« July 2014 Issue

Transformation Ahead: A Conversation with Susan Sherry

With more than 30 years of experience working in health policy and consumer advocacy, Community Catalyst Deputy Director Susan Sherry possesses a very broad long-range view of the ongoing efforts to expand health access, improve quality and build community participation in health policy and health care systems. We asked her to share with us some thoughts on the challenges ahead as Community Catalyst seeks to play a major role in health system transformation.

What do you mean by the term “Health System Transformation?”

There is a lot of rhetoric these days about a patient-centered health care system. I think we mean that for real. We want the consumer to be at the center of it all. We know that as a nation, we are not getting the kind or quality of care we should be getting, especially for the money we spend. We should be getting better value, and the way to get it is to be truly patient-centered and have consumer needs drive what happens and how it happens. That is the transformation we are talking about.

Why is Community Catalyst focused on this area?

It’s core to our mission, which is about making sure people can lead healthy and productive lives and are involved in the decisions that affect their health. Getting access to coverage was certainly one part of that, but now we need to make sure that coverage works for people, is responsive to what their health needs are and gives them tools to stay healthier.

Why is it important at this time?

A couple of reasons. First, the fundamental question of getting value for our health care dollars is an important one. To the extent we are spending on things that aren’t making us healthier or aren’t effective, this money could be better spent on other things.

Also there is enormous change going on right now in how we pay for health care. Some of that is associated with the ACA and some is change in how care is paid for, driven by insurers and private sector purchasers. Providers respond to these payment changes. So there is opportunity to make the system better, but there’s also potential risk associated with some of those changes if there isn’t accountability and transparency. So it’s timely for us to get involved to shape the changes that are happening to make the system better and also protect against bad things from happening.

What do you see as Community Catalyst’s unique capacities to make key contributions on these issues?

A lot of the changes ahead are going to be tried out at the state and local levels – ‘All health care is local’ in the end. Because we partner with state and local groups in over 40 states, we are on the ground where the changes that are going to inform national policy are actually being built. This isn’t just about making change at the policy level through legislation or regulation. This is about making change in the health care system itself by actually building new mechanisms for consumers to have a place at the table with their health plans and give them input: ‘This is working; this is not; you should change this.’ I think Community Catalyst is uniquely positioned to have a great impact in these changes in the coming years.

Why is it important to have consumer advocates involved in these issues?

Part of the problem with the health system is that it has been operating in its own little medical silo for so long. For people’s health to be improved, I think consumers have to be active participants in getting the medical system not just to think about medical care and treating illness, but also to think about the things that create and maintain health. Without having consumers at the table, things are not going to change in the right direction.

What are the most pressing issues at this time?

That’s a tough one to answer, to be honest. I think it depends on what constituency you’re talking about and where they live and what’s happening there. The dual eligible demonstration projects are one example. If they are happening in your state and you’re a senior or a person with disabilities on both Medicaid and Medicare, that may be the most important area to work on, toward the strongest possible implementation. In another state or circumstance, it might be that the Medicaid program is moving to Medicaid Managed Care and you’re a family with kids. What are the access standards and accountability for those Managed Care plans going to be? So ‘it depends’ is the answer, and working with our state partners, we can help people get involved in the areas most crucial to their communities.

What steps are happening right now?

As part of our initiative to help consumer advocates enter this new area of work, we’ve been spending a lot of time surveying advocates, through structured focus groups and leadership conversations to hear the challenges they see in their states. Out of that dialogue and additional research, we will develop some ideas and plans for how we might move forward, get their feedback on that, and then more pro-actively start to develop tools for advocates, providers and health plans. We know this will be a long-term multi-year effort given the depth and complexity of the system changes.

Bruce Gore, Communications Coordinator