How strong relationships, strategy can influence health policy


A decade ago, Cleveland had one of the nation’s highest rates of childhood lead poisoning, despite spending years trying to solve the problem.

And as Cleveland residents watched the Flint, Mich., water crisis explode, hospital executives and other stakeholders in Cleveland were spurred to work together to get local laws passed before their own crisis worsened.

MetroHealth, University Hospitals Rainbow Babies and Children’s Hospital and the City of Cleveland Department of Public Health joined forces with Environmental Health Watch, a not-for-profit that for decades had worked on lead abatement in Cleveland.

By urging the city council to create a rental registry and enforcing fines if property owners violated codes or practices to abate lead hazards, the group was able to put to use its work gathering and standardizing public health data that had been sitting in metal filing cabinets.

“That project was really the catalyst for sweeping change to the way lead is handled at the level of the city government,” said Adam Perzynski, director of the Case Western Reserve University Center for Health Care Research and Policy within MetroHealth. He supported MetroHealth’s contributions to the collaborative.

Across the country, health system officials are dealing with the undeniable fact that the well-being of their patients is mostly influenced by factors far beyond what they had previously been responsible for. As a result, they’re looking to influence policy decisions made by local, county and state governments that can help them effect change beyond the walls of the hospital.

“The question is, do you want to set the table or be on the menu?’ ” said Tracy Carter, system director of government relations for Akron, Ohio-based Summa Health.

Experts said that a sound government relations approach requires dedicated staff at the local, state and federal levels, and additional support from consultants with specialized expertise and close ties to key decisionmakers. But often, hospital executives find themselves at a disadvantage. Lack of investment in relationships and in the right talent within their organizations can leave them vulnerable to others more adept at playing the game.

“Healthcare is trying to fill in the hole. But policymakers are digging it out. That’s why we’re getting nowhere,” said Brian Castrucci, CEO of the not-for-profit de Beaumont Foundation, which works to build community health. “All these bad decisions upstream filter down.”

Industry associations like the American Hospital Association and America’s Health Insurance Plans have an impact on large, national issues because of their size and established relationships. But there are many occasions when a hospital or health system needs to advocate for its interests directly.

For example, Summa Health, a not-for-profit, integrated delivery system with a provider-sponsored plan, often views issues like provider taxes differently from large, for-profit healthcare systems. “You always want to be proactive versus reactive,” Carter said. “When you do that, you have a better chance of preserving your revenue and your ability to provide care to patients.”


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