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Kavita Patel Answers 5 Questions on the Supreme Court Decision and Collaborative Care

Posted By Kavita Patel, Thursday, June 28, 2012

Collaborative Care Policy Month

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 national summit?

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 and efforts?

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:

  1. Think of all the changes you would need to deliver collaborative care (change in payment, health IT changes, etc).
  2. Now think of which policy elements are the LEAST difficult - what would not cost a lot or take an act of congress.
  3. Write down in 2 pages or less what you need a policymaker to do and if possible, add in some cost measure.
  4. Get some of your fellow practitioners to support your efforts.
  5. 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.
  6. 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
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.


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