Healthcare and social service providers across ecosystems of care often struggle to meet the complex needs of their patients and clients, as these needs can be unpredictable in nature, quantity, and duration.

Adding to the challenge, the funding which these providers receive to address those needs, whether from foundations, government agencies, or insurers, often comes with significant restrictions on its usage — it can only be used for certain individuals in certain situations, with predetermined limits on how much can be spent and how long the support can last. Funders often require organizations to provide precise, line-item budgets that detail the unit and overall costs of these services over a year or more. While some funders do allow for budget modifications over the course of a funding period, these can often involve lengthy and complicated processes for making the request and securing approval.

But in complex care, flexibility is key. The individuals and communities we serve have multiple, interrelated needs that can be difficult to anticipate and quantify prior to a patient or client expressing them. Moreover, these needs can run the gamut from primary or specialty medical care to medical devices or specific medications, as well as across the social determinants of health, such as transportation, affordable housing, access to healthy foods, and legal and administrative services.

Funding with strict eligibility requirements and usage restrictions can significantly hinder providers’ ability to address their patients’ and clients’ needs in critical moments — and thereby contribute to the very problems the funding aims to address.

At the Camden Coalition, it has been our experience that having the discretion to use our funding as we deem necessary and reasonable, without outside restrictions, has significantly benefitted the communities we serve. In addition to this responsiveness to evolving patient needs, flexible funding has also enabled us to innovate in real-time, creating timely solutions to emerging issues that could lead to poor outcomes if not addressed immediately.

A prime example of this occurred during the COVID-19 pandemic. In our role as a New Jersey Regional Health Hub operating in partnership with the state Department of Health, we received flexible funding to support testing, quarantine, and vaccination initiatives in Camden and across South Jersey. Rather than predetermining who we would reach and with what specific services, the state allowed us to construct our initiatives with real-time input from our care team, community partners, and patients. Just as importantly, this flexible funding allowed our program and administrative staff to devote the necessary time and effort to implementing activities in both responsive and accountable ways.

Now that the COVID-19 Public Health Emergency has ended, flexible funding from the state is allowing us to quickly coordinate outreach to residents who are at risk of losing Medicaid coverage due to post-pandemic unwinding policies.

Foundations are also experimenting with flexible funding opportunities for grantees. For example, after providing an initial, restricted grant to support the launch of our National Center for Complex Health and Social Needs initiative, the Robert Wood Johnson Foundation followed up with several flexible funding grants that allowed the National Center to build out critical infrastructure and innovative initiatives in an iterative and nimble manner, while minimizing reporting and administrative burdens that would only add costs. During the pandemic, this flexibility was especially useful, allowing us to seamlessly expand our virtual offerings and rapidly convene national stakeholders to share best practices for responding to COVID-19 in their communities.

Flexible funding from the Safer Childbirth Cities program — supported in New Jersey by Merck for Mothers, the Burke Foundation, the Nicholson Foundation, and the Community Health Acceleration Partnership — enabled the Camden Coalition to develop a pregnancy care initiation pilot that provided responsive follow-up care to individuals in the first trimester of pregnancy who had visited emergency rooms in Camden, Cumberland, and Gloucester counties. Each pilot site received $10,000 to establish a patient cost fund, which it could use at its own discretion to address patients’ needs and barriers to care as they arose. We found that this significantly improved both provider and patient experiences at a critical moment for people in early pregnancy.

As the Camden Coalition increasingly takes on an intermediary role between funders and community-based organizations and other complex care stakeholders, we are seeking to adopt flexible funding practices. For example, we are currently serving as the strategic implementation partner for the Bristol Myers Squibb Foundation’s New Jersey Safety Net Innovation Program (NJ-SNIP). NJ-SNIP will provide ten nonprofit safety net healthcare organizations with up to $300,000 each over two years to support institutional capacity-building and address community needs. The specific issues to be addressed and the methods used to address them will be determined by grantees and can include everything from direct patient care costs to staff training and infrastructure investments.

Beyond being able to rapidly respond to patient needs and emerging health crises like the pandemic, our experiences receiving and providing flexible funding have revealed a number of other benefits to our organization and community:

• Staff burnout prevention: Seeing patients struggle to get the care they need and feeling helpless to assist them can contribute to staff burnout. Flexible funding enables our staff and partners to quickly support patients in a moment of critical need and to feel empowered to engage patients in a holistic, person-centered way.
• Patient relationship building: As we saw with the pregnancy care initiation pilot, having something tangible to offer patients made outreach easier, made patients more likely to keep appointments, and helped build trust between the patient and provider.
• Long-term growth: Flexible funding supports both organizational capacity-building and programmatic innovation by enabling us to respond and adapt to the ever-changing environment in which we operate. It has proven to be an excellent way to pilot novel initiatives and encourage “out-of-the-box” thinking that has improved how we deliver care and meet the needs of our community.

Flexible funding is ultimately about trusting service providers to use funds in the most impactful ways possible and empowering them to continually harness their creativity and on-the-ground knowledge to grow their programs and organizations.

Whether for supporting a patient in need, building a program to respond to a pandemic, or coalescing the new field of complex care, flexible funding has been critical to the Camden Coalition’s ability to carry out its mission to the fullest. We encourage all funding organizations to think about how they can make their funds more flexible, and we will continue to make the case for flexible funding, drawing on our own experiences and those of our partners across the South Jersey ecosystem of care.