As the transition in Washington moves into high gear this month, it’s not just the new Administration and Congress that are putting in place plans for policy and legislation; stakeholders are busy creating agendas, too.

Many stakeholder agendas will seek to affect how government addresses such prominent health care issues as the Affordable Care Act, Medicare entitlements, fraud-and-abuse policies, FDA user fees, and drug pricing. There will be a myriad of stakeholder ideas, cutting a variety of directions, all framed with an eye to the new political terrain.

But whatever policies a stakeholder advocates, ideas must be translated into a form that that the political system can digest. For this to occur, an important technical conversion must take place; words must be conjured and organized so that desired policy can become legal reality.  This is no easy task, and stakeholders should proceed thoughtfully.

Here are five takeaways for making proposals concrete and workable:

1. Butterfly Effect

A “simple” contract (to buy a house, say) can end up getting pretty complicated, even when the stated rights and obligations apply to no more than two parties. In contrast, a policy proposal typically seeks to set arrangements for a broad array of parties (perhaps a whole economic sector) and thus will usually involve substantial complexity.

The large number of parties potentially affected means that even the most minor-seeming policy adjustment can have large, unintended, and unpredictable results – not dissimilar from how the proverbial flap of a butterfly’s wings can start the chain reaction that leads to a distant hurricane.

2. Pre-Drafting Steps

Taming the butterfly effect should begin before putting pen to paper. It starts with a clear view of the problem to be solved and the ways to solve it.  Notably, the legislative drafters available to Congress place some considerable emphasis on the steps that precede actual drafting.

For example, the House Legislative Counsel’s Office recommends use of a pre-drafting checklist that includes questions like these:  What is the planned policy’s scope (expressed as populations or subjects)?   Who will administer the policy?  Who will enforce it?  When should the policy take effect (and are transition rules needed)?  Each of these questions contains multiple sub-questions.

Similarly, the Senate Legislative Counsel’s Office points out that most legislated policies build on prior statutes. As such, it is important to know how new provisions will harmonize with — or will override — previously adopted language.  Making these judgments requires a solid grasp of existing legal authorities and ways these authorities have been interpreted.

3. Words on the Page

Translating concepts into words is a specialized task, for ultimately the words must be “right” – they must be technically sufficient to effectuate the policy intended.

It is not news that Congresses, Presidents, and courts sometimes have different views on the meaning of statutes, regulations, and other types of policy issuances. In theory, the drafting curative is to make the words so clear that only a single meaning is possible.  But realistically, legal contention often comes with the territory of a controversial policy, and so stakeholders should at a minimum avoid such unforced errors as these:

  • Obvious mistakes – e.g., purporting to amend a U.S. code title that has not been enacted into positive law;
  • Wrong law – e.g., confusing the statute that enacts new language with the statute that the new language amends;
  • Wrong time – e.g., getting the words right but putting them into effect for an unintended time period;
  • Imprecise labels – e.g., referring to concepts or parties via shorthand phrases similar to, but not identical to, defined terms; and
  • Vague references — e.g., omitting enough key details to confer unintended discretion on an agency or administrative official.

4. Document Silos

Today’s integrated world doesn’t look kindly on silos, but, in the specialized context of Washington policy development, they can be a helpful check on the temptation to combine technical drafting with political messaging.

The desire to combine these two forms of communication is understandable, for it is an appealing notion that policy proposals be “user friendly” so they can be quickly scanned for substantive gist. In fact, however, the practice is dilutive and dangerous; it can put the wrong words on the page and undermine policy intent.

A better course is for stakeholders to manage separately siloed sets of documents that, while consistent, operate at different levels of specificity. One silo should be reserved for the technically rigorous proposals that effect legal authority and a separate silo for “plain English” issue briefs, fact sheets, and other materials that summarize the authority.

5. Plug & Play

Washington policy debates are less often set battles, more often fast-moving skirmishes. Such places a premium on ability to adapt as new ideas emerge, political signals morph, and coalitions shift.  For the task of converting ideas into policies, there are at least two implications.

First, stakeholders should be prepared to think and draft in modules – in discrete chunks of policy that can be embedded in one or more larger proposals. In Congress, stakeholder-originated ideas are more likely to emerge as legislative amendments than as free-standing bills.

Second, stakeholders should be ready to iterate quickly as debate advances. Feedback from reviewers will often focus on proposal summaries because they are easier to read and understand.  But changes in response to comments must also be reflected in the technical proposals themselves.  Tight deadlines are the norm, so separately siloing the two types of documents (see above) will help speed an effective response when political opportunity strikes.

Epstein Becker Green and EBG Advisors, as part of the Thought Leaders in Population Health Speaker Series, will host a complimentary webinar titled The Impact of Value-Based Purchasing and Other Employee Initiatives on Population HealthThis session will discuss several approaches for population health managers to reduce costs and improve health care.

The webinar, scheduled for November 20, 2014, at 12:00 p.m. ET, will be led by Laurel Pickering, MPH, President & CEO of Northeast Business Group on Health, and David Lansky, PhD, President & CEO of Pacific Business Group on Health. Adam Solander of Epstein Becker Green will moderate the session.

For more information, click hereTo register, click here.

Epstein Becker Green and EBG Advisors, as part of the Thought Leaders in Population Health Speaker Series, will host a complimentary webinar titled Moving to an Integrated Population Health Management Model. This session will highlight several approaches to help manage populations to promote better clinical outcomes, more cost savings and enhanced patient satisfaction.

