LSU Health Medical Students Go to Washington

“As I was considering summer options, I came to the realization that this was my ‘last summer’ until I retire,” recalls LSU Health New Orleans second-year medical student Kelsey Cramer. “I felt compelled to do something big and different and exciting.”

An opportunity few medical students get checked all the boxes. Cramer was one of seven fellows in the AmeriHealth Caritas Health Policy Fellowship Program at LSU Health New Orleans schools of Medicine and Public Health who spent eight weeks in Washington, DC, this summer learning the answers to questions like: What is a physician's role in public health? In health policy? What factors will shape how physicians can care for their patients and improve the health of the communities they serve? How can physicians improve population health and health care quality? How do disparities affect health and what can be done to address them? The fellows are all members of the LSU Health New Orleans School of Medicine Class of 2021.

Cramer worked at the Congressional Research Service, where she learned firsthand how health policy is made and implemented in our country. She also contributed to the research done for Congress.

“I spent half of my time attending seminars, hearings, and briefings all over Capitol Hill on topics ranging from medical nutrition to the future of artificial intelligence in health care,” says Cramer. “The other half I spent researching and writing a product that will be distributed to members and staff of Congress. For my product, I selected a topic that is relevant to today's policy concerns and is also relevant to my experiences as a medical student – Emergency Department Utilization and Flow. Emergency Department crowding and costs affect hospitals all over the country, including the hospitals that are affiliated with LSU. I hope to be able to continue to learn and work on this issue in New Orleans.”

It was an eye-opening experience that broadened both her knowledge and perspective.

“This fellowship allowed me to bridge my medical curriculum with health policy in a completely unique way that could only happen in Washington, DC. I learned how policies go from ideas to laws and the actual process of writing policy and legislation. The Health Policy Fellowship has given me a unique perspective of the ‘macro’ world that will affect my future patients. In school, we are trained in incredible detail to work on the ‘micro’ world of anatomy, physiology, pharmacology, pathology, etc. This fellowship has allowed me to see how policy and social determinants (the ‘macro’) will affect my patients in just as tangible ways. Lifetime health policy experts told me time and again that doctors need to be more in the loop with what is going on in the legislative world. It has been an invaluable addition to my medical education.”

Cramer’s agency was just as pleased with her.

“Thank you for sending us another excellent fellow this summer to help us with our policy work and for starting a relationship with the Congressional Research Service and LSU Health New Orleans,” says Matthew Berry, Health Services Research Section Manager at the Congressional Research Service.

Policy Shapes Practice

Peggy A. Honoré, DHA, AmeriHealth Caritas-General Russel Honoré Endowed Professor at LSU Health New Orleans School of Public Health and School of Medicine, started the fellowship three years ago. Primary goals of the fellowship include advancing the student's understanding and abilities for influencing and setting federal, state, and local health policy agendas with emphasis on policy issues that impede the improvement of quality, reduce cost and eliminate disparities.

“Having spent eight years in DC at the US Department of Health and Human Services in the Office of the Assistant Secretary for Health, I appreciate the value of understanding the health policymaking process,” Dr. Honoré explains. “I knew that it was particularly important for physicians to understand these processes since it frames the context in which medicine is practiced. A value of attending a medical school in Washington, DC, is that it is common for those students to do Health Policy Fellowships there. I thought LSU Health New Orleans medical students should also have the opportunity to gain knowledge they would not get in medical school. Driving my desire to create the program was that students who would eventually practice in the state could benefit from knowing how to influence policies that could improve the health of Louisianans.”

Honoré matches the students’ interests with the policy topics that participating agencies have on their policy agendas.

“For example, a former NFL football player who is now an LSU Health New Orleans medical student was placed on the Congressional Committee that was holding hearings on the problem of concussions for grade school, high school, and college students, as well as NFL players,” Honoré says.

Addressing Disparities

2018 fellow Adeem Nachabe worked at the Association of Community Affiliated Plans (ACAP). Nachabe researched rising maternal mortality and morbidity rates in the United States.

“Since 2000, these rates have been rising in almost every state in the country. This issue has been disproportionately affecting women of color, who suffer from maternal mortality 3-4 times more and have a higher case-fatality rate from pregnancy-related illness. As part of my research, I studied why these rates are increasing, the cause behind the racial/ethnic disparity, possible solutions to the issue, and what ACAP-member safety net plans are doing to quell the rising trend. I attended forums with presentations from non-profits and members of Congress attempting to craft solutions to this issue. This project has strong implications for my future as a practicing physician. Throughout my work, I have learned how health outcomes can be improved beyond treating the immediate physical ailment.”

A detailed understanding of the ins and outs of how safety-net health plans work will make him a more effective physician.

“This fellowship has exposed me to how health care is delivered to a certain population and how health policy can affect this delivery. I learned about Medicaid, Medicare, and Marketplace health plans and delivery of health care to low-income, elderly, and special needs populations. As a result, it will help me help my patients navigate it. It will also help me understand how I can provide feedback and help continuously improve how we provide coverage and treat our population.”

Nachabe was also there to see his agency grapple with a significant change in a policy affecting its operations.

