Advocacy 201 - Dos and Don'ts in Producing Long-Term, Productive Relationships with legislators
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This presentation was given at the Family Medicine Congressional conference in session "Lobbying 201" by Greg Griggs, MPA, CAE.
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This document summarizes two pieces of Georgia legislation related to rural health and primary care education. The first is the 2017 Preceptor Tax Incentive Program (PTIP) bill (HB 301) that aimed to provide tax credits for physicians, nurses and physician assistants who serve as preceptors for students. The second is the 2018 "Achieving Connectivity Everywhere (ACE) Act" (SB 402) that established a framework to expand broadband access across Georgia, especially in rural areas, by providing grants to public-private partnerships. The bill recognized broadband as essential for education, healthcare and more. It prioritized grants that would provide connectivity for hospitals and telehealth facilities.
Improving Health in U.S. Rural Communities: The Role of the AAFP
Improving Health in U.S. Rural Communities: The Role of the AAFPAmerican Academy of Family Physicians
This document discusses health issues facing rural communities in the United States and the role of family physicians in addressing these issues. It notes that rural residents have higher rates of poverty, fewer physicians per capita, and worse health outcomes. Common challenges for rural physicians include workforce shortages, lack of specialty care access, and long work hours. The AAFP aims to establish itself as a leader on rural health issues through initiatives like advocacy, payment reform, practice support, and collaboration with other organizations to improve health in rural America.Prescription Drug Abuse: A Chapter Focus
The document discusses Florida's HB 21 legislation aimed at reducing opioid deaths and addiction. It establishes a 3-day limit for acute pain opioid prescriptions but allows exemptions. It requires PDMP checks and continuing education for prescribers. While intended to curb the opioid crisis, there was no input from medicine and it has led to unintended consequences for chronic pain patients. Amendments are being considered once elections are over.
Prescription Nation 2018: Facing America's Opioid Epidemic
The document is a report from the National Safety Council on prescription drug use in 2018. It discusses key actions states are taking to address the opioid crisis, such as prescriber education, integrating prescription drug monitoring programs into clinical settings, increasing access to naloxone to treat overdoses, establishing opioid prescribing guidelines, improving data collection and sharing, and increasing treatment availability for opioid use disorders. It also outlines new legislative trends on issues like emergency room interventions and education requirements.
Scope of Practice: A Chapter Focus
This document summarizes the recent changes to South Carolina's laws regarding the scope of practice for advanced practice registered nurses (APRNs). It outlines the history of legislative efforts over the past two decades to expand APRN scope, culminating in a compromise bill passed in 2018. Key aspects of the new law include replacing written protocols with practice agreements between APRNs and physicians, expanded prescriptive authority for APRNs, and specifying medical acts APRNs can perform. It also provides guidance for developing practice agreements and lessons learned from the advocacy process.
Scope of Practice Legislative Landscape
This document summarizes scope of practice trends for various healthcare providers. It discusses how 26 states and DC have granted independent practice to nurse practitioners. It also outlines proposals for physician assistants to establish independent regulatory boards and directly bill insurers. The document reviews passed legislation in 4 states creating a new provider category called assistant/associate physicians who have completed medical licensing exams but not a residency. It summarizes scope expansions under consideration for pharmacists, psychologists, and naturopathic providers.
State Roundtable
This document lists 35 U.S. states and territories in alphabetical order. It appears to be a list of locations for some type of event organized by state rounds or locations, potentially for medical professionals based on the URL referenced.
Work on Primary Care Spending Measures
This document summarizes the work of the Milbank Memorial Fund to develop and promote measures of primary care spending. It discusses a study finding that commercial health plans spend between 4-8% of total medical spending on primary care. It outlines Milbank's agenda to build evidence on primary care spending, collaborate with other organizations, and disseminate findings. Milbank plans further research, supporting state efforts to replicate measurement and regulation, and continued work to increase primary care investment.
Primary Care Spend: A Chapter Focus
This document summarizes Oregon's experience increasing primary care spending through legislative and collaborative efforts. It outlines how Oregon created a patient-centered medical home program, increased transparency of primary care spending across payers, and eventually mandated a minimum primary care spending threshold of 12% of total medical expenditures. Key lessons included starting with less controversial policies, using data to drive transparency and goals, and engaging a multi-stakeholder collaborative. The presentation recommends similar best practices for other states seeking to invest more in primary care.
