Well, certainly, thank you for joining us today. Dr. Gwilliam and I will be discussing with you advocacy in the clinical environment. My name is Doug Harley. I'm a program director in family medicine. I'm also the president of the Ohio Osteopathic Association. And my co-speaker is... Hi, I'm Jennifer Gwilliam, and I am a proud osteopathic family physician, and I am board certified by the ABOFP. My current title, I work for Ohio University Heritage College of Osteopathic Medicine, and I'm the chair of the Department of Primary Care, and I also serve as clinical assistant dean. I completed the Health Policy Fellowship in 2013. I'm a past Ohio Osteopathic Association president. I'm also past Ohio ACFP president, and I will be joining the National ACFP Board of Governors in April of this year. I've also served on numerous AOA committees, including COCA for nine years, Bureau of Osteopathic Education, and currently, I'm on the Bureau of Federal Health Policy. Our disclaimers today, we have no financial disclosures. And while we are both family medicine physicians, legislation is important to all specialties in medicine. Much of our conversation today will be about our personal experiences and the components of Ohio's efforts for advocacy. So certainly today with you, we're going to discuss the importance of advocacy, both in the clinical as well as the educational environments. We're also going to really talk about the importance of collaboration across disciplines. Again, you know, both Jen and I have been part of our Ohio Osteopathic Association, which is all specialties of osteopathic physicians within the state. And certainly we're going to share some of our personal stories with you today, as far as our experiences with advocacy, as well as in the state legislation for Ohio, and really how we're helping to drive change through our state osteopathic association. Advocacy and medicine. Advocacy involves actively supporting and promoting policies, practices, and initiatives that benefit patient care, medical professionals, and healthcare systems. It also shapes health policies, influences legislative change, and improves the quality of care provided. It's critical in both the clinical and the educational settings. Advocacy is an activity by an individual or group that aims to influence decisions within the political, economic, and social institutions. It's any action that speaks in favor, commends, argues for a cause, supports or defends, or pleads on behalf of others. Strategic actions taken to drive social, organizational, or policy change on behalf of particular health goals for population health. Role of advocacy in the clinical setting is important to improve patient outcomes. This is advocating for evidence-based practices, advocating for better resources, and appropriate funding, which will ensure optimal healthcare. Improving concerns of medical professionals. This is not just physicians and healthcare. This can involve nurses, behavioral health, allied health professionals, and other providers advocating for the patient's needs. Access to resources. This is ensuring that patients have the correct needs that they need. For example, appropriate treatments, access to medications, and the appropriate technologies that they require to receive access to that good healthcare that they need. Advocacy helps clinicians navigate the systemic barriers that hinder patient care and provides a voice for those in need. Role of advocacy in educational settings. This is important because we're training the next generation of providers, and we need to have well-trained and prepared physicians. Curriculum and policy reform. This is important because we're promoting curricula that includes diversity. Not only diversity in our curriculum, but diversity in those individuals we're training. For example, I grew up in a rural town in Southern Ohio, Appalachian area, for any of you that are familiar with that term. For me, my patients, many of them that see me, are from Appalachia. I'm currently practicing a dermatology practice one day a week, and I will tell you, many of these individuals that come and see me have pretty extensive skin cancers. They were always afraid to go to the dermatologist before, however, because they feel comfortable with me because I grew up in that area. They know me. They may know my family. They're comfortable coming to me. I can't tell you how many of them I've diagnosed with skin cancer. So that's an example of meeting your patients where they need. Also, it's important for mental health, public health, and social determinants of health. You know, thinking about things such as food insecurity, transportation, especially when you're going to refer a patient two hours away to Columbus, Ohio. I have to think about, does this patient have the ability to travel that far? If not, what are my options for helping that patient? Also having collaboration across disciplines and advocating for that team-based care. Again, having the physician, having the mental health provider, having nurses, having other providers involved. This is so important that COCA came out with a standard for medical students. It's in the guidelines for accreditation. Each medical school has to ensure that there's a simulated patient aspect, which is called interprofessional education. During this course at Ohio University, we integrate the medical students with PT students. We also integrate them with nurses, paramedics, and also integrate them with pharmacists. They go over scope of practice, learn how to write prescriptions. All of this stuff is extremely important in that education system of teaching advocacy. So again, education ensures the training aligns with evolving healthcare needs and fosters future advocates in the field. One of the unique experiences that I get to take a part of is within the Ohio University Heritage College of Osteopathic Medicine, the TCC curriculum, which is the Transformational Care Continuum, which is a 3 plus 3 family medicine, medical school, accelerated program really