Case Study #15: Clinical Philanthropists
Bristol-Myers Squibb shows how to measure results
When people say, “There’s so much out there and we don’t really know what works,” our response is, “that’s one of the funder’s responsibilities to facilitate.”
—John Damonti, president, Bristol-Myers Squibb Foundation
In 2010, the Bristol-Myers Squibb Foundation (BMSF), the philanthropic arm of the bio-pharmaceutical company, had no history of giving to veterans, servicemembers, or their families. By the end of 2012, it had committed nearly $7 million to such projects—ranging from evaluating web-based mental-health interventions for veterans who would not seek treatment through traditional avenues, to a new model of community-based support for military populations. And thanks to a clear investment strategy and the scientific culture of its corporate parent, BMSF’s early giving in this field has already attracted major public and private funders to support the work it is piloting and evaluating.
While BMSF remains a relative newcomer to this branch of philanthropy, it benefits from a funding strategy honed over the last 15 years. Established in 1955, the foundation aims to reduce health disparities by strengthening the capacity of healthcare workers, integrating medical care with support services, and mobilizing communities in the fight against disease. The company focuses on developing medicines to treat unmet medical needs, while the foundation focuses on the role communities can play to improve health outcomes. Using as an example HIV/AIDS in Africa (one of the foundation’s program areas), BMSF president John Damonti explains that “you could have all the medication you need to control the virus, but at the end of the day, if you don’t have the right nutritional supplementation, if you haven’t disclosed to your partner, if stigma is high, you’re not likely to get maximal benefit.”
BMSF taps its core business for skills and technical guidance on grantmaking. “On our foundation board, we’ve got our heads of medical and regulatory affairs, as well as the heads of our global businesses—they’re always pushing us to take the same approach with our grants as they do with their business,” says foundation director Catharine Grimes. “We look for more than just goals and objectives. We try to evaluate grants through a clinical-trial approach,” explains Grimes. The foundation often advises that grantees bring on independent evaluators to implement objective assessments.
Grantees are sometimes surprised at the centrality of evaluation in BMSF’s giving, says Grimes, and “will ask, ‘Really, there’s budget for that?’ Our answer is that it’s absolutely necessary—you can’t afford not to do it.” The foundation homes in on one particular type of evaluation: program efficacy. “A lot of funders focus on outputs—how many patients go through this,” explains Grimes. “But we’re focused on hard data on the health outcomes.”
A New Venture into Military Philanthropy
When Grimes left her position in the company’s neuroscience department and joined the foundation in mid-2010, she inherited a portfolio of mental-health programs focused primarily on populations with severe mental illnesses. Not finding many avenues for piloting new approaches, only replication and expansion, Grimes decided to turn her attention to serving new populations.
Tipped off by a friend exiting the military, Grimes saw great potential for BMSF in helping veterans who needed help settling into new civilian lives. “It was a place where we could build out a strong grant program according to our strategy—modeling supportive community services.” The move was met with wholehearted support from the foundation board and the company itself (which simultaneously created a Veterans Community Network, a group of 500 employees committed to recruiting and retaining veterans within the company). Very quickly, the veterans mental-health program at the foundation became one of the most popular recipients of donations from the employee-giving campaign. Damonti explains that company employees “feel good about our work with AIDS in Africa, they feel good about our work on oncology in Central and Eastern Europe, they feel good about our work on hepatitis in Asia, but there’s this whole other layer of passion around mental health among veterans.”
Passion alone, however, does not make effective philanthropy. Grimes freely admits, “We didn’t know the space—we were new. But what we did know, and I think this is where a lot of funders weren’t as clear, is what kind of grants we were looking to make. We have a very clear strategy for our grantmaking, so we know what kinds of proposals fit into our wheelhouse and what kinds don’t.” Their strategy was clear—pilot and rigorously evaluate new models of community-support services in mental health for veterans, servicemembers, and their families.
To fill the still-sizable gap between clear guidelines and concrete grants, Grimes turned BMSF’s lack of experience into an advantage—they encouraged grantees to come up with new ideas to test. Grimes explains:
We posted an open call for concepts on our website. Three pages—it wasn’t even a full proposal. I just wanted ideas, and left it very open-ended. We got about 80 replies to that in 2011 and 150 in 2012. We could wade through the stack quickly because we had this clear focus on community-based care. But then you get down to 25 to 35 that are really innovative and interesting models. Both years, we invited full proposals on 15.
From those full proposals, BMSF whittled the options down based on available funds at the foundation, the program’s focus on unmet needs, and the applicant’s evaluation plan. Twelve grants were made, most of them lasting two to three years. Between continuing and new project funding, BMSF’s annual budget for this portfolio hovers around $4 million.
