Successful collaboration

Thursday, September 01, 2016 12:15 PM

AMA, CMS and other states team up on advocacy strategy

by James L. Madera, MD, Executive Vice President & CEO, American Medical Association

This July, the American Medical Association (AMA), the Colorado Medical Society (CMS), and our coalition of 16 other state medical associations achieved a tremendous victory for the nation’s patients when the United States Department of Justice (DOJ) and numerous state attorneys general sued to block the Anthem-Cigna and Aetna-Humana mergers. Your Colorado Medical Society was at the forefront in coalition efforts and strategic thinking.

This victory was a major triumph in a difficult environment – an environment where the health insurers spent millions of dollars more than the coalition did on state and federal lobbyists, where close relationships exist between state insurance regulators and the health insurers they oversee, and where closed, nontransparent merger review processes stacked regulatory reviews in the insurers’ favor.

Jointly developing a uniform, evidence-based advocacy strategy was just one way in which the AMA, CMS and the rest of the coalition worked together to successfully challenge the mergers. The formula for our success was clear: (1) create an irrefutable evidence base; (2) develop and implement a shared strategy; and (3) partner with stakeholders both within and outside of medicine.
In terms of the evidence base, the AMA’s authoritative “Competition in Health Insurance: A Comprehensive Study of U.S. Markets,” which uses the DOJ’s and Federal Trade Commission’s own metrics when evaluating health insurance mergers, provided empirically rigorous data showing that the proposed mergers would be bad for patients. So too did the AMA’s retrospective analysis of the 2008 merger of United HealthGroup and Sierra Health Services, which disproved claims that insurers pass on savings to consumers.

We then developed a shared strategy that allowed us to align our values and communicate with authority. CMS’s and other coalition members’ efforts added to the AMA’s work in ways that were essential to the success of this evidence-based advocacy. For example, CMS’s extensive survey of Colorado physicians gathered a wealth of information that helped tell the merger monopsony story in great detail. The survey data was shared with the DOJ, which opened the door to communications between practicing Colorado physicians and that agency. These communications gave Colorado physicians the opportunity to express their concerns about the negative effect that the mergers would have on their patients in the most realistic, practical and convincing terms. Our joint efforts paid off – after filing its lawsuits, the DOJ called to thank both the AMA and our state medical society collaborators, including CMS, for our collective efforts. It was this joint, evidence-based advocacy that ultimately enabled us to trump insurer rhetoric. Our voices were heard – in large part because we never lost sight of the key issue – that the mergers would hurt patients’ access to, and the quality of, health care.

Finally, we forged a robust alliance with key allies. We were creative and relentless as we developed the third prong of our formula. We found ways to work with hospital associations, consumer groups, and the nation’s top experts on antitrust and other key issues. With a robust evidence base and a shared vision, the path to aligning with critical stakeholders was clear and unencumbered.

So what’s next? Although the lawsuits have been filed, the final chapter has yet to be written, as Anthem and Aetna are vigorously challenging the lawsuits in both federal and state courts. The AMA and our state medical society coalition will continue to actively oppose the mergers at every opportunity until all merger issues are finally resolved. We will continue to engage both the national and local media – making certain that our shared message is heard – as a counter to the insurers’ specious claims that these mergers benefit patients. Our work is not over. We will not rest until the legal process has run its course.

The dramatic success we have already achieved demonstrates the value of being a member of organized medicine. It provides a perfect model illustrating how the AMA and state medical associations can work together to jointly achieve success on other issues of primary importance to organized medicine – issues that impact patients and physicians committed to protecting them.