focused on population health management. So we actually just had the wonderful opportunity to be able to graduate our first residents from this curriculum this past June. So really it's in full force at this point in time. We take in eight students total at two separate campuses for residency. And really the reason we talk about this is how do we incorporate advocacy within the educational environment? Again, this is focused on population health management. And really one of the biggest pieces as we think about value-based care, we're not quite there in the United States. We certainly are making headway towards that. Many of you may have experience with value-based contracts. Those of you in the audience that are students or residents, these may be new terms towards you. But really as we think about how do we take care of a population as a whole, thinking about our A1C control, thinking about our blood pressure control, that's really baked into this curriculum and really advocating for these students to think about that, not only in their medical school time, but also thinking about it as they move into a family medicine residency program. As we think about and look at the curriculum of how we teach those students, it really focuses on lots of areas of advocacy. Many of you, including myself, probably remember back to your medical student days. We didn't do a lot necessarily in training you to be an advocate for legislation. We might have trained you on how to be an advocate for osteopathic medicine. I remember the brochures, I remember the talks, I remember the books on how do we teach others, the MDs, our community patients on what a DO is. At least for us in Ohio, we have a wonderful osteopathic family. We have three campuses of Ohio University. We have a new upcoming campus of Xavier down in the southwest portion of Ohio. We really have a large growth of osteopathic medicine. But we really need to think about how do we advocate, not just for osteopathic medicine, but how are we advocating for all of those other components that matter to us as osteopathic physicians. To us, again, Jen and I are family docs, so in the family medicine realm, or even in the dermatology side, as she alluded to. But really, this does represent all specialties. And so these students are learning about on the state level. They're learning about value-based payment initiatives. They're learning about how do they get involved on the legislative aspect. They're learning about how does the state budget get put together. That's always a really unique thing to think about, and how does the national budget get put together. They also start to think about and look at the federal side, look at what medicine has been in the United States, not just osteopathic medicine, but medicine as a whole. How has it affected different races, different classes of individuals? What are the economics behind it? Because learning from that history is how we move forward. They're also looking at how do trade associations help in with policy decisions, and how can we as physicians help to be influencing in that aspect as well. They learn about things like insurance that wasn't around all the time. That's a new thing, or a newer thing. Thinking about all of the other acronyms that many of us know about, but as students and residents, these are going to be ones that you hear about, about DRGs, about HMOs, about HEDIS, NCQA, the ACA, the repeal of ACA, lots of different things that we really need our students to think about, know about, and be able to advocate for the things of them. Then really looking at medical education as an industry, it really is an area where students can come in and learn and grow, and there is a lot of industry component to it. Now, that doesn't certainly mean we're making the same widget over and over again. They're all unique individuals in their own right, and certainly fulfill different aspects within different areas of the communities. One of the other cool things within this, they engage in debates and switch sides to make it more interesting and make it more meaningful to the student. One of the questions that they go over is, should the government be responsible for ensuring all Americans have access to healthcare through a single public program? They find out who's for it, who's against it, and then they have them switch sides, and they have to argue from the other side. If any of you might have been in debate club whenever you were in high school or in undergrad, that's a similar thing that most debate teachers will do. It's really about thinking about the argument, thinking about how do we develop the facts for our side, even if it's not something that you necessarily stand for, and really also thinking about how do we think about the community practice, building on organizations like the AAMC, and really putting the evidence forward for the students into the advocacy aspect. One of the other cool things, if we ever have the chance to be able to do it, is to get DOs on to different aspects of legislation. Certainly this example is not one of a DO getting on, but DO adjacent. So Caitlin Rader is one of our residents. She's in the middle area here. She's one of our TCC residents, and her husband recently was inducted into one of our house representative districts in Ohio. So really being able to share some more of, at least on the state of Ohio level, osteopathic principles at the state house. So it's really a neat way to have that voice into that component. Chris then actually was on their local, the town where the Ohio campus, I'm sorry, where OUH Com Cleveland campus is, and where our residency program is. And so he was able to serve on the local level at the town council, but then moving upward as he saw his aspirations getting bigger. So really it's a cool thing to have that voice there. And you'll see we have a couple of other DO voices within our house legislation. We'll share some pictures here momentarily as well. I had earlier mentioned that I'm a program director for family medicine. And