A few days ago I had the pleasure of hosting a call between two of my colleagues from separate private foundations from different states. Both are well-capitalized organizations and have exceptional leadership, and both have taken a keen interest in the transformation of their states’ safety net provider system through practice improvement measures. Specifically they have identified the integration between primary and behavioral health as a key concept to the transformation.
While they both came to the table with some knowledge the basics, they each quickly learned a lot about the challenges of change management and workforce development at the provider level, but also about the obstacles and logjams at the systems level – specifically at the policy and payer level.
Our small brief summit focused much on the systems level challenges. Two key points emerged:
- We identified that there is a constant “bleeding of institutional knowledge” in stakeholders, policy makers and often payers. This is through administration changes in the governor’s office, shifts in healthcare priorities and usually some other political wrangling.
- States often claim that certain potential policy shifts are not their priority at this time. For example, many states continue to prohibit the allowance of billing for two services in one day, and restrict the use of certain code sets that would promote integrated services. “(State Medicaid officials) don’t see this is a priority right now because they’re focused health homes,” is what we typically hear.
We brainstormed about these issues for a while. We talked about strategies on how to counter or adjust to the fairly constant changing of personnel in key positions; while there are certainly challenges in that, there are also opportunities. How can leverage that known variable to our advantage? Are there workarounds we can utilize to lessen the impact of political changes? We also talked about the priorities of policy makers and the perceived stalling or avoidance of dealing with the same-day billing and code modification issues. What we’re talking about in these modifications aren’t tectonic shifts; in fact in states where they have been applied, the process was rather simple and impact on the state rather minor (yet significant for the providers). How can we demystify these issues? What is our best advocacy steps to educate a rather disinterested and avoidant group of people on this important topic?
Certainly some foundations come to the table with significant financial and political equity. Leveraging their influence is a powerful arrow in the quiver – but it has to be used at the right time, at the right target, and with the most impact – otherwise you risk diminishing returns every time you fire it. Understanding the political landscapes and relationships between payers and policymakers is vital, and making sure you have access to the people who can navigate you through those potentially dangerous waters is necessary. Knowing that certain positions in some state or payer departments wield more influence than others is also important; for example, we know when pitching out-of-the-box contractual agreements with payers our best tack is to deal directly first with the plans’ medical directors, not the contract specialists. And most importantly coming to the discussion armed with data; but not just raw spreadsheets full of statistics and outcomes. It has to be scoured and polished, refined and processed, and presented in a simple uncomplicated form that tells a story in, ideally, 3-4 slides of a Powerpoint presentation. This is where a good data analytics professional is a great investment.
Do we have a story to tell at Cherokee Health Systems and how our behavioral-enhanced patient centered medical home model is effective for populations and efficient for payers? You bet we do. Figuring out the best way to tell that story is a new challenge in every state where we provide technical assistance to our safety net colleagues, but through the support of some terrific foundations, that process takes on a whole new life.