The webinar, scheduled for October 30, 2014 at 12:00 p.m. ET, will be led by Sarika Aggarwal, MD, Senior Vice President and Chief Medical Officer of Fallon Community Health Plan, and Julie O’Brien, RN, BSN, MS, Senior Vice President and Chief Operating Officer of Alicare Medical Management, and moderated by Mark Lutes, Chair, Epstein Becker Green.

For more information, please click here.  To register, please click here.

 

 

Epstein Becker Green and EBG Advisors, as part of the Thought Leaders in Population Health Speaker Series, will host a complimentary webinar on September 30, 2014 on emerging trends in value-based purchasing in health care. The next session will feature a former key official from the U.S. Department of Health and Human Services (HHS), Gary Cohen, JD, who played a central role in the implementation of the Affordable Care Act over the past several years and is moderated by Lynn Shapiro Snyder, Senior Member, Epstein Becker Green.  The session, The Impact of the Affordable Care Act on Population Health Management, will assess how much progress the federal and state governments have made expanding health care coverage and bending the cost curve.  Specific insurance reforms to the individual and small group markets will be examined along with emerging trends such as the role of accountable care organizations (ACOs), patient accessibility issues, and the drive towards integrated population health solutions.

For more information, please visit:  http://www.ebgadvisors.com/cciio-director-gary-cohen-address-key-health-care-reforms-impact-population-health-management/.

 

 

 

 

Epstein Becker Green and EBG Advisors, as part of their Thought Leaders in Population Health Speaker Series, will host a complimentary webinar in July on emerging trends in population health. The webinar—What Role Do Patient Engagement Strategies Play in Promoting Population Health?—will examine different approaches to target, engage, and modify individual behaviors to lead a healthier lifestyle. Key thought leaders in population health will share examples of ways to engage high-risk and chronically ill groups so as to achieve meaningful clinical and financial outcomes.

This webinar, scheduled for July 31, 2014, at 12:00 p.m. ET, will be led by Kathleen Ann Fraser, RN-BC, MSN, MHA, CCM, CRRN, President, Case Management Society of America (CMSA); and Ben Gardner, Founder and President, Linkwell Health, a leading technology-enabled content marketing company serving health plans. Linda Tiano, Member, Epstein Becker Green, will moderate the session. To register, click here.

During the webinar, the panelists will discuss:

  • Methods to promote better eating and exercise
  • Avenues to promote healthy behaviors and address chronic disease head-on
  • Ways to improve medication adherence
  • Approaches to optimize provider involvement in patient care over the continuum
  • Strategies to benchmark positive change in targeted populations and provide meaningful feedback loops to the patients

The summer webinars of the Thought Leaders in Population Health Speaker Series will focus on key aspects of the emerging population health paradigm, addressing big data and IT integration issues, patient engagement strategies, and population health strategies for employer-based coverage. The tenth session in the series will be held on August 26. The presentation, Population Health Strategies for Employer-Based Coverage, will assess how the Affordable Care Act is influencing population health management strategies for employer-based coverage.  To register, please click here.

“This webinar series attempts to find some common ground for health care professionals and other health care stakeholders by identifying best practices and creating a call to action for collaboration and outcomes improvement nationwide,” says Mark Lutes, Chair of Epstein Becker Green’s Board of Directors. “From the Affordable Care Act and data analytics to advancement in health IT systems, a number of factors are having a significant impact on the health care delivery system.”

________________________

The Speakers

Kathleen Ann Fraser, RN-BC, MSN, MHA, CCM, CRRN, and President, CMSA

Ms. Fraser has an extensive background in hospital nursing, which includes emergency room and labor and delivery experience, and as a Director of Nursing.  She became a Case Manager 21 years ago, creating the first Case Management Department for a large national health care system.   For the past 19 years, she has specialized in workers’ compensation, and, for the past 14 years, she has been a Regional Director of Managed Care Case Management for Zurich Financial Services.

Ms. Fraser is the current President of the CMSA National Board of Directors and will serve in this position through June 2016. She is also on the Role Delineation and Expert Panel Committees of the American Nurses Association Certification Council for Case Management.  She is the current Immediate Past-President of the Houston/Gulf Coast Chapter of CMSA and, during the past 21 years, has served three previous chapter presidency terms in Houston. She has also served twice as Chair of her chapter’s Annual Educational Conference and is a past Houston/Gulf Coast CMSA Case Manager of the Year.

Ben Gardner, Founder and President, Linkwell Health

Mr. Gardner founded Linkwell Health in 2007 with the mission of developing simple, meaningful ways to engage and empower consumers to promote healthier lifestyles. His 20+ years of experience span both the health care and marketing services sectors, working primarily in startup and early stage businesses.

Mr. Gardener’s earlier career was focused on health care, working with such companies as Stryker Medical (medical devices) and HPR (clinical software). He graduated from Bentley University with a B.A. in Marketing.

Linda Tiano, Member, Epstein Becker Green

Session moderator Ms. Tiano is a member of Epstein Becker Green’s Health Care and Life Sciences practice, in the firm’s Washington, DC, and New York offices. She has more than 30 years of experience serving clients in the health care industry, in legal and executive capacities.

Ms. Tiano has published extensively in the health law area and is a regular speaker at industry conferences. She is also a former adjunct faculty member at the New York University Graduate School of Public Administration. In 2013, Ms. Tiano was selected as a “Leading Lawyer” in the Health Insurance category by The Legal 500 United States.

 

To learn more, log on to www.ebgadvisors.com or click here to register for any of these webinars. A Q&A period will follow the webinar, so don’t miss this unique opportunity for leading population health experts to answer your questions. To listen to the previous webinars from our Thought Leaders in Population Health Speaker Series, please click here.