I think as we talk about advocacy in the clinical environment, I think it's important for practicing physicians such as yourself to know what the next generation of residents, particularly in the family medicine realm, are learning and what they're expecting to do. So under our ACGME, our family medicine milestones or competency-based components look at advocacy as being part of that education, of that training. And we have those sub competencies present. If you're not familiar with this, I'll show you a table next, but level four is really what we want to get our residents to in family medicine. Level five is hopefully what we expect for us practicing physicians. For those students in the virtual realm here, certainly these are going to be the things that you look forward to as you move into residency. All the residencies have different milestones. I cannot speak for the other specialty milestones, but they may also have pieces of advocacy within them. As you look at systems-based practice for the family medicine resident, the physician role in healthcare systems, a level five, which is again where a lot of practicing physicians should be, but we also want to maybe see our third-year family medicine residents here, is a level five as you are participating in health policy advocacy activities. We'll talk a little bit later about how you can easily get involved, even while you're sitting in your chair. There's lots of pieces. It doesn't mean that you have to travel to DC. It doesn't mean that you have to travel to the capital of your state to be an advocate for policies. You can write letters, you can do all kinds of other things. We'll talk and share a little bit more about that later on, as well as some of our stories with that. One of the other milestones is actually advocacy, and you can see here a level four and a level five. Level four is where a resident is accessing advocacy tools, such as the AOA Speak Out, or other resources to really achieve policy change. Easy things that a resident is able to do. Easy things that we, as practicing physicians, should be able to do. Level five, we may not all be there, and we'll talk a little bit more about this as we go on, but developing relationships with your stakeholders, with your legislators, that can help you to advance policies that create change within your community, within your medical school, within the university that you work in. All of those things are things that we are teaching our future family medicine residents. Hopefully we are teaching our students, and hopefully we, as mentors to the next generation of students and residents, are being prime examples of that. So certainly, you being here this weekend, participating in the virtual DO Day, is taking one step towards that. If you're on Capitol Hill for the in-person part, you're certainly taking part of that, and we thank you for that. It's a great experience, especially if this is your first one. Enjoy it. Keep coming back. It's an amazing and wonderful experience. Advocacy highlights the importance of collaboration across disciplines. Holistic care, which is one of the pillars of the osteopathic profession, is definitely highlighted here as well. Health care is multifaceted. You know, unfortunately, I can't say that I remember this always being true, especially when I was coming through school. It seemed like it was always physician, then nurse, then social worker separately. Now we've learned that working in a model of collaboration actually provides better care for the patient. We also have shared perspective. Each discipline brings a unique insight. However, we all have the same goal. Our goal is access to quality, cost-effective health care for our patients. So building stronger advocacy efforts results in us collaborating together. Now sometimes we may not have goals that necessarily align with one another, and that may put us against each other, especially things like scope of practice, those sort of things in some of these states. However, we find that working together, and we'll go over some examples at the end of ways we've worked with other medical entities in Ohio and really accomplished a lot. So collaboration between disciplines strengthens those advocacy efforts and brings forward a more impactful approach to addressing health care issues. You know, the next important part Doug alluded to a little bit is meeting our legislators where they are. You know, legislators have very interesting backgrounds. You know, so understanding legislators are just people. So if you can get a personal connection with these legislators, they're going to be much more likely to see you when you come to their office. So you know, Doug and I have talked a lot about this. You know, when you go meet with a legislator, it's not you go in and tell them what you want. You go in, introduce yourself, tell them what your background is, and say, what can I do to help you? Do you need data? Do you need explanation on something? Do you need me to deliver testimony? It's those personal connections and you connecting with these individuals. I remember we had a new representative in Ohio that I had gone and met with, and he literally had only been in his office for maybe a month, and he was a farmer. He has no formal education past high school, really knew very little about health issues, especially. We developed a great connection with him through the Ohio Osteopathic Association and really he listened to us when we came in because he knew that we were going to come in and bring him information and not ask for something. Many individuals approach these legislatures and are always asking for something. But if you go in and ask them, what can I do for you? They are much more likely to help you or to listen to you or come to you and ask you for help. Hey, can you come and do this? Can you provide me data on this? And you may not interact always with the legislator, but they will have the legislative aides definitely reach out to you. They're also great people to get connections with because