Multi-school, Student-led, Grassroots Movement Covers New Ground

"Primary care physicians and medical students often find themselves uncomfortable being involved in health politics. However, politics have a dramatic effect on our health care system and patients," this med student writes in today's post. Read what happens when students find the courage to mobilize and get involved in health policy. At PCP, that's what we're all about!

By Cleveland Piggott

“Medicaid is broken,” Governor Pat McCrory of North Carolina said soon after taking office. North Carolina decided not to expand Medicaid when given the option under the Affordable Care Act. Before many in the state had time to digest this decision, the discussion quickly shifted from expansion toward drastic Medicaid reform. Though no one would say that the Medicaid system in N.C. is perfect, there was great concern from physicians and patients alike that the proposed changes could take the state in the wrong direction after it had spent over a decade building a nationally acclaimed system known as Community Care of North Carolina (CCNC).

CCNC is a non-profit, public-private partnership with the state to manage almost 80 percent of its Medicaid patients. What makes CCNC unique is that it has a provider-led, local infrastructure in which more than 6,000 primary care providers choose to participate. Using the medical home model and information technologies, CCNC has become a model of care known for increasing quality and reducing health care costs. From 2007 to 2010, CCNC saved the state over a billion dollars! It is not surprising that many states in the nation are trying to emulate its success.

With all of CCNC’s success managing Medicaid patients, one of the greatest concerns voiced by advocacy organizations and medical societies was allowing for-profit managed care companies to replace the current system. The lure of these companies is the promise of quick and reliable cost savings in the Medicaid budget. These companies are true to their word and do provide quick cost saving measures, but this is at a great cost to patients. Mental health and disability services are often the first to be cut. In addition, access to primary and specialty care decreases as these managed care companies further reduce reimbursement to health care providers who care for Medicaid patients. Physicians are often then forced to take fewer and fewer Medicaid patients to stay financially solvent. We all know of primary care practices that refuse to take Medicaid patients or have stopped accepting new Medicaid enrollees. This has significantly decreased access to care, driving patients to emergency rooms and driving up costs.

NC has one of the highest reimbursement rates for Medicaid patients, yet it leads the nation in containing Medicaid spending growth, and boasts one of the highest percentages of primary care physicians in the country that care for Medicaid patients. So as a medical student, like many of my peers and future colleagues, I became very concerned about the future of NC’s Medicaid system and felt discouraged.
 
Thankfully, two other fourth-year medical students, future family physicians, from the University of North Carolina shared my concern. Last November, they wrote a letter to NC’s state representatives and Governor McCrory that expressed their understanding of the complexity and magnitude of reform efforts, but made it clear that students believed building on the foundation of CCNC was essential to success:
 
“To this end, we ask that you strengthen the state’s relationship with Community Care of North Carolina to help manage the health of North Carolina’s Medicaid population. As a physician-driven, not-for-profit organization with a history of delivering high-quality and cost-effective care to the citizens of the state, CCNC gives us reason to be proud of our state’s Medicaid system. Your support for this organization would send a message to medical students in this state, as well as around the country, that North Carolina is committed to fostering one of the most innovative, successful medical communities in the United States.”
 
Though many have come forward in support of CCNC in the Medicaid reform debate, the students expressed a concern rarely raised in the debate. Changes in the system now may have a significant effect on the physician workforce of tomorrow:
 
“We also worry that losing CCNC would diminish our ability to retain medical graduates of North Carolina and attract new trainees to practice in North Carolina, especially much needed primary care providers. As future physicians, not only do we look forward to the support CCNC would give our patients and us, we also want to work within a groundbreaking and nationally recognized model for health care improvement. Eliminating support for CCNC would hurt North Carolina’s reputation as a center for health care innovation and lessen its appeal to new medical graduates.”
 
With this letter as the students’ unified message, a multi-institutional, entirely student-led grassroots effort began, raising awareness of the issues surrounding Medicaid's future in the state and serving as an opportunity for other students to add their voice.
 
By the morning of January 15, the day of the Medicaid Reform Advisory Group meeting, over 300 medical students from all five medical schools in the state had signed the letter. The letter was presented to the Medicaid Reform Advisory Group by four future family physicians. Standing tall in white coats, the four medical students told a patient story of CCNC's success and let the reform group and all that were in attendance know what was important to hundreds of medical students in Medicaid Reform.
 
Many of these 300 medical students have pledged continued involvement in this process and several students at UNC have committed to restarting a Health Policy Interest Group to promote interest and facilitate future advocacy. “We are so excited about this letter, but if we don’t continue to engage with the legislature, we are in danger of practicing advocacy tourism. We want to develop long-term relationships with our state’s leaders so we can better affect change and advocate for patients that rarely have a voice,” said Laura Cone, Co-President of UNC Health Policy Interest Group. Medical students at Duke and Wake Forest are currently in talks about starting their own health policy groups.
 
I’ve been inspired by my medical student peers and glad that I stood with them to tell NC’s leaders what is important to us, but I’m disappointed that we are the exception and not the rule. Primary care physicians and medical students often find themselves too busy, uninformed, or uncomfortable being involved in health politics. However, politics have a dramatic effect on our health care system and patients. If we don’t speak up for what type of health system we want to practice in, we are doing ourselves a disservice. Most importantly, if we don’t speak up for vulnerable and underserved populations, we are doing patients a disservice.

What’s happening in health politics in your state? Have you contacted your representative lately?

Cleveland Piggott is an MD/MPH candidate at UNC School of Medicine with a double major in biology and psychology from the University of Georgia. He's been involved in the NC Academy of Family Physicians and undertaken multiple leadership roles. He also helped start his school's PCP chapter and the first undergraduate family medicine interest group in the U.S.

Further reading
Posted by Sonya Collins on Feb 11, 2014 12:00 PM US/Eastern
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