“I had the chance to be in the office the day after the administration stopped risk-adjustment transfers between plans intended to offset losses and stabilize the market. This was of big concern to ACAP plans that operate in the Affordable Care Act marketplace as it affects their bottom line. It was unique to be in Washington and in this office to hear their concerns along with the reasoning behind ending the transfers, instead of reading a report on it.”

Expanding Horizons

Honoré placed Joseph Ragusa at the National Academy of State Health Policy, where he worked in the prescription drug pricing division. The non-partisan, non-profit organization works to help states address health policy issues including rising drug prices.

“I went to Senate committee hearings, wrote blogs about current state legislation and brainstormed with the prescription drug pricing team on how to better help states lower prescription drug costs. Learning about the laws and regulations that affect patients, especially ones related to the rising cost of prescription drugs, allowed me to better understand their circumstances, which will make me a more compassionate physician.”

Delaney Sheehan worked on Latino health at the National Hispanic Medical Association.

“I represented NHMA at events concerning health issues like liver disease, mental health and sexually transmitted diseases, just to name a few. I also attended hearings on Capitol Hill on both the Senate and House sides on topics including the 340B program and prescription drug prices in the presence of Secretary of Health and Human Services Alex Azar. Following these events, I wrote summary reports for my organization and drafted calls-to-action for our website and social media asserting NHMA's positions on the various topics. I wrote statements addressing proposed bills in Congress that had the potential to impact the health of Hispanics and worked with NHMA partners to submit comments either commending or opposing pieces of legislation.”

Caroline Bilbe spent her time with the Energy & Commerce Committee’s Health Subcommittee, which has jurisdiction over a variety of health care areas. “I attended briefings or hearings on subjects ranging from the discounted drug program to health information technology. Most of my work, however, was on projects relating to the opioid crisis due to the committee's contribution of dozens of bipartisan bills aimed at ending this epidemic. The knowledge I have gained viewing the legislative process first-hand is invaluable to me now as a medical student and will help me better advocate for my patients in the future as a physician.”

Nancy Kieu Diem Tran contributed to the National Council of State Legislators in a variety of ways. She kept updated on HHS issues with an emphasis on state-federal relations by covering congressional briefings and hearings, as well as talks by outside entities. She used what she learned to help write policy briefs. She provided a medical student’s perspective on issues. She helped prepare for the annual legislative summit where various areas of the organization discuss and vote on committee policies and resolutions.

“Outside of policy work, I wrote a post for NCSL's blog and helped them re-vamp their website,” Tran says.

NCSL’s Haley Nicholson comments, “The partnership between NCSL and the LSU Health Policy Fellowship Program allowed us to elevate NCSL and LSU's presence with our federal partners, work on projects combining the fellow's medical studies with health and human services policy, and deepen their understanding of how to engage in future federal and state health and human services advocacy.”

Ashley Smith worked with the staff of senior Louisiana Sen. Bill Cassidy, MD.

“The first thing that the Senator and his aides did when meeting me was to ask me about my interests.” Smith says. When she answered determinants of health, she was paired with staff working on maternal and fetal mortality rates, Medicare and Medicaid, factors that drive up prescription drug prices and the opioid crises.

“It was very fast-paced, but questions were welcomed and uncertainty on a topic was never met with judgment. On the contrary, the Senator and his staff wanted to make sure that I left with a better understanding of how health care works so that I can one day be a part of the change that needs to happen.”

Senator Cassidy looks at the program as in investment. “Our country benefits when smart, young people get engaged in government. Doctors serve our communities in the examination room; and I've found that as a Senator, you can use that experience to improve your community with wise public legislation,” says Cassidy. “This program gives the next generation of doctors an understanding of the connection between patients and policy.”

Steve Nelson, MD, Dean of LSU Health New Orleans School of Medicine, concurs. “The fellowship opens avenues to the medical students that will enable them to effectively advocate for their patients as they become practicing physicians and affect changes to improve health. We are grateful to our elected officials and participating organizations, and most especially to AmeriHealth Caritas, for expanding our students’ horizons and providing them opportunities to augment their education with invaluable knowledge.”

A Healthier Louisiana

So far, 19 LSU Health New Orleans medical students have participated in the program.

“Some have continued work on policies once they return to campus,” reports Honoré. “One student who worked on the problem of opioid addiction in big cities continued her work on this topic with physicians on campus and is a co-author with them on papers that provide guidelines for opioid prescribing. Another student is currently seeking to be engaged with health policy in the city of New Orleans.”

Funding from AmeriHealth Caritas Louisiana supports the fellowship program, which includes travel expenses, housing and transportation, and also includes a stipend for each student.

“AmeriHealth Caritas Louisiana is demonstrating through action that they have a vested interest for providing expanded educational opportunities for the future physicians of Louisiana,” says Honoré. “Policy is a cornerstone of public health, and population-based policies, such as smoking laws, seat belt laws, and access to care laws have benefits that far exceed interventions targeting one person at a time. The fellowship provides the medical students with concrete hands-on experience about something that will impact the context in which they practice medicine. They learn how policy can be influenced through advocacy and how they can inform lawmakers about health problems that need attention. I hope that some will rise to health policy leadership roles in the state as well as in the nation's capital. I hope that they will use this health policy knowledge to improve conditions in the state of Louisiana to raise the state up from being ranked 49th in health status in the nation.”