they sometimes are the people who come and ask for, hey, can you get me some data on this? So you'll actually have the aide reach out to you instead. So again, it's building those relationships. You know, successful advocacy is built on empathy, understanding and collaboration with those who have the power to influence change. And again, you know, the power of advocacy in legislation is shaped by legislators, but a lot of times it's influenced by those professionals that approach them. Again, talking about communication, you know, do you have somebody that's a friend in the legislature? If you do, use that connection. Or if you have a neighbor who has their grandson in the legislature, whatever you can use as those connections to try to make those personal connections, that's what you want to do. It's the same thing with patients. Many patients will stay with you because you treat grandma, you treat grandpa, and you treat their little niece, and then they'll actually come and see you as a patient. Just like in my little small hometown, you know, I basically started out with a small practice of patients, of dermatology patients, and now it has grown huge. I see between 40 and 45 patients a day and I'm booked out six weeks because patients, word of mouth, you know, it gets around, they feel comfortable with you. So to be effective, advocacy must humanize complex health care issues and foster personal connections with those legislatures. And I think, building off what Jen was talking about too, you know, I always teach our residents and even students that I'm with, that as physicians, you're leaders in your community, within your state, within the national component. And our legislators, I think, know that as well. They know that, you know, we have a large group of patients that we take care of, that we can have conversations with about things. So certainly, our state level, I think, you know, don't think too big. Sometimes thinking nationally can seem too overwhelming, but just think about in your state, what can you do with that? Certainly, there are lots of different components. These are just some of the different components within our state legislation. Jen alluded to a couple of them in the sense of things that we've been working on over the years, as far as scope of practice or scope creep. That's certainly been a lot of different components. New licensure types. We've had several new licenses come up that are trying to essentially take different pieces, as we see it, away from us as physicians. But really looking at how can we make sure that we don't come across as just simply trying to defend our territory, but really trying to work with our legislators. Because it can be really off-putting to them, depending on how we come to them about things. Certainly, as DOs, proud DOs, we want to make sure that we continue to fight for osteopathic equivalency and recognition. I know last year, one of our big things was the equivalency of COMLEX to USMLE, and really how still a lot of our students expect that they are expected to take USMLE because, well, if I apply to this residency program and I don't have a USMLE, they're not even going to look at me. And we need to continue to work on those things at a state level, but definitely at a national level. Certainly, truth in advertising, our public health workforce, our physician workforce, telemedicine are huge things. And really one of the big ones now that we're going to need to all pay attention to is generative AI, and really how that's going to be impactful, not only to our practices, but to our patients and to our students, and how we think about and look at how people apply for medical school, apply for residency, but also how we document in the clinical realm. Those kind of things are all things that we need to think about, advocate for, and as Jen alluded to, making acquaintances with your legislators and say, hey, look, if you have questions about how this might impact patient care, give me a call. I'd love to go out for a cup of coffee, sit down, have dinner. Do something where they can feel comfortable giving you a call and just asking you the questions, knowing that you're not going to have a list of demands on the other end, that they are expecting you to vote, that you're expecting them to vote certain ways on a bill. That's not how we should build relationships with our legislators. I've worked on it over many years in practice, having different legislators both in my office, even having some of them kick off their campaigns. Some very well-known Ohio senators and so forth that were in my office early in their career. I used to work at an FQHC, so I know the community health worker, I'm sorry, the community health center side of things and really how we can be incredibly impactful in how they think about medicine. Not all of them have that background, so we really need to make sure that we are out there trying to help educate. We talked about on the state level, certainly one of the big parts is having a strong osteopathic association. Heidi Weber is our new executive director. She's a little just about a year in and we're excited about that. We'll talk about some of the stories about how she's hitting the ground running and really trying to make sure that we as Ohio osteopathic physicians have a voice on our state legislation and really as they think about bills that affect us as physicians affect our community. So certainly working even with our governor to make sure that we have little things such as a proclamation recognizing osteopathic medicine month. You know sometimes that seems like well that should be a no-brainer but it isn't always necessarily something on the legislator's mind or the governor's mind and so sometimes a nice gentle reminder of hey don't forget about us. We are a really big part of your community and we want to make sure that we're a part of that. Certainly getting students involved. If you have a medical school in your state, trying to take one of your medical students. They are our future