused on our network is called Housing is Health. And our project specifically is focused on eviction prevention and homelessness prevention. It's a $1.4 million project, we have it funded for three years, it is a collective effort of five agencies Health Leads was asked by our four other partners who are actually the people on the ground doing this work. But we were asked to step in to really play a backbone an intermediary role to provide short term capacity, oh my gosh, we just need a program manager or project manager and one of those four agencies like we shouldn't be the people that we can invest in that right now well Health Leads can provide that to do some capability building of we want to try this work on but we don't know what best practices there are to try things on well Health Leads can teach you rapid cycle learning and Health Leads can teach you how to make decision making frameworks to support collective action of that 1.4 million, a million of it, it goes outside of Health Leads to those other agencies to pay for their efforts. I should also mention this is work that is on the heels of a planning grant investment were all of those folks around the table to help us decide what we were going to focus on in the very first place. So it can be done, you can invest in planning because we did it. You can equitably invest across community and government agencies and help folks get resources that they might not have been able to get themselves or resources that it might not have been worth their time getting. Some of these larger grants are administratively incredibly onerous. We just started talking about the potential more evergreen revenue strategies and contracting with the government's in some capacity or contracting with health systems who are focused on eviction prevention, and our partners were like, well, you guys are going to be there, right? Because the things are, so onerous, such a pain to deal with them. And so I think that model gives me, it's just been such a joy, as a person that's been in it like, I love this project. I love this team. I love our advisory group who told us we shouldn't do it, and to do it fast in the middle of the pandemic. And we said, we're gonna try I think we did. So I love this project. But I love the wonky money bits of it. Because I think we're seeing some potential Promising Practices in how we do things, our funded partners don't owe us report, they collaborate together on the creation of what is our collective narrative and story. And when funders need something that's a drop of the dime. It's my job and my colleagues job to answer that for them so that our partners can stay focused on the actual work. We're halfway through the project. And we're already able to start having conversations about sustainability and expansion. They're like, I can't believe we're already having these conversations and makes all the sense in the world. How would we have ever done that? And the answer is, well, that's Health Leads spending our positional privilege, we can think about those things while you help to serve 110,000 people in the Bay Area who otherwise wouldn't have been asked if they were at risk of eviction, or know their housing, right? There's a case study, I guess, of this notion of the emergence of intermediaries, which very much excites me. I think there's some caution when we think about intermediaries, right? We can't pursue an intermediary funding strategy to pursue a new line of business folks who stepped into that role need to really hold on to what a privilege it is to be in that role, and really focus on not just doing Savior design funding of like, oh, it wasn't do me you when you've gotten your money, I'm here for you. And like, we really need to be focused on capability and capacity building. But I'm really excited about it. Because some folks in philanthropy just aren't ready to do what they say they want to do. That's okay, get help. I'd be remiss not to mention the work that you all lead and Together Towards Health because you know, $1.4 million out, that's great. I'll celebrate it. But y'all did that times, however many, our team has been so impressed with what you were able to do through that project. And again, looking at this intermediary, emerging practice and navigating it with care. I think it takes a lot of care to make it happen.

Yeah, I mean, I couldn't have said it better myself and one, that's how we got to meet each other. But that idea of having that responsibility, and that ability to take in the things we know and that we've been in the situation to see or experience and how do we try to do it differently or better, for Together Toward Health doing that as part of COVID being fueled consistently by the organizations that we were serving and the communities that they were serving, and everything they were going through, it was a lot. But it was also so rewarding to be able to put all of those pieces together and hear that feedback that it worked for the people that we were able to fund. But it's definitely made me think a lot more about the potential of intermediaries that are more than pastors. It's kind of an intermediary Plus model, and embracing all of what that is. Not everybody can do it. And I think we have to make some of those distinctions of pass through or providing these wraparound pieces with the organizations that we work with.

Yeah, I think it's so crucial in this moment, to I'm a person who's all about efficiency, and there's nothing inherently efficient without an intermediary. It's even just using the name. Its even inherent in the word? Because I can hear my father in the back of my head being like, are you just gonna take 10 off the top? But he's not wrong either. Right?

Sometimes it has to be done.

But I think it's this notion of how much harm have I firsthand experienced as a fund seeker, when folks say they want to invest in more equitable solutions, and they're using the words but they don't know how to do it in action. There's so much harm that can be done. If we aren't honest with that might be my intention, but I'm not ready to do it. So how do I again ask for help in the interim, Intermediary, in the interim, to get me there, I think humbleness goes a really, really long way. And I don't know if this will resonate for you and the TTH team Sue. But I feel like I was able to, and our team was able to shape this funding arrangement with our partners in a more equitable way. Because we've seen it we've had it done to us unto us when it was done well, and when it wasn't. One of our partners was like, oh, you know, we have you listed as our program officer, right. And like, it made me so uncomfortable, but they weren't wrong. That's effectively the role that I'm playing. But I think the reason we're able to do it is because we have all this lived experience. It's not a notion for us. I'm not at a grant on the spreadsheet reporting to a board of directors, I've been that person. And I think that goes a really long way in all dimensions of public health work.

Yeah, I would agree with you completely.

Loving the discussion conversation, I definitely appreciate that focus outside of the traditional social determinants of health, really looking at and calling folks out in terms of how we're investing dollars in relation to prevention equity work. And so I'm curious to hear how it changes impact the work on the ground as it relates to efforts to address health equity and racial justice. And you touched upon some of those changes within the work with the housing partners, but I'd be curious to hear what we might see moving forward implementing those changes.

