What I Did on My Summer Vacation

Medical Students Work on Health Policy on Capitol Hill

Imagine being listed as the point person in your organization for a $128.5 million bill in Congress. A heady thing for a 26-year-old who is still in school. It was an experience that Michael Bates will never forget. Bates, a member of the LSU Health New Orleans School of Medicine Class of 2022, is also a member of the 2019 Class of the LSU Health New Orleans Health Policy Fellowship Program. He, along with five of his classmates, spent two months in Washington, D.C., this summer gaining real-world, applied experience in health policy development, research, analysis and advocacy.

These students devoted the last summer vacation time they’ll have for a while to this program. “I really wanted to use my ‘last summer’ to learn about medicine from a completely different perspective that I would never get from the classroom,” said fellow Fellow Nicole Rueb.

“Medical students in the Health Policy Fellowship Program gain valuable experiences regarding the impact of policy on the delivery of health care,” said Peggy Honoré, MHA, DHA AmeriHealth Caritas-General Russel Honoré Endowed Professor at LSU Health New Orleans Schools of Public Health and Medicine. Dr. Honoré founded and leads the 4-year-old fellowship program made possible by the generosity of AmeriHealth Caritas Louisiana.

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Bates, a New Orleans native and Jesuit High School grad, was paired with the National Hispanic Medical Association (NHMA). He attended briefings and hearings, and reviewed bills introduced in the Senate and House committees, combing them for language that allowed NHMA to seek funding if passed into law for its programs or for external programs that further its mission. He wrote the Legislative Update section of the NHMA newsletter to inform members of pending bills. Bates also learned more about media at The Washington Post and through interview shows at the Newseum studio.

The $128.5 million bill Bates championed is very close to his heart. It is about graduate medical education and addresses a shortage of primary care physicians in underserved areas. H.R. 2815, “Training the Next Generation of Primary Care Doctors Act of 2019,” reauthorizes section 340H of the Public Health Service Act to continually encourage the expansion, maintenance and establishment of approved graduate medical residency programs at qualified teaching health centers.

Global Efforts to Combat Diseases

James Mickler, whose undergrad university was LSU, worked at the Centers for Disease Control and Prevention (CDC) Washington, D.C., office. He was assigned to the NCIRD (National Center for Immunizations and Respiratory Diseases) and NIOSH (National Institute for Occupational Safety and Health) accounts. He tackled such health issues as the measles outbreak on the U.S. and the resurgence of black lung disease in coal miners. But the highlight of his fellowship involved another serious health concern.

“Halfway through my fellowship, I was invited to join the chief medical officer of the CDC to attend a briefing at the State Department's Truman building on the current state of the U.S.’s involvement with the Ebola outbreak in the Democratic Republic of Congo,” Mickler related. “The meeting was attended by diplomats from over 50 countries, and I got to witness the vast global effort that was being assembled to combat this epidemic. After the meeting I got to ride in a long cab ride through D.C. traffic with the chief medical officer along with the head of the Bureau of Democracy, Conflict and Humanitarian Assistance (DCHA) of U.S. Agency for International Development. During the ride, they shared a life full of adventures -- traveling around the world to help people from all walks of life, telling stories of strange food and stranger diseases. Their passion for helping others was contagious, and it was truly inspiring to hear the life stories of the people behind the Ebola response and the U. S.'s humanitarian and global health efforts.”

Surprise Medical Bills

Carley Boyce worked in Sen. Bill Cassidy's office. Two of her main assignments were the Surprise Medical Billing issue and Lowering Health Care Costs.

“I was tasked to read through each state’s law and determine what sort of protection against surprise medical bills was in place,” noted Boyce. “We created our own map separating out states with two specific approaches, Benchmark and Independent Dispute Resolution.”

She helped create graphics for the senator to present supporting data. One was on the different health care costs by state.

“I researched reasons for these differences, such as minimally invasive procedures, reduced opioid care, more holistic approaches, more specialization, hospitals going green, teaching hospitals, etc.,” Boyce explained.

She attended strategy meetings, biweekly staff meetings, roundtable press meetings and meetings with many insurance groups, physician groups, hospital groups and patient advocacy groups. Boyce also attended and wrote summaries of the House Energy and Commerce Hearing on Surprise Medical Billing and the Senate HELP Committee Hearing on Lower Health Care Costs. She even made it on C-SPAN, sitting behind the senators of course, but clearly visible.

Safety Net Health in Action

Baton Rouge native Caroline Bonaventure was assigned to the Association for Community Affiliated Plans (ACAP). ACAP is an association of 66 nonprofit and community-based Safety Net Health Plans located in 29 states. Collectively, ACAP health plans provide coverage to 20 million people enrolled in Medicaid, the Children’s Health Insurance Program (CHIP), Medicare Special Needs Plans and Qualified Health Plans.