learners. Legislators love having them in their office to talk with them. Any of the students in the audience, if you go to any of the especially the national offices for your house of representatives or your senators, a lot of times your health legislative assistant is about your same age. They can relate to you. They know where you've been through with undergrad and those kind of things and those are easy conversations to get into. In the middle top is Terry Johnson. He's our DO that's on our state legislation. He's been there for many years. Certainly a strong voice for osteopathic medicine within the state. We're lucky to have him there. We're lucky to have him being willing to take on medical students to talk with to allow them to share their ideas, their concerns about student loans, about all of the different things that are incredibly important to students and moving forward but also taking time for us as physicians. Seeing some of our representatives at in D.C. is also an exciting time for our students to be able to have that exposure. Certainly one of the big things for us in our Ohio Osteopathic Association and a game changer has been hiring a lobbyist that works for us as an association. He allows Heidi to be able to set up meetings, working through our PAC, to be able to participate in different events, to meet the legislators, to have our elevator speech about our mission and our vision as the Ohio Osteopathic Association and what we as DOs can mean back to the legislators. We have about 9,000 DOs in the state of Ohio. We have a large voice. That's a lot of patients that we as DOs take care of on a day-to-day basis and I think it really speaks to the power that we as physicians have and this is really why I think Jen and I are incredibly passionate about making sure that we are out there advocating not only for osteopathic medicine but for our patients, for our communities and really trying to make sure that we have the ability to meet up with these legislators when possible. Sometimes we even meet up with past legislators or future potential legislators. This is Amy Acton. Some of you may know her from the national press that happened around COVID. We had Amy at our Ohio Osteopathic Symposium that we co-share with the Ohio Osteopathic Association and Ohio University Heritage College of Osteopathic Medicine. So really again building those relationships, having their ear to know that hey if you have any questions about osteopathic medicine in the state, reach out. We'd be happy to talk with you. Amy's an MD so she has not had as much experience with osteopathic medicine but certainly has the potential to learn more and is willing to learn more and we're excited about those relationships that we have been able to build over the years. Certainly I think one of the other components is really that being core to the mission and vision of your organization. We recently embarked in a strategic planning for our Ohio Osteopathic Association to think about what the next three years was going to look like. Advocacy rose to the top as far as that being one of the pieces that we as an organization, as an association needed to focus on. It's really front and center and being there and that can be of value to our members. You know trying to make sure that we get DOs on different committees for the state. Kishan Patel is actually one of my fellow faculty members in the residency program. We were successful in getting him on the Ohio State Medical, I'm sorry the Ohio Department of Medicaid P&T committee. Certainly he is not our only DO on a committee within the state. We try as best as we can to continue to advocate for DOs being on our state medical board, being on different parts within the Ohio Department of Health, within the Department of Medicaid and really focusing in on that. And we're also even looking at how do we impact our next generations. The Ohio State Science Day happens down in Columbus. It's actually for high school students to really focus on science but it's really a way to expose them to osteopathic medicine early on. That's really how we can continue to think about and advocate for not only osteopathic medicine but also to continue to advocate for the future for our patients. Jen had talked about coalition building. Huge, absolutely huge. One of the unique things that we have in the state is our Ohio Coalition of Primary Care Physicians. These are the groups that we're made up of of the different primary care components and it really makes us into a stronger voice. So as we think about and write letters to our legislators, to the different committees, we're able to not just say, hey, we represent the 9,000 osteopathic physicians in the state. We represent well more than that. As we pull in our allopathic counterparts and our other subspecialties, it really allows us to create a bigger and stronger voice to let our legislators know, hey, there's some weight behind this. We all really think this is something that is important for the health of our patients. Certainly also at times, some of the things expand not just the Ohio Osteopathic Association but into our hospital association, into the different hospital systems within our state. You can see some of the letters that we've written out in the last several months to our legislators on behalf of different components where we're advocating more for our patients, for the patient physician relationship, to make sure our patients have access to the necessary things that they need for their health and well-being. I think at this point you're probably starting to see the connection between advocacy and collaboration. I just want to highlight another example of collaboration with the Ohio Osteopathic Association and the Ohio Academy of Pediatricians. Last year, we got together and decided to have a summit to brainstorm how we can improve immunization rates. This meeting was held on August 7th and why this is important is because August is National Immunization Awareness Month. We met and discussed what are some of the barriers