It’s Not A Sprint, But A Marathon: Lessons From The Field On The Many Ways One Can Advocate For Family Medicine STFM Annual Spring Conference April 27 th, 2015 Dennis M. Dimitri MD, FAAFP Vice Chair and Clinical Associate Professor Department of Family Medicine and Community Health University of Massachusetts Medical School UMass Memorial Medical Center

Disclosures  I have contributed to political candidates  I have contributed to political parties  I have contributed to political action committees

Learning Objectives Learn how family medicine students, residents and faculty can distinguish themselves as effective advocates Understand how to disagree without being disagreeable as you advocate Become familiar with some of the successes of state level advocacy

Advocacy Support for a cause or position – let them know if you are for or against a policy – make suggestions for improvement – use your expertise to educate Forms of advocacy – meet with legislators – write to legislators – work with organized medicine –attend FMCC or NAC – financial contributions (individually or PAC’s) – vote for your candidate

Distinguishing Ourselves Advocates are not the same thing as lobbyists You are constituents giving of your own time and treasure No one paid you to say what you are saying

Emphasize our Difference Physician advocacy carries a special cachet Family Physician advocacy is even more special Make it about our patients Use personal stories

Goals of HCR Increase number of covered Americans Decrease healthcare costs Improve healthcare quality How do you accomplish all three? More Primary Care

Play Nice Do respect the Office Don’t be insulted if you are meeting with their legislative aide (they’re the ones who do a lot of the work) Bring data to the knife fight –Handouts are good –Offer to send follow-up information about data you quote

Play Nice Be conversational Don’t go “all ad hominem” on them –They have families who love them too –I never met a man I didn’t like Will Rogers Be polite Build a relationship Assume good intent They are trying to do a good job Ask, not tell Use motivational interviewing

Play Together Find out what their issues are Find even small areas of agreement: e.g. –Somehow the uninsured need to be taken care of –Somehow the cost of care needs to be moderated –Somehow we need to improve quality

2006 Massachusetts Health Reform  Goal: Universal Coverage!  Medicaid expansion to 133% of FPL  Subsidized private insurance to 300% FPL  Insurance market reforms  Creation of Massachusetts Health Connector  Individual and employer ‘Shared Responsibilities’  Model for the ACA Gov. Romney Signing Chapter 58 April 12, 2006

Advocacy Success Story Massachusetts Legislation Chapter 305 Section 30. Authorizes MassHealth to establish a medical home demonstration project. The specific language is as follows: "The office (MassHealth), subject to appropriation and in coordination with the Health Care Workforce and the Massachusetts Academy of Family Physicians, shall develop a program to provide support to practices interested in developing an organizational structure necessary to provide a medical home"

Advocacy Success Story Massachusetts Legislation Chapter 305 Section 8. Establishes a Health Care Workforce Center within DPH with an Advisory Committee. The MassAFP has a seat on the Advisory Committee. The bill creates a new loan forgiveness program for doctors and nurses who commit to practicing primary care in medically underserved areas. MassAFP invited to seat a representative on the PCMHI pilot

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