Fostering Productive Dialogue on Health Reform Implementation

By Catherine Hess
May 2011
This blog post was originally published on Health Affairs Grant Watch Blog

Catherine Hess of the National Academy for State Health Policy (NASHP) reports on how foundations are supporting efforts to foster dialogue between states and stakeholders during implementation of health reform. Facts, not ideology, should ground discussions was among the lessons learned at a meeting of state officials and advocates in southern states.

Even in political climates where health care reform can be polarizing, shared goals in improving health care and health can bring officials and advocates together in productive dialogue about how each can carry out complementary roles to achieve those goals, a March meeting of advocates and state officials in southern states, sponsored by the Public Welfare Foundation, showed.

Subsequently, on May 11, the National Academy for State Health Policy (NASHP) convened a webinar based on that meeting and titled “Building Partnerships: State Officials and Advocates Working Side by Side on Health Care Reform.” Sponsored by the Public Welfare Foundation, this webinar and a forthcoming brief share some of the lessons learned in complementary projects conducted by NASHP (a national policy analysis and assistance organization focused on states) and the national consumer advocacy organization Community Catalyst.

For several years, Public Welfare invested in building consumer advocacy capacity in eleven southern states, through grants to Community Catalyst. In the past year, the foundation supported NASHP to help engage southern state officials with those advocates on implementation of health reform—that is, to reach out to the officials and invite them to talk with and work with advocates on common-ground issues. While this most recent project was short-term, the need remains for support (financial and otherwise) to bring together policy makers, advocates, and other stakeholders to build or strengthen working relationships to tackle the daunting challenges of health care reform.

At the May 11 webinar, Rebecca Mendoza of the Virginia Department of Medical Assistance Services shared some lessons learned from Maximizing Enrollment, a Robert Wood Johnson Foundation (RWJF) initiative (for which NASHP serves as national program office). (These lessons had sparked active discussion, at the previously held March meeting, among the nine states attending about the roles that advocates and states each can play in improving enrollment systems, which will be so critical to the success of health reform.) Mendoza also talked about plans to convene a variety of stakeholders for a health care reform summit focused on children, with support from Virginia’s Maximizing Enrollment grant.

Moriba Karamoko, director of the Louisiana Consumer Healthcare Coalition, talked frankly at the meeting and during the webinar about how his organization and the state had developed an effective working relationship in planning for the movement of Medicaid recipients into managed care. Karamoko emphasized to webinar participants that both agency officials and advocates need to come prepared for productive exchange. Advocates, for example, need to be ready with potential solutions and not just dwell on problems, and state officials need to respect advocates’ cultures; both need to be okay with, as they say, “agreeing to disagree.” At the meeting, and on the webinar, we summed up some of the key lessons learned in improving working relationships—build trust through direct communication (do not blindside each other); create formal (for example, advisory committees) or informal (for example, monthly phone calls) ways to communicate; and aim to ground the discussions in facts, not ideologies.

NASHP will be applying these lessons in Children in the Vanguard, a collaborative network of ten states focusing on maintaining and increasing the number of children with health insurance coverage in the context of health care reform. Supported by the Atlantic Philanthropies as part of its campaign to protect and expand children’s coverage, this network is made up of Medicaid and Children’s Health Insurance Program (CHIP) officials from states across the country who want to work toward this goal. One of the objectives here is to strengthen states’ relationships with advocates, and NASHP will be convening state officials and advocates to focus on improving enrollment of children and youth now and as states prepare new systems for 2014, when the expanded eligibility for Medicaid and new insurance exchange provisions of the Affordable Care Act kick in.

While my and NASHP’s experience suggests that nothing is as effective as face-to-face interaction for promoting exchange of information, learning, and collaborative problem solving, other less costly means such as calls and webinars can be effective in sustaining and nurturing such relationships. The May 11 webinar shared ideas with a diverse audience of state officials, advocates, and others, such as policy researchers, and tried to stimulate interest in such collaboration. However, newer technologies and modes of communication also can be tapped to foster exchange of ideas and information.

NASHP’s recently launched State Refor(u)m, a Web-based platform for exchanging information on state implementation of health care reform, already has more than 600 registered users and many more visitors, including a variety of stakeholders beyond the core audience of state officials. With funding from the RWJF, NASHP developed and is maintaining this website, which offers real-time opportunities to share materials and converse about milestones toward implementation of eleven key indicators of state success in health reform implementation. The slides for the May 11 webinar can be found here, posted under the indicator called “Engage the Public in Policy Development and Implementation.” Other indicators address such areas as simplification and integration of eligibility systems and being strategic in implementing insurance exchanges.

The foundations mentioned in this blog post have invested in supporting information exchange and building relationships between state officials, advocates, and other key stakeholders. Supporting neutral convening of key parties to come up with solutions for implementing health reform is one of the most important roles that foundations can play. If we are to reach 2014 ready to enroll millions of uninsured people in coverage that will offer access to high-quality care, we will need funders to play a continued and even stronger role.


Leave a Reply