and why have our numbers fallen off on vaccines. What we decided to focus that conversation on was conversations with parents, addressing vaccine hesitancy, and working with those rural populations because really those seem to be the kiddos that are falling behind the most with their vaccination rates. The two individuals in this photo, we're very fortunate to have a lot of active executive directors with us. We have our new executive director Heidi Weber and we also have our former executive director John Wills who had actually been the executive director for the Ohio Osteopathic Association for just over 40 years. Those two actually spearheaded this event and attended on behalf of the Ohio Osteopathic Association. As we've been talking about advocacy, you might be saying why me? You might not. Certainly there's going to be some survey bias here. You're participating in this event which tells me that you're already biased towards engaging in advocacy, but I think one of the other pieces that we need to do after you go home, I know this is virtual so you're already at home, but after you finish off this virtual event or after you've been in DC, you need to talk to your colleagues, to the med student that might be rotating with you, to the resident that might be rounding with you. Talk with them about the importance of getting involved, whether it's on the local level, whether it's on the state level, whether it's on the national. Now we would love it if they actually ran for office, but we're not talking about that. We're talking about writing a letter, doing an email, one of those kind of things that we'll talk a little bit more about here soon, but there are all different levels that you can get involved and pull those in around you that they can also get involved. Now let's talk about some strategies for effective advocacy. Again, the word that we keep talking about is collaboration. So collaborating with those professional organizations and as Doug said earlier, it doesn't have to be on a national level. Could be at the state level or even on your local level because you know your reps are going to be located in your local area, so it's going to be a much less distance for you to travel than going to the state or to that national level. Engaging in grassroots advocacy, what does this mean? This means basically communicating with your colleagues, asking them to, hey, would you support me with this? Would you write your senator? Would you write your congressman? You know, all of this kind of grassroots advocacy, you know, and that's opposite from direct lobbying where you're actually going to have people trained to do this, but grassroots advocacy is actually what you can do yourself. The other is educating those policymakers. Again, you know, conducting briefings, sessions, having community forums, offering this real world advice. Again, offering to be there, you know, make sure you take your business card with you if you're going to meet with any of your legislators with your cell phone number on it so you can give that to them and say, hey, give me a call because they do keep a little Rolodex of those, believe it or not. I think now they don't probably keep Rolodexes like they used to, but you know, they take photos of those. They may add you to their phone and they'll put in there exactly what your background is and what you can offer them. So certainly, you know, we talked about different pathways. Some of the easiest stuff we tried to put together for you, hopefully some of these are not new to those of you. Again, you're here, you probably have some selection bias as far as you've already done these, but these are certainly things that you can put up around your office, put up at the medical school, especially with QR codes to really be able to advocate for individuals participating. So the Osteopathic Advocacy Network is a great way to connect, to get involved. As you see things and the AOA tells you about things that are coming up, you'll get emails with a quick pick of as far as a quick button to push to talk about, hey, what is it that we need to do? You know, as we think about how do we prevent the Medicare patient physician cuts, how can we help with that? So really trying to help to move the needle forward and if you haven't done one of these, they look incredibly easy to do. This is one of the ones from ACOP, but I took a screenshot of, this is basically what comes up. It'll automatically recognize that it is you that is putting in because you have to log in with your address, your home address, not your office address, but your home address and it'll grab for you who are your senators, who are your House of Representatives, so that it can automatically send them an email. You'll see in the subject line it talks about whether you want them to support or oppose and then it gives a brief message that the ACOP or the AOA or whatever national organization has put together. You don't have to use what they have put together. It's certainly a super easy way to say, you know what, sounds good, I'm going to sign my name, send it off, done, took me 30 seconds, if not less than that, but certainly if you actually want to personalize it, particularly if it's a legislator that you know, you can put a little bit more personal component into that. Does that necessarily mean they themselves are going to get it? Hard to say, probably going to go to their health care legislative aid, but if you happen to know your health care legislative aid, through all my years of going to DOD, you really got to know your legislative aides and the point is, is I was actually a lot of times emailing the health care legislative aid more than I was having conversations with my senator or my house of representatives individual, but they are also the ones that have the ear of the senator. If you don't know how that works, they're the ones that get the bill, they review the bill and say, you know what, senator, this is how you should vote on this or I have some reservations on this part. They're