Executive office update: Managed care reforms of the 2017 General Assembly: Turtles on a fence post

Saturday, July 01, 2017 12:07 PM

by Alfred Gilchrist, CMS CEO

The panel of legislative managed care operational fixes covered in detail in this issue of Colorado Medicine, to borrow a barnyard mixed metaphor, are turtles on fence posts: They didn’t climb up there by themselves. They are the result of two years of the blocking-and-tackling fundamentals of grassroots engagement, in-depth policy development, message development and political involvement to ensure on-the-ground support from the bill sponsors and their colleagues on both sides of the aisle. This is what is required to move a complex legislative package in an adversarial process to the governor’s desk.

Our board of directors, drawing from extensive surveys of CMS members measuring their managed care “pain points,” listening sessions between physicians and practice managers and the Department of Insurance, and the insights drawn from our vigorous opposition to the health plan mega-mergers, set a goal of achieving enhanced patient and provider protections matched to member concerns.  Over the two-year period, we worked through the range of time-honored tactics to give us the best possible chance at success, i.e., a failed mediation with Colorado Association of Health Plans, the ongoing work of a multi-specialty policy development working group to filter and assess the evolving policy options prior to and during the session, and – just as critical during the 2016 election cycle – a methodical local medical society engagement on behalf of candidates and incumbents generally supportive of our policy choices.      

Sometimes, and this is one of those times, our commitment to political engagement on your behalf has a more visible ROI, an investment that can be measured both in terms of managed care reforms (laws enacted) and the opportunity costs – bad things that could have happened but for our advocacy and the strong alignment of legislators with our views. (Exhibit A: Blocking a push by the plaintiff attorneys to find some means of raising the damage cap or otherwise enhancing the economic return on their investment in a malpractice suit, which will no doubt soon return with the full force of the trial bar’s formidable political muscle.)

You need not have a single political chromosome in your DNA to see the consequence of politics on health care policy. But, even as we survey our members to assess the possible real-world, exam-room and community-centric consequences of what Congress is considering, our politically and policy-engaged physicians are looking at changes that could profoundly alter the means of federal support of Medicaid, health insurance purchased on the exchange, and a complex shift of funding and operational issues.

Most physicians are understandably cynical about health care politics. So let us and your more politically inclined colleagues manage that investment. If you lack the appetite or interest in political engagement, join us vicariously by investing in COMPAC, the CMS political action committee. In the 2016 election cycle, COMPAC backed a diverse range of legislators on both sides of the partisan aisle who will now be challenged by our many adversaries in the 2018 election cycle. At a minimum, these legislators deserve and must be able to count on our unwavering loyalty and support next year.

Our adversaries have the guns, the deep pockets; we will always be outspent – but we have the numbers. (Anyone recall the late-60s Doors classic?) We are organized, engaged and we will not be outworked. The medical community, especially in the districts where you live and work, has a locally relevant street credibility when we back a candidate or an incumbent that others don’t. The visible support of the medical community outweighs the sheer weight of the contributions, directly and more so indirectly of those who would oppose us.

It is an honor and a privilege to be a medical society advocate, especially during this volatile transition. Thank you for participating in Central Line and for completing our member surveys. Participation in these activities is vital to advancing sound, sustainable health care policy in the tumultuous parallel universe of politics. Now is the time, post-adjournment of the 2017 General Assembly and pre-election cycle, to recharge and recommit.

Please consider joining me and “max-out” your support of COMPAC, though any level of contribution will be appreciated and used wisely – which is to say shrewdly – on medicine’s behalf. (See this link for how to join us.)

Thank you for your consideration and all that you do for patients.