Last week we discussed SB 1004 as an example of public policy administered under Medicaid. The discussion revolved around my attendance of a stakeholder meeting to operationalize the new policy (SB 1004). Longest (2010) uses the example of implementing the Older Americans Act to discuss the process of applying new policy. He writes “the essence of the implementation phase of policymaking is that one or more organizations or agencies undertake the operation of enacted legislation, ideally in a manner that realizes the intent behind the legislation” (p. 135).
This is where the private sector is most active in public policy- in the operational activities of legislation.
Longest (2010) continues that the implementing organization and the objective of the policy must closely align to ensure success. SB 1004 is a great example.
SB 1004 directed the California Department of Health Care Services (DHCS) and any interested stakeholders to assist Medicaid care plans in implementing a palliative care benefit to their members as a pilot project (California Legislative Information, 2014). While this program is administered within the public sector, DHCS and Medicaid, the private sector is shaping and informing the policy development. The intent behind SB 1004 is to promote better health outcomes for individuals with serious illness. This legislation recognizes that individuals live longer, have fewer hospitalizations and spend less on health care when enrolled in a palliative care program (California Legislative Information, 2014). Several private organizations were instrumental in providing the appropriate evidence. These organizations continue to guide the policy as it is operationalized under DHCS.
The Coalition for Compassionate Care of California (CCCC) is a private, not for profit partnership of organizations throughout the state that advocate for the highest quality end of life care for Californians. This private organization is often called upon to offer their expertise in guiding policy development. They were in attendance at the stakeholder meeting.
The California Healthcare Foundation (CHCF) is another example of the private sector’s work in guiding public policy. This organization is not for profit and philanthropic in nature. They provide grant funding toward initiatives that support their mission, this includes improving clinical outcomes, removing barriers to care, and supporting healthcare reform, among others (CHCF, 2015). CHCF formed the Palliative Care Action Community in 2013 to establish collaborative partnerships between organizations that were providing palliative services. This community was able to share successes and challenges of their programs and offered support to developing programs. This organization was also represented at the stakeholder meeting for SB 1004.
The Center to Advance Palliative Care (CAPC) is a third illustration of the private sector’s influence on policy. The CAPC is supported through membership and private philanthropy. This is a national organization with a simple mission- “palliative care everywhere” (CAPC, n.d.) The CAPC offers recommendations to policy makers for improved research, greater access to services and workforce development.
I was really unaware of how heavily public policy relied on private sector recommendations to inform legislation until attending the SB 1004 stakeholder meeting. While the meeting was heavily attended by those serving in ‘public’ capacities (Health plan managers, DHCS staff) the discussion revolved around information provided by private entities.
This is an encouraging thought as we move forward in healthcare reform. The subject matter experts are actively involved and often called upon to assist in policy advancement. This is an exhortation to each of us serving in healthcare to participate in policy development regardless of whether we are involved in the public or private sector.
California Healthcare Foundation. (2015). Retrieved from http://www.chcf.org
California Legislative Information. (2014). SB-1004 Health care: palliative care. Retrieved from http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml;jsessionid=7123b315241991b8d06d98c81298
Center to Advance Palliative Care. (n.d). Retrieved from https://www.capc.org
Coalition for Compassionate Care of California. (2015). Retrieved from http://coalitionccc.org
Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.