actually the ones that help to drive the show, so they're really the ones that I think are the ones that you want to make sure that you get in touch with. So when you're in D.C. next week for the actual in-person component, don't feel bad if you get an appointment with just the health care legislative aid. That's actually a bigger win than you realize. Yeah, you may not get the great photo op out in front of the capitol building with your senator. We've done that plenty of times in the past, but it's really a great way to make impact and it's not just the AOA or the ACFP or your specialty society. We also see these within the AACOM as well as far as different components. A lot of times some of the things that we have the AOA might focus more on whereas AACOM is going to focus more on things like you see here like about student loan debt and really going to focus on those pieces that matter to our students. So for any of the students that are listening today, know that we're also having your back on this and we're really making sure that we are watching out for you as well and these again are things that your legislators want to hear from you as well. This is not just for practicing physicians to do. This can be for every med student, resident, and physician out there. But now let's go over some real world examples of successful advocacy in the state of Ohio. I'm going to give a few examples of the first case study. So case study one, advocacy leading to changes in health care funding or legislation such as expanding access to health care services for underserved communities. The one that I can think of that's probably been the biggest in Ohio recently started in 2014 and continues to present. And that was the Medicaid expansion and continuation. This is important because this was a group effort by the Ohio Osteopathic Association, the Ohio Hospital Association, many primary care physicians, and public health advocates. They worked together really to push this through. At that time, we had a lot of political resistance. We had a super conservative governor at the time, John Kasich. But with support from health care leaders and patient advocacy groups, we used the Ohio Controlling Board to improve this expansion in 2014. And we have continued funding to ensure its viability today. So its impact on the underserved communities. We were able to insure 700,000 low income Ohioans with this initiative. We also provided critical funding to many rural hospitals that really would have closed. And this gave access to health care for individuals who may otherwise have not had health care. And we also increased mental health and substance use disorder treatment availability, which is super important for Ohio because unfortunately, we're very much caught up in the opioid crisis like many other states throughout the country. Another example of success is the Telehealth Expansion Act of 2021. And this happened after COVID. You know, this advocacy effort was supported by numerous health care organizations, including the Ohio Osteopathic Association, the Ohio State Medical Association, and many hospital systems. They wanted to permanently expand telehealth. The COVID-19 pandemic again helped with this because this showed the importance of telehealth. And in 2021, Senate Bill 3 was passed, expanding virtual health access. This impact resulted in increased access to specialists, especially for those individuals in Appalachia and rural Ohio. Again, transportation is a huge issue. Also, people from southern Ohio, I will tell you from my community are afraid to drive to Columbus. They don't know anything about driving on big major highways where there's more than two lanes of traffic. They also don't have cars that can get there and they can't afford the gas to get there. So this is extremely helpful. Also, it allowed for mental health services to be delivered more efficiently. And again, reduce that travel burden, not only for individuals who can't get there, but think about the elderly. You know, if you're in your 80s or 90s, you probably, and you're in pain, you don't want to get in a car and drive. And also disabled individuals. A third example is the funding for maternal and infant health. And this came about in 2023. And this was an advocacy effort by the Ohio March of Dimes, Health Equity, and numerous physician groups. They were seeing racial disparities in maternal infant fetal health in the state of Ohio. This increased, this led to an increased Medicaid reimbursement rate for doulas and midwives so that care could be provided. This lowered maternal mortality rates among black women in Ohio. It expanded home visit programs for new mothers and those low income communities. Again, gas prices, especially as expensive as gas is right now. People can't afford to feed a new baby by formula if they can't breastfeed and then have gas to get to numerous appointments. This also improved access to perinatal mental health services. I think you're seeing a theme here. Mental health services are also extremely important. And we're going to talk about some of those examples, but I'm going to let Doug take the next case study. Yeah. So case study two is really talking about interdisciplinary collaboration in the medical education realm. Really how we can continue to focus on improvement within the training. If you remember back towards the beginning, we talked about our TCC curriculum at OUHCOM and really it's focused on population health management and focus on value-based care. Again, really looking at thinking about public health. All of the students within the TCC curriculum find a community organization that they partner with and develop a project over that three-year period and continue that into residency. One of my residents has a relationship with our local homeless shelter, and we continue to provide care for that. We have another one of our TCC residents that works with our resettlement agency for immigrants and refugees that are coming into the state of Ohio, particularly those from war-torn countries, and