Testing Mental Health Interventions
In its 2012 grant cycle, BMSF used its prowess in clinical evaluation to bridge the gap between an innovation of private philanthropy and the funding requirements of the Department of Veterans Affairs. Grimes learned about a program called VetsPrevail that delivers personalized early mental-health interventions over the internet to patients who would not seek traditional treatment. The program had received funding from several private foundations and the National Science Foundation. Its results seemed promising, yet the V.A. was unable to fund the program because no rigorous evaluation existed for it.The Bristol-Myers Squibb Foundation taps its core business for skills and technical guidance on grantmaking.
Perplexed, Grimes asked, “It’s got a lot of big funders. Do you mean they didn’t engage in an evaluation of the program?” She investigated and found that the private funders and the V.A. were defining “evaluation” differently. For the private foundations, evaluations delineated goals and targets in terms of patients served, rather than outcomes achieved. “This,” Grimes reflects, “is when I started learning what a different approach we have from other funders.” Grimes knew that what was really needed was “documentation of the program’s efficacy. As a science foundation running a mental-health program, we understand that.”
So BMSF brought on Rush University to develop a research protocol and determine whether VetsPrevail actually reduces the symptoms it targets. Just as important, Grimes brought on “a steering committee of V.A. members to make sure that the design met their criteria and that if they found positive efficacy, it is something they would look to implement in their facilities.” BMSF made sure to include a range of medical professionals, research scientists, program officers, and even technology experts who might eventually be responsible for implementing the program.
Damonti explains the design: “The evaluation is enrolling 150 vets who will get the VetsPrevail intervention, and 150 subjects who will not, and comparing them. This is what our company does as a business.” To ensure an adequate random sample of participants, BMSF funded Iraq and Afghanistan Veterans of America (IAVA) to recruit participants in the study. Thanks to IAVA’s advertisement and endorsement, 275 veterans signed up to participate within 24 hours of the site going live. In this partnership, BMSF is funding innovation and an efficacy evaluation that healthcare providers will rely on to make future funding decisions.
Such work is not cheap. Rush University will receive nearly $600,000 to conduct the study, and IAVA received nearly $200,000 to recruit patients and ultimately produce a report on the findings. If the research provides definitive proof of program effectiveness, though, and helps inform the decision making of other funders, it will be money well spent.
Demanding Rigor in a New Program
Just before Grimes began her work at the foundation, she heard Barbara Van Dahlen, the founder of Give an Hour, speak at a conference of the American Psychiatric Foundation. While Van Dahlen’s work with Give an Hour centered on matching volunteer mental-health professionals with veterans in need (see case 12), she was also working on a new idea for coordinating local services for veterans.
It was called the Community Blueprint, and the concept was to have localities provide packages of support services to veterans, servicemembers, and their families. “It sounded like a good model,” says Damonti, “but no one had operationalized it to see what works, what doesn’t work, what are the things you should think about. How do you bring community groups together around veteran issues?”
It was a good match for BMSF. Van Dahlen had an innovative idea. It needed to be tested, and then its lessons shared nationally.
BMSF didn’t just cut a check and hope for the best. Grimes worked with Van Dahlen to refine the grant. “Barbara is a huge visionary—she wanted to go national, she wanted to roll it out. But we said, ‘We’re all about targeted programs—testing things before you expand them. So what do you think about developing it, then partnering with one or two communities to really evaluate it?’ She totally got it. Most of our grantees really appreciate our ability to help them focus.” Damonti continues, “So the initial grant we made to Give an Hour was to go to two very large military communities—Norfolk, Virginia, and Fayetteville, North Carolina—to model the Blueprint, put it to work, and kick the tires on the thing.”
With a keen eye on outcomes, BMSF helped Give an Hour design a before-and-after survey of military families to measure the Community Blueprint’s effects. Grimes and the BMSF team also required Give an Hour to develop a step-by-step manual encapsulating what was learned in these pilots. Taken together, these will help any future funders or organizations aiming to replicate the Blueprint.
The Scientific Approach
Other grants in BMSF’s mental-health portfolio run the gamut: behavioral interventions for disabled veterans, family education for veterans at risk of suicide, peer advisors for veterans on college campuses, intimate-partner violence prevention, and care for homeless female veterans, among other topics. Asked why BMSF funds such a wide variety of projects focusing on different subpopulations, Damonti answers in true BMSF fashion:
When you work for a healthcare company, you don’t do a clinical trial for heart disease on 5,000 men, look at the results and say, “Okay, this is going to work on a woman.” Strategies have to be developed for specific populations because the complications of, for instance, getting young males and females to treatment are different.
By adhering strictly to its roots as the philanthropic arm of a rigorously science-based company, the Bristol-Myers Squibb Foundation has thus carved out a distinctive niche for itself. It is a niche that will yield benefits not only to veterans, servicemembers, and their families—but also to fellow donors who want to be sure that, when they reach out a friendly hand to those populations, they are actually helping.