State Efforts to Rein in Drug Costs
This document summarizes state legislative efforts to address rising prescription drug prices. It finds that in 2018, 28 states passed 45 new laws focused on drug costs, particularly related to pharmacy benefit managers and increasing transparency. It also discusses emerging policy approaches like price gouging laws, drug affordability boards empowered to set rates, and importation from Canada. The document predicts more state action on these issues in 2019 and provides resources for advocates and legislators working on drug pricing reforms.
Election Update: What's at Stake?
This document provides an overview of competitive US House races for the 2018 midterm elections that will indicate whether Democrats are having a good night in their goal of taking back the House majority. Key races to watch are listed for New York, Pennsylvania, Illinois, Minnesota, California and other states. Winning toss-up seats will be important for Democrats, while winning tilts and likely Republican districts would signal a strong Democratic wave. The document also promotes the work of the American Academy of Family Physicians in bringing its members together with legislators to advance its policy agenda.
Election Update: What's at Stake?
FiscalNote is a leading technology company providing policy data and tools to over 5,200 clients. It has 350+ employees across offices in Washington DC, New York, Baton Rouge, Brussels, and Seoul. Upcoming state elections may impact policy issues like healthcare, Medicaid expansion, and prescription drug prices. The document forecasts outcomes of gubernatorial and legislative races and reviews key ballot initiatives in states like Idaho, Maine, and Massachusetts. It concludes some Republican candidates are embracing Democratic healthcare policies and changing voter expectations may decrease Republican "trifectas" or party control of state government.
What's Going on with Medicaid? Waivers, Parity, and Other Trends
What's Going on with Medicaid? Waivers, Parity, and Other TrendsAmerican Academy of Family Physicians
This document discusses trends in Medicaid Section 1115 waivers. It provides an overview of the National Association of Medicaid Directors (NAMD), which supports state Medicaid directors. The rest of the document summarizes key topics discussed in a NAMD presentation on Section 1115 waivers, including why states use them, operational aspects like stakeholder engagement and budget neutrality, and trends in waiver policies around community engagement, pharmacy benefits, delivery system reform, and behavioral health integration. The document concludes by providing additional NAMD resources on these topics.Medicaid: A Chapter Focus
The document discusses Georgia's successful advocacy for increasing Medicaid payment rates for primary care physicians and OB-GYNs. It outlines the steps taken: 1) Forming a coalition of physician groups; 2) Building the case by highlighting Georgia's Medicaid payment rates had not increased in 15 years and physician shortages; 3) Presenting a unified ask that resulted in increasing 78 payment codes to Medicare parity levels. The coalition is now asking to open after-hours care codes for Medicaid. The document also discusses Arkansas implementing the first Medicaid work requirement and over 8,500 people losing coverage for not complying with reporting hours worked monthly online.
State Strategies for Administrative Simplification
This document summarizes efforts to advance prior authorization reforms. It shows that 86% of physicians report prior authorization burdens have increased, with an average of 14.6 hours spent per week on prior authorizations. 92% of physicians report care delays and treatment abandonment as a result. Principles for reform focus on clinical validity, continuity of care, transparency, timely access, and alternatives. Recent legislative activity and tools/resources to advance the conversation on reform are presented.
Administration Simplification: A Chapter Focus
This document summarizes the journey of prior authorization legislation in Ohio from 2015-2018. It discusses how the author testified in support of bills in 2015-2016 (SB 129) and 2017-2018 (SB 56/HB 72) regarding step therapy. The legislation went into effect in 2017 with additional provisions in 2018. It outlines the new rules for insurers related to prior authorization, including disclosure requirements, timelines for responses, and prohibitions on retroactive denials. Additional rules implemented in 2018 include requirements for web-based prior authorization systems and faster response times.
