This week the Lamont administration announced that Vicki Veltri will be leaving state service in a few weeks. She will be missed. Director of the Office of Health Strategy is a tough job. The cost of healthcare is straining every budget in the state, including families, businesses, payers, and government. And we aren’t getting the quality we are paying for. Prices are rising without any restraints. We can’t afford any more. For what it’s worth, here is some advice to Vicki’s successor from an advocate with the same goals.
OHS is tasked with improving access to high-quality healthcare while making it more affordable for every state resident. Expectations are impossible, misinformation is rampant, conflicted interests are everywhere, and there aren’t enough resources.
Some good news, everyone involved wants the same things – better, more affordable care, and improved health. Getting us on the same page is hard, but our motivation grows with every annual budget and new contract negotiation.
First, build trust. Progress happens at the speed of trust and Connecticut’s health system is riddled with mistrust. Good relationships will ensure that doors are open when you need to iron out miscommunication and the inevitable wrinkles when implementing policies. You won’t be running a hospital, an insurance company, a public coverage program, or seeing patients. You won’t vote in the General Assembly. You’ll need to move all those stakeholders and more to make things happen. There are very few levers to make anyone do anything. But people are getting tired; there is growing interest in moving past mistrust. Tell the truth, keep your promises, and show your math.
Follow the evidence – hard stop. Use all your analytic skills to see through the weeds of data and policy to recognize unintended consequences. Evidence is the best answer to lobbying and political challenges. Don’t rely on others to point you through. Take the time to dive into the jungle yourself.
Use all your management skills to hire the smartest people you can find, keep them happy, and get out of their way. Be clear that you expect the truth from them – even if it may displease you. Ignore the herd of agencies and companies hiring consultants for everything, especially data analysts. They don’t know Connecticut, they’re only worried about keeping you happy, and they’ll be long gone when implementation hits the fan. Create the cool kids’ table that everyone wants to join.
Don’t fall into idea cults – the latest buzzwords in health policy that everyone’s talking about. Some may have value, but most are just fads. Especially beware of old, failed ideas dressed up in new labels. Stick to the evidence. If there isn’t any, test ideas in pilot programs and evaluate honestly. Don’t get emotionally attached to your ideas. You must be able to change or abandon a project if it’s not working.
Open the policymaking process. Seek out contrary perspectives. Your critics are a gift. Don’t be afraid of opinions that diverge from the path you’re on. You’ll save yourself a lot of delay, acrimony, and bad press by taking the time to consider if they’re right. Graciously and publicly admit when you’re wrong – it adds to your credibility.
Don’t start planning anything with the outcome already decided and then reverse engineer the process to get there. I’m far too impatient to love process, but I’ve learned its value the hard way. It gives you time to find and fix the flaws and an opportunity to engage the people you’ll need to make it work.
Take your time. Don’t attempt to do too many things at once. Try out ideas, evaluate, revise, and learn. Progress is slow, but it’s better than doing nothing. Don’t waste time on ideas that sound good but have little chance of working. Knowing the difference requires listening to the evidence and to people who know more than you. Get comfortable with hearing both.
Use all your resolve to hold people and organizations accountable. You’ll be responsible for deciding if healthcare organizations can merge into massive health systems and if they can add or drop services. The latest maternity center closings highlight the conflict between profits and community needs. Many are concerned that having this function in your office is a conflict. Other states don’t have cost-control efforts in the same agency as approval of mergers and service cuts. Checks and balances are key to good government. You’ll have to be okay saying no to powerful interests.
You’ll also have to hold your own office accountable. After many years and millions of taxpayer dollars, Connecticut still doesn’t have a viable All-Payer Claims Database or a health information exchange. The first is critical to knowing where we are overspending and what we need more of. The second is critical to patient safety, improving population health, and provider accountability. But don’t sell our sensitive medical data to fund it.
Healthcare is complicated and messy. It’s hard to make real progress, but if you follow the data, build trust, and listen more than you speak, you’ll be fine.