Consumer Engagement in Reform Implementation:

A Roadmap for Funders and Advocates

Preliminary Report

Susan SherryCommunity Catalyst

GIH Audioconference December 2009

Work Supported by the Public Welfare Foundation

Image: avecteatre.wikispaces.com

Passing Reform Legislation

Making Health Reform Work

© Community Catalyst 2009

Overview of Presentation

The Work Ahead Lessons from Prior Implementation Capacities Required Defining Reform to Public Policy and Regulatory Demands State Actions Key Success of Reform On-the-Ground Infrastructure Needs Role of Funders

© Community Catalyst 2009

The Work Ahead

Maintain and expand public support for national reform

Protecting existing coverage (Medicaid, CHIP, etc.)

Implementation

Making improvements in the law

New opportunities and unaddressed issues

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What We Have to Do

Define reform to the public Policy and regulatory work

• Intensive and complex• New federal/state paradigm

Make it work on the ground • Grassroots infrastructure & systemic feedback• Health delivery system – quality and cost• Population health

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Lessons from Prior Implementations – SCHIP, TN, FL, MA, ME and Others

Consumer feedback improves policies

Advocates encourage transparency and play unique intermediary role with public

Agency relationships are important

Documenting how reform is working is valuable

Implementation happens in many places and requires resources for a set of integrated core advocacy capacities.

© Community Catalyst 2009

Capacities Required

“Consumer Health Advocacy: A View from 16 States” (2006) found strong systems of advocacy make a difference in all environments

Effective advocacy requires coordination across state and local organizations of six core capacities

Grassroots organizing Policy analysis Coalition – stakeholder alliances Campaign Communications Resource development

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Capacities Have Grown

Since 2006 – significant investment in building systems and learning community• CVC – RWJ - 18 states• SHP – PWF – 11 states• Many other national and local funders in above states and in NH,

MO, NM, and others

Advocates developed strong relations with both state and federal policymakers

State infrastructure and learning community in place

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Defining Reform to the Public

Defending against attacks • 2010 elections – key battlegrounds in specific states• State referendum, “symbolic” legislation, linking state

budget crises and Medicaid with reform

Proactive engagement • Public education• Recognition of specific progress along the way• Acknowledging specific problems (and solutions)

© Community Catalyst 2009

Defining Reform to the Public: What is Needed

Coordinated national opinion research and messaging support including “rapid response” capacity

Ongoing public education

Build a grassroots base

Continued local communications with federal and state policymakers

Engage with referendum and legal attacks

Electoral support

© Community Catalyst 2009

Policy and Regulatory

Federal and state interaction – two-way street

States will have significant implementation role (see NASHP policy brief)

Issues include: • Medicaid/CHIP• Insurance reform and exchanges• Affordability• State fiscal and revenue issues• Safety net • Delivery system reform

© Community Catalyst 2009

Policy and Regulatory: What is Needed

Coordinated national consumer organizations to monitor, analyze and address consumer concerns at federal level

Build new state advocate policy expertise

State (and federal) governments under-resourced • states will rely on well-organized interests for policy development• state consumer advocates must be well-organized

Build stronger stakeholder relations at state level

© Community Catalyst 2009

States Will Influence Success of Reform in Different Ways

“Leader” (proactive) states will push envelope on cost/quality issues to move national agenda further

“Defensive” states (many southern) have largest access, quality and disparities issues – success here gives real meaning to national reform

“Intermediate” (purple) states have disproportionate influence on sustaining national political will

Individual states have specific significance (NV)

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State Political Environments Vary Widely(2008 Electoral Map)

Image: dashboardinsight.com

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Making It Work On the Ground

Consumer representation

Consumer assistance/feedback

New/unfinished business• Health equity• Delivery reform in proactive states – new models• Delivery issues in defensive states – low income• Community benefits – population health

Grassroots advocacy and mobilization

Strengthening stakeholder relations

© Community Catalyst 2009

Needs

Immediate need for both defense and implementation

Develop new expertise in new issue areas

Coordination among national organizations – division of labor

Collaboration and coordination between state-based and national organizations

Strengthen and build state systems of advocacy and campaigns

Resources from a variety of sources (c(3), c(4),and electoral activity)

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Image: theyoungconservative.wordpress.com

© Community Catalyst 2009

Stay the Course!

Role of Funders

Mission not accomplished - - - - -

Role of Funders

Foster collaboration among national organizations

Support new expertise

Invest in state-based systems of advocacy

Engage in multiple arenas – state and federal, implementation, public education

Build new funding partnerships

© Community Catalyst 2009

Community Catalyst, Inc.

30 Winter Street, 10th Fl.

Boston, MA 02108

617-338-6035

Fax: 617-451-5838

www.communitycatalyst.org

Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all.  Since 1997, Community Catalyst has been working in partnership with national, state and local consumer organizations, policymakers, and foundations to build the consumer and community leadership required to transform the American health system so it serves everyone—especially vulnerable members of society.

Our staff of experienced policy analysts, attorneys, community organizers, and communications specialists has worked with organizations in over 40 states. From Oregon to Orlando, Community Catalyst strengthens organized consumer voices wherever important decisions about the health system are made: in communities when hospitals go up for sale; in courtrooms where consumers challenge the illegal practices of drug companies; and in statehouses when advocates strive to win improvements in health care programs.

Presented by Susan Sherry

Electronic copies of this presentation are available by calling 617-338-6035.

Organizations seeking to distribute or otherwise make widespread use of this

publication are asked to notify Community Catalyst.

Work supported by the Public Welfare Foundation

© Community Catalyst 2009