Yeah, it's such a good question. Marcel. I first and foremost, I think if you're able to make such happen here, if I can borrow from Mean Girls. We would undo the scarcity mindset that I think plagues the social safety net, this notion of entrepreneur to be full of, like, I'm just, I'm just happy to be relevant. Like no, you've always been doing valuable work, stand up and stand in the power that is valuable work, you housing tenant, counselor, you pro bono, Legal Aid provider, you utility assistance company, you've always had so much power in with your communities, we can fundamentally redesign how funding is flowing. I just hope people can find and love on the power that they have, and really break out of the scarcity mindset. I think an unfortunate reality right now is that scarcity, mindset fuels, the lack of prevention forward investments, like I don't have enough, I don't get enough. I don't ask for enough. I don't have enough. I don't get enough. I don't ask for enough and round and round we go we've got to break that cycle. And take that weighs on people to like that weighs on executive directors and program directors. This work is so inherently hard. It's made harder by the notion of how much cash on hand do I have? How much longer can I possibly be here to let people in, keep my lights on to walk through the doors of this shelter or the doors of this? You know, domestic violence center? It's I think, I know, our people in the social safety net in the nonprofit world are tired. We're so tired. You can't do good if you're tired yourself. So I think that's a big change. And then beyond that, I think when I had an internship in Baltimore working for the largest homeless services provider in the county at the time now I learned a lot there. And I loved a lot of the people I got to work with. But on my second or third day, they handed me this envelope and told me to go to City Hall to hand it in. And that was my task for the day. And I was like, cool, cool. Why there's a long time ago, I'm handing in a manila envelope. And I was like, Sure, but why and what is this? And they were like, well, it's the grant application, They don't know you. So when you walk in, our peers who are competing for this funding, aren't going to know that we made the financial requests, and we're going to have a leg on top because they're not going to know. And that blew my mind. I was like, why aren't you working together? Why are you working in competition? And they think if we can, fundamentally, I'm still mad about it, obviously. But I think if we can fundamentally redesign how this work is financed, we would find joy in executing on collaboration rather than competition. I just go back to like health is multifactorial, we can't have a health system, trying to be the Legal Aid provider and the Food Bank and the shelter, there's no need to vertically integrate in the social safety net life is too complicated. But the way the money flows, I think incentivizes people to grow their service market share, to speak business and try to be a lot of things that they probably shouldn't. Those I think are the two big things.

Such an interesting dynamic and the sense of competition versus collaboration, I really wish that more folks would be in the mindset of let's do this together. Rather than have to do this by myself, even knowing that they might not be the best entity to lead some forward. And then how we do that with community generally operates a little better when we collaborate, leverage resources and partner. So I really appreciate you shedding light on that. And looking at some of the action in the future, can you share some of the critical points of action that you see moving forward that really could support prevention forward investments, in addition to you know, having the money? What can really help move this forward?

Yeah I think for fund grantors, be they in health care, government, private philanthropy, it really goes back to first off, I'm going to start off by saying, I'm assuming everybody is down to work for a more equitable and just future. And if you're not, I'm not talking to you, and I don't need to talk to you. So let me just name that chair from the jump. There's that that's another conversation. The focusing on the folks that are wanting to advance equity and justice in their communities, I think it just goes back to that notion of like, acknowledge your positional privilege and power within the ecosystem, and do an honest assessment about what are you capable of doing around your goal to advance equity and justice. And it might mean that you're not ready to walk the walk, because you're not even crawling yet. And that's a lot of Brooklyn coming out, I'm sorry. But I think that's okay, I just go back to like, it's okay to ask for help. There's nothing wrong with saying, Gosh, I've got all this money I'm supposed to distributed equitably to advance justice in X, Y, or Z cause or geographies. And I don't know that I'm the best people to do it Gucci go get help, or whether it's an intermediary, whether it's I bringing on a consultant to build your capacity inside. I think that like I said, the humbleness and vulnerability goes a really long way. And I think it is the thing we need folks who have power over to spend more of theirs that fund makers ask for help, be honest. For fund seekers, I think it goes back to that like, I want to encourage folks to be brave into stepping into power that they already have. The ecosystem wants to fund collaboration. The ecosystem wants to fund prevention, I see that word constantly. Cool. Make them mean what they say, they're coming to you because you have something that they want. That's into your power. And been asking folks to break that scarcity mindset and probably some survival reflexes around when a funder says jump, I say how high but as a person that has, I've put up on the screen, how can you advance us financially and doing this and just sat there with a bunch of funders looking at me, I promise you, I made it out of that room and made it out of that room with a bunch of money, you can do it. And I think stepping into that power will go a really, really long way. I think for all of us collectively, it's staying focused on asking those why questions like oh, well, CalAIM is coming and they want to contract with us for a sobering center. Why are we focused on sobering center? To what end? What is the root cause that we are trying to get out? And can we invest equally, if not more in that root cause in those moments, then in alleviating the symptoms, it's not an either or definitely a both and I want to get that other clause in the picture. And I think it's going to take all of us to do that.

I think that's a great place for us to land on here in this podcast. Again, Lauren, I really want to thank you for taking the time to talk with us today. It's been so great engaging in this conversation around money that is important for us in our society, and important in how we use it for good. And I think you've shared some really wonderful insights and ideas. I know I wrote down some things like effort goes where the money flows. And for those of us who may find ourselves in situations where we become the funder, how do we take what we know and implement things differently in the spirit of the principles that we value. So if anybody wants to learn more about the work that Lauren does at Health Leads, we will definitely have information on the podcast website. And links to I know you're working on a report. I'm not sure when it's going to be ready. But we'll definitely be making that available as soon as we can. Thank you for joining us. And thank you all for listening to another episode of CA4Health's People.Power.Perspectives. Podcast.

Thank you!