Health Advocacy: A Case Study

U-M students get valuable coaching on moving good ideas from academia to better health outcomes on a large scale.

On March 23, 2018, motivated students from across the health science schools at the University of Michigan were introduced to skills to help them advocate for the changes in health policies, systems, and practices. The future health professionals also got a sense of challenges and pitfalls they could encounter on the path to improving population health and patient outcomes.

The program began with a welcome from the incoming vice president and president of U-M’s Health Policy Student Association (HPSA), pictured above, which sponsored the workshop along with the Interprofessional Health Student Organization, the U-M chapter of the Institute for Healthcare Improvement-Open School, and the Michigan Center for Interprofessional Education (IPE).

U-M Professor A. Mark Fendrick, M.D. took the podium to present a lively case study of Value Based Insurance Design (VBID), the successful legislative initiative he co-developed at University of Michigan more than a decade ago. In essence, VBID provides a commonsense alternative to conventional health insurance cost-sharing with patients that is set by the price of a prescription or service, advocating instead that cost-sharing be set by the clinical benefit.

“I don’t want my patients to have to get a second mortgage or kickstarter to pay for medication for the cancer I just diagnosed,” Dr. Fendrick said. He cited several more examples of the frustrating situations that he and other VBID supporters seek to improve upon, which often fall under what he referred to as “hashtag InsuredButNotCovered.”

Speaking from his experience with VBID, he recommended getting bipartisan support for any health policy that could – or should – be legislated. When encountering resistance, “assume it’s about money until someone tells you it’s not,” he wryly observed.

He also advised tapping into the expertise of any government relations experts available to you, because they are the “process people needed to help execute good ideas.”

With that introduction, Jenifer Martin, J.D. took the podium. She has worked in government relations at U-M School of Public Health for over a decade, before which she worked in the White House, on Capitol Hill, and for private firms in D.C. She took the students through a step-by-step accounting of how VBID moved from an “ivory tower” idea of a health economist and practitioner to a key component of health care reform, including the Patient Protection and Affordable Care Act.

Clarity of your goal is most important as you try to advocate, explained Martin, a self-described process person. Then comes strategy and talking points. And when swimming into the sea of partisanship, personal stories may help more than numbers, she concluded.

“Jen Martin spoke about effective advocacy – it transcends all areas of health delivery and is critical in moving equitable care forward,” reflected Tianna Morgan, a U-M Public Health student and the incoming president of HPSA. “We must be able to ‘think about the difficult questions and respond from a place of strength’ to be effective.”

Alison Granger, the incoming vice-president of HPSA and also a Public Health student, appreciated how the speakers stressed “the importance of being able to communicate on an issue you care about, to make people understand why they should care.”

HPSA leaders had also been part of another U-M interprofessional workshop a week earlier. Sponsored by the Michigan Center for IPE, it brought together 20 student leaders to brainstorm about how their Michigan education could best prepare them to work together in teams and improve health care.

“The VBID case study is a perfect example of a theme we’ve been focusing on all year – Health in All Policies,” said Michigan Center for IPE Assistant Director Vani Patterson, MPH. “As U-M prepares students to be dentists, nurses, or any other health professional, we also need to prepare them to advocate for better systems which will allow them to provide the best care possible to their patients and communities.”

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