More than one year after the passage of the Patient Protection and Affordable Care Act, the future of health-care reform remains uncertain. While some believe PPACA should be implemented as passed and others think it should be repealed, few believe our health-care system is on the right track and most agree that change is necessary. Reform is happening even as we await the fate of the law.
What steps can case managers and other health professionals take to influence policy and successfully navigate the complexities of the policy process?
I’d like to suggest there are seven P’s of the policy process and offer insights to navigate them.
1. The Problem.
Although our nation is divided about the course we should take, most agree that improving access and quality while controlling costs are the goals of fixing a broken health-care system. Data and information are critical to pointing out the problem but alone are insufficient to determine policy. Case managers and other health professionals are content experts. Sharing information coupled with compelling stories is a powerful way to approach the problem.
2. The Policy.
PPACA implementation is under way even as the court challenges proceed. It is expected that the U.S. Supreme Court will consider the constitutionality of the law sometime in 2012. Stay informed. Refer to HealthCare.gov and other sites that provide information on implementation progress.
3. The Politics.
Despite the partisan environment, it is important to know your elected officials. Many states make this information easily available online by simply entering your home address. In addition to your elected representatives, know which government committees have jurisdiction over health issues. In the federal government, the House committees of Energy and Commerce, Ways and Means, and Education and Labor, and the Senate committees of Senate Finance and Health Education, and Labor and Pensions have responsibilities for key areas of health policy. Congressional members and staff generally influence the policy agenda and shape legislative language. The detailed work of policy implementation is the responsibility of the Department of Health and Human Services.
4. The Process.
Policy making has been likened to sausage making. While neither may be pleasant to watch, it is important to have a general understanding of the policy process and participate in the discourse. Participation can be direct or through involvement with professional organizations and other advocacy groups. For those interested in a brief overview and refresher on how are laws are made, review How Our Laws Are Made.
5. The People and Personalities.
There are many interested stakeholders within and outside of government. Consider collaborations with others to promote a broader vision and message. The voices of many are louder than the voice of one. Two recent examples of this collaborative approach are the Tri-Council for Nursing report and the Interprofessional Education Collaborative report.
6. The Press and the Message.
Publish or perish. It is important to share information with a broad audience and deliver the message with clear and concise communications. Publications in academic peer review journals, opinion editorials and the use of social media capture the attention of a wide audience.
7. The Public and the Polls.
Public opinion matters. The public places a high degree of trust and confidence in information received from health-care professionals, but a survey by the Robert Wood Johnson Foundation and Gallup found the public did not think health-care professionals were among the most influential in shaping future health reform. When asked if they thought health professionals should be more influential, the answer was yes.
In sum, reforming the health-care delivery system will be challenging work for the foreseeable future. Fostering a continued learning environment and navigating the complexities of the process will aid in successfully addressing the challenges ahead.
Deborah E. Trautman, Ph.D., RN, is the executive director at Johns Hopkins Center for Health Policy and Healthcare Transformation. Trautman served as a senior health policy adviser to former U.S. Speaker of the House of Representatives Nancy Pelosi. Trautman acknowledges Dr. Wendell Primus, senior advisor on budget and health to Pelosi, for his unpublished conceptualization of the seven P’s.
> Proposed New QIO Standard on Patient Rights May Link to VBP