2. Influencing Health Care Policy
Advocacy in Neurology
Influencing Health Care Policy

3. Advocacy What does advocacy mean to you?
Merriam-Webster definition: the act or process of supporting a particular cause or proposal
How have you served as an advocate previously?
For patients, peers, younger students, etc.
At the school, hospital, regional entity
To a patient’s school or employer

4. What is Advocacy Anticipate Influence Engage Influence the process,
Anticipate changes in health
care delivery systems
Anticipate
Influence the process,
decisions, and structures
Influence
Engage our members and
patient groups to become
partners in the process
Engage
Important to determine what is happening, how things could be improved, and then act to influence the improvements

5. Formal Advocacy
In this context, formal processes intended to influence public policy by appealing to legislative or regulatory bodies
All lobbying is advocacy; all advocacy is not necessarily lobbying
Lobbying is one form of advocacy and has restrictions on how much and amount of budget spent
Lobbying means advocating on specific piece of legislation
Advocacy may include educating public or specific subsets (e.g., patients) and engaging them to do something
With a regulatory agency, usually also revolves around a specific issue to:
Propose something new or
Oppose something already happening for benefit of those doing the “ask”

6. Policies impacting neurology
Influencing Policy
Policies impacting neurology
Regulation
Legislation
This shows the interconnectedness of legislation, regulation and how neurologists are impacted. While legislation and regulations impact neurologists, the arrows go both ways, so neurologists (via AAN) can also impact legislation and regulations.

7. Legislation Regulation Payers Targets
These areas are the primary areas where the AAN advocates on behalf of neurology. May also engage public to put pressure on these groups as well.

8. Regulatory Agencies of Importance
Here is an overview of many of the agencies that AAN interfaces with on behalf of our members.
CMS oversees Medicare and Medicaid, thus payment for services to physicians. Health and Human Services oversees much of policy related to health care payments.
NIH invests in research.
Office of the National Coordinator releases rules and standards re: EHR.
VA is both payor and provider of care for veterans and some military dependents.
FDA regulates pharmaceuticals.
CDC develops recommendations around disease states.
AHRQ is part of HHS and develops tools and guidelines for clinicians and researchers.

9. Organized Medicine
Simply, vehicle that gives physicians a voice for influence
Way to collectively argue on behalf of physicians or patients
Can be local, state-wide, or national
Can be single specialty, a coalition of specialties, or all specialties
American Academy of Neurology—single specialty example
American Medical Association—all specialty example
Neurology is small specialty (less than 3%) of physicians, so often have a better chance of success by adding other societies to amplify voice. AMA is the umbrella organization encompassing all specialties.

10. Influence Has Many Forms
Legislator
Bills
Sign-on letters
Media
Hearings
Speeches
Inquiries & Requests
In addition to lobbying for or against bills, AAN can do many things.
Legislators use media in a variety of ways-not just social media, but Sunday talk shows, radio, etc.
AAN sends sign-on letters to Congress, but Congress also sends letters to each other. The Congressional equivalent is called a Dear Colleague letter and this method can have a lot of impact during the appropriations process.
Legislators can make formal requests to government agencies to explain a decision, provide data, or to ask for a study. This can be very effective to apply pressure to an agency where a public individual or organization cannot.
Hearings are a great way to have an in-depth issue heard, with AAN providing expert testimony. The AAN has developed strong relationships with key committee members and staff and often suggest questions to be asked during important hearings.
Members of Congress make speeches on the floor of Congress, address many events in their own districts, put out press releases, etc.

11. Getting Started Choose an issue—helps if timing is right
Gather stakeholders—build numbers
Educate those who don’t agree, or at least don’t know
Build a case
Include written materials to leave with office after visit
Seek the optimal timing opportunity
Go to those making the decisions
Tell a story—make it a personal example—better than statistics

12. Important to Neurology Stakeholder Alignment Legislative Opportunity
Perfect Issue
Important to Neurology
Stakeholder Alignment
Legislative Opportunity
Available Resources
These are some of the factors that impact determining the perfect issue to be the “ask.”. A good issue is more than identifying a solution to a problem.
Liability reform is a good example. It’s important to AAN members, others agree reform is needed, legislators even agree action is needed.
However, it is effectively stalled on Capitol Hill. Organizations as big as the AMA can’t inch it forward, so, it doesn’t make sense to invest additional limited resources to consider it an actionable priority.

13. Avenues for Advocacy—Groups
Join county and/or state medical association
Often free or low-cost membership
Opportunities may include committees and/or legislative days
Funding to attend annual meetings in which policy decisions are debated and adopted as medial student representatives
Join American Medical Association ($20/year)
Become a part of the Medical Student Section
More active engagement/serve as a delegate for your school (
Join the AAN
Follow Capital Hill Reports or Twitter feeds
As a medical student, what can you do now?
Many county medical societies may have opportunities to participate on committees alongside the physicians.

14. Capital Hill Report
Bi-weekly update on legislative action and advocacy for neurology
ed to all AAN members

15. Avenues for Advocacy—Actions
Find a physician mentor involved in advocacy
Write state or Congressional representatives
Join group legislative days at the state capital/DC
Schedule visit on own or in small group with representatives in district offices or DC
Engage with patient advocacy group in a particular area of interest (e.g., Multiple Sclerosis Society, American Heart Association)
Other AAN opportunities once a resident: Neurology on the Hill, Palatucci Advocacy Leadership Forum (PALF)
District office best way to actually meet with them, instead of their staff

16. Engaged Advocates
Neurology needs engaged advocates!

17. Palatucci Advocacy Leadership Forum
Annual Training event over a few day period
Three components:
Media training
Grassroots legislative training
Action planning
Many graduates serve in AAN leadership roles
Competitive application process
~30 advocates selected each year

18. 2018 Successes
Passage of the Furthering Access to Stroke Telemedicine (FAST) Act
$3 billion increase in NIH funding for FY2018
$400 million in new funding for the BRAIN Initiative
Repeal of Independent Payment Advisory Board (IPAB)-group determining Medicare savings
10-year reauthorization of Children’s Health Insurance Program (CHIP)
For example, some recent wins nationally.
BRAIN initiative-Brain Research through Advancing Innovative Neurotechnologies Initiative® -public-private collaborative effort aimed at developing new experimental tools that will revolutionize our understanding of the brain.
CHIP-covers low income children ineligible for Medicaid

19. AAN Legislative Priorities
Demonstrate value of neurology
Improve cognitive reimbursement
Reduce regulatory burden
Increase research funding
NIH appropriations
BRAIN Initiative
Non-opioid pain treatments
Improve access to neurologists
Drug pricing
GME funding
Telemedicine
Examples of Priorities in 2018; three priorities chosen to take to Neurology on the Hill each year; these often stay on for years, but the details of the ask change each year.

20. More Information AAN.com https://www.aan.com/public-policy/
Social Media
#AANAdvocacy
Washington, DC
Can follow staff contacts as well

21. So, what will you do?

22. Questions?