Medical College of Wisconsin (MCW) Department of Medicine Assistant Professor Rachel Bernard, MD, MPH, FACP, recently completed her year as a member of the inaugural class of the National Academy of Medicine (NAM) State Health Policy Fellowship program. As one of the first fellows in this pilot program funded in part by the Advancing a Healthier Wisconsin Endowment (AHW), Dr. Bernard spent the year embedded within Wisconsin's executive government branch offices, contributing to the development and implementation of state health policies and programs.
Describe your professional journey and how health policy became central to your work. How did your medical experience highlight where policy change is needed?
I first became interested in health policy when I attended an American College of Physicians (ACP) Leadership Day in Washington, D.C., during my residency. This was the first time I was able to see how physician organizations can organize around health policy issues and influence national health policy.
Since that time, I have learned that physicians and other healthcare workers can have a huge impact on national, state, local, and institutional policy. We are all experts in healthcare through our work with patients, and this expertise is highly valuable to policymakers. When something seems to be under-functioning in the clinical space, it can often be traced back to a national, state, local, or institutional policy. Once you identify the policy leading to your clinical frustration, all you need is interest and energy to start working on a policy change!
Prior to my time working at MCW, I was a medical director in the COVID Response Bureau at the Chicago Department of Public Health. During the COVID-19 pandemic, I was able to see firsthand how important state and local governments are in the implementation of health policy.
Through my recent work with ACP-Wisconsin, I began to understand that state-level policies can have a huge impact on the work of physicians and the lives of our patients. The NAM fellowship helped me understand in much greater detail the role that the state executive branch, including DHS, plays in the implementation of health policy that affects us every day.
As a primary care physician, I had some idea about the role of Medicaid in the healthcare system. Through my work with DHS and the DMS this year, I was able to learn much more about the scope of services offered by Medicaid, as well as the processes and collaborations that go into updating Medicaid policy.
I was able to learn about how much Medicaid programs can differ by state and how a state Medicaid program can adapt to the specific needs of the residents of that state.
One of the major projects I worked on was helping Wisconsin Medicaid review and update their coverage of obesity treatments, including the bariatric surgery coverage policy. This space has had so many clinical updates in the last several years that my experience as a clinician was especially helpful to the team in identifying components of an effective policy. I learned through this process that clinician input can be critical to the folks at DHS, who have vast policy experience but not as much experience with treating patients every day in the current, rapidly changing clinical landscape.
My previous experience at the state level had been focused on advocacy at the state legislative level, especially with physician group advocacy. After completing the NAM fellowship, I have a better understanding of how physicians can support the work of the executive branch, including providing clinical guidance and participating in advisory groups. Both avenues of impacting state health policy are important!
One of the biggest benefits of completing the NAM fellowship is all of the connections I was able to make with other clinicians who work on national and state health policy. I was also able to build relationships at Wisconsin DHS, especially in Medicaid and public health. I have a much better sense of how the different cogs work together on the state level and where to start with advocacy regarding health policy in Wisconsin.
My best advice for healthcare professionals considering policy work is to choose an issue you are passionate about and follow national and state groups who work on those policies. This is a good way to stay updated in a quickly changing policy landscape.
I also recommend getting involved with national healthcare organizations, as they have good opportunities for advocacy and coalition-building. Many of these organizations would benefit from more work on state-level advocacy, so that is a great way to get involved!
To learn more about the NAM State Health Policy Fellowship program and future opportunities, visit: https://nam.edu/our-work/health-policy-fellowships-and-leadership-programs/state-health-policy-fellowship/