« November 2017 Issue

Mark Rukavina Brings His Expertise to the Center’s New Consulting Work

Mark Rukavina, who joined Community Catalyst as Business Development Manager for the Center for Consumer Engagement in Health Innovation early this year, is a recognized expert on health care affordability, financial assistance, billing and collection and community benefit requirements for tax-exempt hospitals. With his arrival, the Center has been expanding its consultative service offerings to assist health plans, provider groups, social services providers and others to more effectively engage consumers in new models of care. As the former executive director of The Access Project, Mark brings a unique set of skills and a long history as a health advocate, organizer and non-profit leader. At the same time, he has a strong background in consulting with hospitals and health systems.

We talked to Mark about his vision for the road ahead in the Center’s consulting work.

Why has the Center for Consumer Engagement in Health Innovation created a consulting practice?

Consumer and community engagement is at the heart of the Center’s mission. From its inception, the Center was envisioned as a platform for Community Catalyst to expand its reach. There is growing recognition of the importance of consumer engagement by health systems, social service agencies, health plans, foundations and state agencies. Our consulting work makes it possible for us to promote our mission with an ever-expanding group of stakeholders – in particular, with providers and health plans. Through our engagements with clients, we will emphasize the benefit of meaningfully engaging with consumers – especially vulnerable populations whose voices and needs are too often overlooked in decisions on policy and programs. Our work is informed by research and endeavors to help health plans, hospitals and health systems, and provider networks put in place effective structures that enable consumers to have input into the delivery of care that will affect them.

You have spent much of your career as a consumer advocate. Is managing consulting work a new type of role for you?

I worked as an organizer and consumer advocate for most of my career. However, for the five years prior to joining the Center team, I consulted to hospitals and health plans helping them conduct needs assessments and design consumer-friendly policies. This and my previous experience taught me the importance of listening to consumers and working with them to develop solutions to the problems they face. Repeatedly, I have learned that engagement with consumers in designing policies and programs is an essential element to achieving better results.  This role provides me with new opportunities to advocate in a different way for consumer involvement with providers, payers and public programs as they implement new models of person-centered care. My passion as an advocate and organizer is satisfied as we help health plans and providers strengthen active connections to their communities and consumers. Meaningful consumer engagement is shared responsibility for improving policies or programs and being part of this work is deeply satisfying.

Is this type of work new for Community Catalyst?

While consulting to heath entities is different than the typical work done by Community Catalyst, we do have a history of creating social ventures. Community Catalyst incubated Real Benefits Inc., a web-based program that screened people for eligibility for a broad range of human services and produced applications that could be sent electronically to states. This was better for both consumers and providers. It was then spun off as a non-profit social venture that was ahead of its time. It won a MacArthur Creative and Effective Organization award, and at one point was used by four health systems in Massachusetts and many human services organizations in both Massachusetts and Illinois. Since that time, Community Catalyst has provided contract services to other organizations. My job is to organize, expand and institutionalize our consulting work.

Why is this work important at this moment?

Many health plans, hospitals and provider organizations do not have structures in place to get feedback from their consumers in an ongoing and constructive way. Not only is this problematic in terms of the actual care that individuals receive, but it also has real implications for the organizations’ “bottom line.” Consumer engagement is a win-win for all involved. Center staff are experts at just the sort of relationship-building and best practices related to engagement proven to work in creating effective feedback loops with consumers and their families. This results in high-quality care that better meets the needs of consumers, especially those with complex medical and social needs. As the health system transitions to value-based care, improved communication between providers and consumers will be vital to ensure cost savings and quality care work hand-in-hand.   

Given your familiarity with both the health care delivery and health advocacy spheres, do you think the Center is in a unique position to provide a service that is new and valuable in meeting the needs you just outlined?

I really do. Community Catalyst has always been at the hub of a multi-stakeholder network approach, partnering with consumer advocates in more than 40 states. But we also work with providers, health plans, policymakers and foundations to find common-ground solutions that promote better health care. That makes us unique. The Center, because of our credibility with such a wide variety of stakeholders, is well-positioned to share with clients what genuine person-centered care consists of. From the care delivery side, Center Director Dr. Ann Hwang is a physician working clinically with patients with complex health and social needs, which adds a vital connection to the realities and pressures of medical practice today. Center staff also have a wealth of experience working on hospital community benefit and in addressing the social determinants of health, adding a unique perspective to the Center’s work.

