In March, I had the opportunity to participate in a Government Relations Academy as a mentor for the America’s Essential Hospitals (AEH) group (formerly the National Association of Public Hospitals). Our UTMB executive vice president and Health System CEO Donna Sollenberger is on their Board of Directors. As a part of the Academy, we paid a visit to the office of Domestic Policy at the White House.
No, I did not get to meet with President Obama, nor the First Lady. On a prior visit I did get to greet the First Dog in the actual residence. He has his own security detail.
When people visit the “White House” for the purpose of providing information to policy analysts, that visit actually takes place in one of the many auxiliary buildings next to the residence. Security is still the same and consists of passing through multiple screenings contingent upon advance background checks and clearances. Our meeting was in the Eisenhower Building, which in itself is a beautiful piece of architecture.
The meeting was productive in that we had the opportunity to discuss any subject that we wanted to with the domestic affairs staff. I had heard so many rumors about the imminent demise of the Medicaid 1115 Waiver that I asked the staff member if that was indeed true. He replied promptly that he had heard nothing of that issue, and responded that he would check into it.
He did ask me for a description of “how” the 1115 Waiver was making a difference in Texas. I provided him some specific examples of projects in our 1115 program that Craig Kovacevich and Katrina Lambrecht have so effectively administered, and I described the personal cases with which I was familiar: how lives were changed because of the expanded reach through education, disease management programs, telemedicine, hospital readmission reductions, and the learning collaborative that enables program leadership to share best practices.
As we left the meeting, staff asked for my card. As I handed it to him, he said, “I would like to talk more about the 1115.” Thinking this was a formality, I doubted that I would ever hear back from him. So I was quite shocked when I got a call from Bruce Siegel, president and CEO of AEH, that Domestic Policy Council staffer Tim Gronniger wanted to meet and finish the conversation we had started related to the 1115 Waiver.
Mr. Gronniger and AEH staff
Bruce is very strategic policy expert. He immediately seized the opportunity to invite me to attend meeting #2 with Tim and his staff, along with Dr. Mitch Katz, representing the Los Angeles 1115 Waiver program, and LaRay Brown, senior vice president of the New York City Health and Hospital Corporation.
Craig and Katrina provided me with a comprehensive list of our outstanding 1115 Waiver projects, and Dr. Maureen Milligan, president and CEO of Teaching Hospitals of Texas, put out a request on my behalf to regional anchors for the waiver all over the state of Texas to send examples of their favorite projects. I had an abundance of information to sift through for the April 29 meeting in DC.
On Tuesday evening, I flew to Washington and joined Bruce and his colleagues for breakfast to plan the meeting with Tim Gronniger at the White House. We walked over to the White House gates after numerous detours because of increased security procedures. Finally, we worked our way through the multiple checkpoints and found our way to the Domestic Policy conference room on the third floor of the Eisenhower Building.
Bruce made the introductions and we immediately plunged into our personal explanations of “why” the 1115 Waiver has played such an important role in the transformation of health care and the improvement in access and quality in America’s health care marketplace. Since every minute counts in meetings like this, there was no small talk or comments on the beautiful Washington weather. We immediately got down to business.
My colleague from L.A. described the tremendous impact the 1115 Waiver has had on the improvements to access to care in their entire hospital and clinic system and the marked decrease in readmissions they’ve seen for patients with chronic health problems. He addressed their improved ability to address those social determinants of health that impact patients and their families, such as food security, housing, transportation, prescription medicine access and health wellness education.
My turn came to describe Texas’ and UTMB’s programs. I sensed Tim’s desire to hear more about the individual impact to patients and evidence of real transformation in the system.
I told him the story of Tyler County Hospital in Woodville, Texas, and its DSRIP (Delivery System Reform Incentive Payment) project designed to improve patient satisfaction, value-based purchasing and access to “after hours” care. I also told him of my firsthand knowledge of that hospital, having been born there six decades ago. I described the impoverished “eastern border” of Texas, which is home to a diverse population with high incidence of chronic disease, premature death, serious mental health disorders, food and housing insecurity, unemployment and overall lack of access to health care.
I told him about Dr. Wright, the CEO and administrator of Tyler County Hospital, and her passion to improve access to care and patient satisfaction. I shared the success of her efforts and the fact that she had just informed us that the hospital had receive a 5 Star rating from CMS (the highest ranking obtainable) as a result of their 1115 improvement efforts. I described the pride in the hospital’s staff that led them (on their own time) to repaint and decorate the hospital cafeteria and break areas for staff and families of patients.
I also shared the multiple improvements that have occurred in the delivery of mental health services in the entire 16-county Region 2, for which UTMB is the anchor. Improvements have included the Burke Center’s collaboration with law enforcement, outpatient providers, supportive housing options and comprehensive care clinics.
Other innovative programs resulting from the 1115 Waiver include the use of Community Health Workers and their inclusion now in Texas as certified health profession workers, as well as the collaborative work among the Texas Medical Board, Health and Human Services Commission, UTMB and the DEA to ensure access to prescription medication for behavioral health patients in underserved areas and delivery of psychiatric services to children.
LaRay Brown provided an overview of the challenges faced in the New York City health department and the challenges facing access to services. In spite of East Texas and NYC being polar opposites in many respects, both share many of the same barriers to health care access, food insecurity, housing issues and other social determinants that diminish the wellness of the community.
At the conclusion of our session, I played a two-minute video of the work done to open a cancer treatment center in Childress, Texas, with partners from Texas Tech—demonstrating the power of the 1115 Waiver to bring about transformations in health care that would not have occurred without that startup funding and technical support. This powerful video brought home the message of transformation for remote cities across our state.
Now it is wait-and-see time. Will our visit and talks make a difference? Who knows? We can only hope that the power of those personal accounts and glimpses into the impact zone of health care transformation will make a difference. Meanwhile, visionary people like Donna Sollenberger, Katrina Lambrecht and Craig Kovacevich will continue the battle for improved health on the front lines, both in Galveston and in rural Texas.
I boarded a plane at DC’s Reagan Airport a couple of hours later and headed back to Austin, where another messaging battle is raging. What will the state legislature do to improve access to health care for those individuals in Texas who remain uninsured and without adequate access to health care? It is all too easy to stereotype the disenfranchised as lacking personal accountability or being irresponsible, but in truth most of our state’s uninsured are working people who simply make too little money to afford the high cost of health insurance.
In the end, all of us pay for that care through higher insurance premiums so that hospitals can shift costs and recover their losses on the delivery of care to the uninsured. This has been an age-old problem in health care. In truth, it is a hidden tax on every American and every American business that provides health care benefits for its employees.
As Texas continues to seek solutions to the crisis facing health care in the state—or the lack thereof for significant parts of our population—we must come to grips with how to ensure access to care for vulnerable populations. Like it or not, the costs are greater when we do nothing because of the negative impact on our state’s future productivity. Pay now or pay (more) later! Never a good choice!