What Makes Engaging the Public Meaningful? Willingness to Change

In a September 2011 webinar, Lorez Meinhold of Colorado, Dan Meuse of Rhode Island, and Joel Cantor of Rutgers University in New Jersey all participated in a thoughtful discussion on their experiences bringing the public into the health reform conversation. They assessed how their work is going so far, described the purposes their efforts are serving, and explained how they are tackling the challenges along the way.
The panelists agreed that reaching and drawing in many different kinds of stakeholders has been important, and mostly successful, as they seek input on health care reform.  Joel Cantor, who conducted stakeholder outreach for the state of New Jersey, invited 160 stakeholder organizations to participate in a total of 13 focus groups. Joel told the webinar audience, “Many of the leaders of these disease groups are volunteers. They bring the experience of real patients to the conversation.”
Dan Meuse of the Rhode Island lieutenant governor’s office reported “We have right now roughly 19 monthly public meetings that are organized just out of our office.” He also described the state’s health care reform commission, with more than 200 public members, and noted, “We have not had anyone claim that they were excluded.”
The panelists described extensive and time-intensive engagement processes, but were clear that this hard work serves a valuable purpose.
Meuse, of Rhode Island, acknowledged that buy-in often follows when stakeholders are involved in what he calls the “policy refinement” process.  “By using the stakeholder process effectively throughout policy development, we don’t get as many challenges and as much jostling when it comes to actually trying to get policy implemented,” he said.
Lorez Meinhold, who serves as Colorado Governor John Hickenlooper’s health policy advisor, noted that insincere engagement won’t reap rewards. “Meaningful engagement means a willingness to change [the state’s plans] to incorporate some of what you hear from the stakeholders…If a state’s not willing to change anything, then you’re going to have a meaningless process and people are going to know that and be frustrated.”
She reported success with her own state’s outreach. “A large part of what our engagement was about was building trust. The exchanges are new for so many people. Legislators, constituents, businesses, and insurers had different levels of trust and mistrust over what this was going to result in. It was really through stakeholder engagement that we had the support for our legislation from consumers, insurers, providers, brokers, and business entities.”
In New Jersey, focus groups found some consensus in their discussions of exchanges. They agreed on New Jersey creating its own exchange; focusing on basics rather than “bells and whistles” of that exchange; building on the state’s existing competence in regulation; maintaining transparency; and working toward a high take-up rate in exchange use. Disagreements were recognized, too. Stakeholder groups differed on issues such as whether the New Jersey exchange should be a clearinghouse model or an active purchaser model; whether nongroup and small group risk pools should be combined; and how exchange operations should be financed.
Cantor reported some uncertainty around implementation issues, as well. “On many of these issues I’d say the most savvy of participants in our forum said they couldn’t formulate an opinion until they had more details.”
Health care reform is unmistakably complex, both for “savvy” stakeholders waiting for detailed federal regulations, and for the average American. The challenge of complexity is made more urgent by breadth of reform’s impact throughout the population.  There are countless members of the general public who aren’t fluent in the technical language of health care, but who nonetheless will be affected by reform.  Colorado eased the transition into stakeholder conversations for these residents by preparing short, impartial issue briefs for them to check out before attending meetings. That way, Meinhold said, “it put everyone on the same playing field.” Meuse used another technique: communicating through consumer groups in Rhode Island. He said these organizations are well connected to “everyday Rhode Islanders” and serve as good translators of health care information for the public.
And no public discussion of health care reform is complete without acknowledging the political controversy that surrounds the topic. The panelists all shared the opinion that focusing public and stakeholder meetings on identifying or exploring points of agreement makes the conversations more productive. Cantor, whose governor in New Jersey opposes the Affordable Care Act, said he centered his focus-group forums specifically on decisions New Jersey needed to make about implementation. That way participants could describe the approaches that would best work for their state, instead of concentrating on the national political issue.
These three health care leaders had even more ideas and reactions about public engagement and their experiences in their states. Listen to the full webinar, and add to the conversation. Chime in with what your state has been doing, and how it has been working.