Dr Kavita Patel, a fellow of the Brookings Institution, and a former policy director in the Obama White House, provides high-level analysis of today's Supreme Court ruling and other important collaborative care policy issues.
CFHA: Today (June 28, 2012) the
Supreme Court ruled that the Affordable Care Act and its individual mandate
are constitutional. How do you foresee that this ruling will impact the
growth of collaborative care models?
Kavita Patel: The Supreme Court's
decision today reaffirmed that now more than ever, we need to spend less time
debating the merits of a mandate and more time doing the hard work- putting
together models of care that are truly collaborative and finding financial
incentives that help to show providers that they can deliver collaborative care
and have income security. For patients, the decision today will help them
look for collaborative models of care when they are trying to purchase a health
insurance plan that is both affordable and truly patient-centered.
CFHA: Each year at the CFHA conference, clinical
leaders and policy makers convene a 1-day summit to advance collaborative care
policy in the host state. As our 2014 conference will be in Washington
DC, it will be our first opportunity to host a national summit. If you
were chairing the DC planning committee, what would be your vision for the
Kavita Patel: I believe that the
vision for 2014 is about truly bringing the dialogue around collaborative care
into the national forefront. This means
that we will need to better illustrate how collaborative care is superior to
care in silos (not that difficult to do).
But also, demonstrate the spillover effect into other aspects of health—well-being,
workplace productivity, decreased social isolation/loneliness and ultimately
upward mobility. Now we may not have all the research to support these
claims that I am making or hypothesizing, but if we can think beyond our
traditional borders and stretch ourselves in ways that might really make us
even uncomfortable at times, than we are really making a contribution. I think
that is very worthy of Washington D.C.
The other pitch I would make is for
the CFHA to invite the policy leaders from the various sectors that
collaborative health care touches and put them on a stage and ask them to
figure out how they could redefine policies to better facilitate collaborative
care. So for example, how can folks from Medicare sit on stage with people from
the NIMH and SAMHSA and really honestly address barriers, suspend judgment and
find a path forward to accelerate these models.
CFHA: Does the production of quality
research that supports collaborative care as a best-practice actually help to
move policy? Or, does momentum to change policy come mostly from other sources
Kavita Patel: High quality
research does matter but the momentum to change policy really comes from being
strategic about utilizing research to support the policy change along with
providing policymakers with a sense of how such a policy change will meet their
short term and long term needs. For example, a pressing issue for federal
policymakers is the role of dealing withburgeoning state budgets- the
states of Illinois and Maine recently had their bond ratings downgraded by
Moody's which is devastating for states. Since they can't run a deficit and a
downgrade in a bond rating makes it difficult to borrow money for capital
investments, etc. In downgrading the states' ratings, analysts cited Medicaid
costs as a principal issue. So how can research support the notion that collaborative
care models will help to address growing state Medicaid costs? The answer might
provide the momentum for a policymaker or elected official to take action when
they otherwise might not express interest.
CFHA: As a practicing primary care
internist, what role does collaborative care play in your clinical
setting? What do you see as the obstacles to expanding collaborative care
in your practice?
Kavita Patel: I practice in a
pretty traditional fee-for-service setting.
The truth is that we don’t really practice collaborative care as a group,
but I try to do it in piecemeal. It is
frustrating. I desperately would love to see our country make bold
statements such as the following: "We will only accept care that is
collaborative in both design and in practice”, but unfortunately most of our
financial incentives do not reward such behavior.
CFHA: At the 2011 CFHA conference
you and Frank deGruy presented a plenary session on developing collaborative
care policy "From Grass Roots to Tree Tops". A frustration for
front-line clinicians is that they can see how policies that promote siloed
care and prevent funding integration have direct impact on the viability of
their careers. What do you recommend that a front-line clinician do to
promote policy change at a local or state level?
Kavita Patel: The key is to not get frustrated: persistence pays. Think about the
patients and their families who need this. That will keep you motivated to follow
these 6 steps:
- Think of all the changes you
would need to deliver collaborative care (change in payment, health IT changes,
- Now think of which policy
elements are the LEAST difficult - what would not cost a lot or take an act of
- Write down in 2 pages or less
what you need a policymaker to do and if possible, add in some cost measure.
- Get some of your fellow
practitioners to support your efforts.
- Set up a meeting with the most
likely policymaker who will listen to you.
This may be a pretty junior person, but still the most important quality
is to take you seriously.
- When you meet with her or him,
offer to help with technical support (changing or revising language) as well as
offer names of other practitioners who will be voices of support.
CFHA: Thank you, Dr Patel, for offering some of your valuable time on this notable day!
|Kavita Patel is a fellow in the Economic Studies program and managing
director for clinical transformation and delivery at the Engelberg
Center for Health Care Reform. Dr. Patel is also a practicing primary
care internist at Johns Hopkins Medicine and served in the Obama
administration as director of policy for the Office of Intergovernmental
Affairs and Public Engagement in the White House. She partnered with Dr Frank deGruy to offer the policy keynote address at CFHA's 2011 conference in Philadelphia, PA.|