Our consultative capacity also benefits greatly from the contributions of two Senior Fellows on our team, John G. O’Brien and Bob Master, MD. John is the immediate past President and CEO of UMass Memorial Health Care, central Massachusetts’ largest not-for-profit health care delivery system and the clinical partner of the University of Massachusetts Medical School. John is a past member of the board of trustees of the American Hospital Association and serves on the selection committee for the Foster G. McGaw Prize, created by the AHA to recognize hospitals distinguished by their outstanding efforts to improve the health and well-being of everyone in their communities. Bob is the founder and former president and chief executive officer of the Commonwealth Care Alliance, and throughout his career has been a pioneer in creating person-centered team-oriented systems of care to address the medical and social needs of people with complex health conditions.

Are there particular groups of consumers the Center is uniquely positioned to help gain a stronger voice in the health system?

We have a special concern with empowering vulnerable populations with complex medical and social needs, particularly, older adults, people with disabilities, people with substance use disorders and children with special health needs. Across all these groups, people of color and low-income people have faced additional long-standing barriers to having their voices heard. We are constantly working to help all these groups gain opportunities to play a greater role in their own care.

Can you share some examples of the Center's work to date or areas you expect to work in?

Working with the Center team, we’ve identified new offerings that give consumers voice in transforming the care they receive. Current services vary; they include skill-building training for staff and members of patient/family advisory councils, as well as conducting analysis of community benefit programming and making recommendations for how to further leverage these investments.

For example, many health plans working with dually eligible populations in Medicare/Medicaid alignment demonstration projects are required to have Consumer Advisory Councils, so we are providing training to the staff of health plans and systems to create such councils. Provider organizations and insurance companies are not historically well-versed in this work, so we’re helping them structure those committees in the most productive way to benefit from the voices of the consumers and caregivers who will serve on them. In other instances, we’re providing training directly to the members of those councils – to the patients, caregivers and family members of patients – to help them be effective in their participation.

We’re also working with hospitals and health systems that are quite interested, not just in the delivery of medical care, but in broader social determinants of health, including housing, nutrition, and other significant factors that affect the health of the communities they serve. We’re connecting them with community organizations that may already have the capacity to better address those social determinants and we can help identify opportunities for them to work synergistically on creative ways to meet the health needs of the community.

Philanthropic foundations are also among our clients. With them, we utilize our content expertise to help build the capacity of grantees so they engage more effectively in policy discussion. We also assess local community health programs and provide recommendations for strengthening them.  

The Center is drawing more and more attention to social determinants of health. You mentioned housing – what makes that a point of focus in this kind of work?

We are currently providing assistance to a housing organization that is interested in further exploring for their members the intersection of health and housing. For Instance, property owners might be concerned with the health of their residents and establish a relationship with a local hospital that already has a program that can serve its residents. It might be an issue of nutrition if many residents have diabetes. It could be exploring whether a hospital might have an interest in helping to finance the rehabilitation of substandard housing that may be contributing to increased asthma.

Given the current threats to coverage and access on so many fronts, is this a good time to be embarking on this kind of work?

People are going to get sick and people are going to be treated in the health and hospital system as they always have been, irrespective of whatever national health care policy debate is going on.  We are constantly looking for efficiencies that keep the needs of the consumer in the spotlight. The Center is all about innovative approaches to care and health system transformation, as are the services that we are providing for our clients. It is every bit as important today as it was two years ago, and will be even more important in the future.

For more information about the Center and its consulting services, please contact Mark at mrukavina@communitycatalyst.org.

Bruce Gore, Editorial and Content Manager, Center for Consumer Engagement in Health Innovation

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Executive Director Rob Restuccia co-authored an article in the American Journal of Public Health, “How Dental Therapists Can Address the Social and Racial Disparities in Access to Care,” citing our Economic Viability of Dental Therapists report to illustrate why dental health care should be treated as an equally important aspect of overall care.

Senior Fellow John O’Brien co-authored an op-ed for STAT with attorney Jenifer Bosco of the National Consumer Law Center about how states can take action to curb medical debt.

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