She worked on a project to create a learning collaborative to push behavioral research to ACAP plans. Bonaventure’s role was to read, summarize and categorize 50+ behavioral health research projects funded by the Patient-Centered Outcomes Research Institute.

Bonaventure also contributed to an examination of programs designed to close the gaps in LGBT health outcomes. She participated in calls, hearings, and briefings related to Medicaid issues such as Section 115 demonstration projects, immigration changes, changes to ACA Section 1557, and pathways to universal health care.

“It was so interesting to see the Congressional members at work and hear from the different witnesses, some of whom I recognized,” said Bonaventure.

Among the highlights of the fellowship for her were the field trips, particularly to the National Institutes of Health and the D.C. Department of Health.

“During these visits we got to learn more about health policy, the future of public health, and how to get involved as a physician in the future,” Bonaventure relayed.

On the Front Lines of Policy

Andre Florea was born in South Africa to Romanian parents and arrived in the U.S. at age 4. He was teamed with the National Academy for State Health Policy and researched why CHIP enrollment is falling in many states. He also worked on expansion of state-based health care exchanges.

He feels the Fellowship program was the best thing he could have done in the summer following his first year of medical school.

“It was a great experience that showed us how heath care is discussed in this country and introduced us to the people on the front lines of policy,” said Florea. “The best experience was going to congressional hearings on the Hill to hear senators and representatives talk about health care issues with witnesses preeminent in their fields.”

Greater Access to Care

Nicole Rueb was matched with the National Rural Health Association (NHRA). She contributed to an analysis of rural hospital closures and how current policies affect rural hospitals. She also worked on access issues, specifically mental health, primary care and maternal health. Other areas included workforce shortages, important not only to access, but to the economies of rural areas because hospitals are often the first or second largest employer in a rural community.

“The fellows work on policy formulation and analysis tasks that provide them with real illustrations of how policy can influence improvements in the health of populations,” added Honoré. “These dynamic experiences help them understand how policy, as an essential service of public health, is a critical component to producing better health in the U.S.”

Dynamic Fellowship Shapes Future Practice

“The best experience I had while working with the NRHA was researching proposals for changes in Medicaid and Medicare in real time then sitting in on briefings on the Hill where my research was explicitly used by the NRHA lobbyist who were panelists.” noted Rueb. “I was able to see how the NRHA influenced policy in order to improve health care in rural America.”

It was a seminal experience for these future doctors. One that really broadened their perspectives and horizons.

“Before the program, I had very little knowledge about health policy,” admitted Bonaventure. “This fellowship gave me the opportunity to learn firsthand about so many aspects of the health care system that I could never have learned in a classroom.”

Added Florea, “Even though I plan to become a practicing physician, I will definitely incorporate public health policy and advocacy in my future career.”

“My fellowship experience has opened my eyes to not only the need but the vast amount of opportunity in internal medicine and primary care, and how I can somehow make an impact in rural health care,” said Rueb.

Bonaventure gained new insight into health care. “This fellowship showed me how important it is for physicians to have a voice in health care policy and to advocate for patients and give firsthand insight into how policy shapes practice.”

Boyce expressed her gratitude to AmeriHealth Caritas, Dr. Honoré, Dean Nelson, and LSU Health New Orleans School of Medicine, “for giving me this unique and once in a lifetime opportunity! I’m so grateful for my incredible summer.”

Bates concluded, “In my opinion, the Health Policy Fellowship Program is one of the best experiences LSU Health New Orleans has to offer. Doctors are more than just clinicians. We have the capability of being community leaders and giving voice to our patients in high places where they are not normally heard.”

Along with Honoré, three of this year’s fellows – Michael Bates, Caroline Bonaventure and Nicole Rueb – will present their newly gained expertise at the American Public Health Association annual meeting in Philadelphia in November.

And who knows where they’ll go from there.

“Leadership skills gained through the fellowship experience prepare them for roles in advancing health system change,” explained Honoré.

Take Michael Bates. “The Health Policy Fellowship Program revealed a calling I have toward leadership in the health care sector of this country's political atmosphere.” But not for a while. “Prior to diving into health policy, I want to be a practicing physician for a long time after my residency training. To influence health care at the 30,000 foot level of Washington, D.C., before developing a ground-level understanding of patient care would be a disservice to patients and health care professionals equally. As a life-long goal, I would be honored to one day be considered for Secretary of the Department of Health and Human Services.”