Prescription Drug Abuse
The document discusses the opioid epidemic in the United States and the role of physicians in addressing it. It notes that opioid overdose deaths have significantly increased since 2012, with over 50,000 deaths in 2015. The American Medical Association (AMA) created an Opioid Task Force to provide recommendations. The AMA is working to increase prescription drug monitoring program usage, safe prescribing practices, and access to treatment for substance use disorders. While physician opioid prescriptions and education efforts have increased to address the epidemic, challenges remain regarding stigma, treatment capacity and access, guideline consistency, and insurance coverage of alternative treatment options.
Health Landscape
This document provides an overview of HealthLandscape, which is a tool created by the American Academy of Family Physicians to help with data-driven healthcare decision making through geographic information systems (GIS) mapping. The presentation discusses HealthLandscape's history and capabilities, provides a brief introduction to GIS, and outlines several free online HealthLandscape mapping tools that can be used to visualize health outcomes, social determinants of health, and healthcare workforce data. It also describes how HealthLandscape can work with organizations to create custom maps and analyses to support advocacy efforts and other projects.
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Government Relations Update - Ways to Get Involved
Government Relations Update - Ways to Get Involved
Improving Health in U.S. Rural Communities: The Role of the AAFP
Improving Health in U.S. Rural Communities: The Role of the AAFP
Prescription Nation 2018: Facing America's Opioid Epidemic
Prescription Nation 2018: Facing America's Opioid Epidemic
What's Going on with Medicaid? Waivers, Parity, and Other Trends
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Advocacy 201 - Dos and Don'ts in Producing Long-Term, Productive Relationships with legislators
- 1. Gregory K. Griggs, MPA, CAE Executive Vice President NC Academy of Family Physicians
- 2. Research – what you should know • What party are they in? • How long have they been in Congress? • What’s their occupation? • What Committees are they on? • Do you have any connections with them? - Example: Sen. Burr’s Former Scheduler • What are their policy interests? • Are they in a Safe or Competitive District? Resources - • Their own Congressional website • Social media: Facebook, twitter, • Google – find their campaign website, news, etc.
- 4. 4 Stories are powerful But the story must be underpinned by the evidence. Health is Primary – About Using Stories to Support Our Evidence • Primary care controls cost/promotes quality • Social determinants drive health inequality • Access issues lead to poor outcomes for patients Plural of Anecdote = Public Policy (If you have the evidence on your side)
- 5. DO: Be Prompt Select Just 1 or 2 Issues to Discuss Be Honest, Brief and Direct – Be Succinct Provide Background Material (If applicable) Be Polite, No Matter What (All the Time) Ask What You Can Do for them Thank Them and Follow Up
- 6. Don’t: Be Inpatient Assume They Will Remember You Spend Excess Time or Be Too Verbose Give too Much Material Be Rude or Argumentative Make Demands Discuss Partisan Politics or Contributions Underestimate the Importance of their Staff – The Staff Member is the Expert
- 7. The End of the Meeting Should be the Beginning (or continuation) of Your Relationship. Offer to Serve as an Information Resource. Ask If There is Anything You Can Do For Them.
- 8. 30% are not even eligible to vote. 30% do not register to vote. So only 40% --200,000 are registered voters. 50% are registered and don’t vote – 100,000 voters. 1% of people donate money – 5,000. 0.1% volunteer – 500. Who Do You Think Has the Influence?
- 9. Send a Thank You E-Mail or Note and Renew Your Offer to Serve as a Resource. Try to Follow Up With Them When They are Back in the District. Go to a District Event / District Councils • Former Example: Small Business Advisory Group Sign Up for their Newsletter/E-News Consider Contributing to their Campaign in the Future.
- 10. Influence Doesn’t Happen Over Night • It Takes Repetition • It Takes a Relationship • And It Takes Money Build Alliances (Medicaid Reform in NC) Support Your Position Through Other Means • Letter to the Editor or Guest Column in Newspaper • Politicians Read their Local Newspaper It’s a Marathon, not a Sprint.
- 11. CONTACT INFORMAITON: • Gregory K. Griggs, MPA, CAE • NC Academy of Family Physicians • PO Box 10278 • Raleigh, NC 27605 • Office Phone: 919-833-2110 • Mobile Phone: 919-417-6692 • E-mail: ggriggs@ncafp.com