really focusing on that integration of them into the community and being a significant part of that as far as how do we think about them from a public health and a social determinants of health component. One of the really cool things that has come about from the TCC curriculum to our residency program, because we don't just take residents or students from the TCC program, but it's a meld of the traditional trajectory as well as that, is it has really allowed our residency program to, one, focus on value-based care, but also really to think about and focus on the social determinants of health. Certainly one of the big political topics right now has been, as Jen said, the cost of gas, but certainly the cost of eggs. Certainly not planning on getting into any political discussion around that, but one of the unique things that has come from that is thinking about food insecurity. Long before the current political component, but even as we were in COVID and before COVID, thinking about what food insecurity looks like for our patients, particularly for the low-income patients, one of our early projects in the realm was focused on food insecurity. One of our residents looked at what is our food insecurity level within our residency program. We're actually a little bit unique of a residency program. We actually are geared more towards a traditional outpatient practice where most of our practice is made up of Medicaid, Medicare, and private insurance. We don't actually have uninsured patients within our family medicine practice, so it's a little unique from that standpoint, but yet we were seeing very high levels of food insecurity. What did our resident do? I'm sorry, what did our medical student do? She's a resident actually and attending now, but really started to think about and work with her teachers at OU, but also starting to think about how do I get my local legislators and our lobbyists involved in the process of everything. What happened was absolutely amazing. So now, and I'll work backwards a little bit, now we have a food pantry on site at our residency program, fully stocked through our local food bank, and it's actually manned by a dietician, so it's not just a little room that has a few boxes of things in, it actually has fresh fruits and vegetables, frozen meats, and so forth, so that any patient that we determine based on our questionnaires for social determinants of health that have identified food insecurity can go home with bags of food after their visit or after they've come in for blood work, so it's really a unique way to be able to meet that need. How that happened was actually working with one of our legislators who put things forth within the Ohio State House to make sure that there was funding available to create, in the hospital, food pantries that were accessible to patients. We have three hospitals in our area where I work. We were the first one that got a food pantry. Our other two hospitals also now have food pantries within them. One is actually a large regional children's hospital, so it's also serving the pediatric population of the state, which actually they pull from about a third of the state, including areas of Appalachia for pediatric care, so it's really unique to see how a small idea from a student that is thinking about the bigger picture and how can we take that up through our legislators, find funding, that then is something that can really be a unique advocacy piece for our patients and for our communities. Our third example and case study is going to be Advocacy and Mental Health Policy Changes in Ohio. The first is the Ohio Mental Health Parity Law, which was signed in 2018. This advocacy was spearheaded by the Ohio Psychiatric Physician Association, NAMI, and the Ohio Osteopathic Association. Basically, the advocates pushed for parity between mental health and physical health coverage because there was a disparity there, so basically they engaged the Ohio lawmakers, got this signed into law. This policy impact has required insurance companies to cover mental health treatments at the same level as physical health conditions. It's increased reimbursement rates for mental health services, encouraging more physicians to actually and providers to participate, which has expanded access, and it's expanded telepsychiatry and virtual counseling access. Again, particularly in those rural areas where there's a shortage of mental health providers. Another example is telehealth, so telehealth expansion for mental health services. Again, this was part of Senate Bill 3 that we talked about in 2021, and this policy has had the impact that Medicaid and private insurers in Ohio must now cover telehealth visits at the same rate as in-person care, and it's significantly improved mental health access for underserved and, again, those rural communities. Expanded teletherapy, addiction treatment, and psychiatric evaluations throughout all virtual platforms, so this has really opened up access and more quality care because these patients are not only going to physicians who may not feel as comfortable treating some of these conditions, so they're actually able to have some of those psychiatric specialists help. It's also helped, especially I can tell you a personal story in my family. This has helped. It's very hard to find pediatric psychiatrists, so now with the advent of doing telehealth, I have a family member who has a child who needs a pediatric psychiatrist, but we don't have any here in the Southern Ohio region, so this child is actually able to get his care through telehealth, and that's worked out great for them. So, those are just some examples of how interdisciplinary advocacy has helped out the state of Ohio. So, some of the other, next slide please. Great, thank you. So, some things that we need to talk about, though, because everything in life, you know, has a challenge, so we want to talk about that. So, some of the barriers to effective advocacy is political gridlock. I know we never have that in this country anymore, however, but this can hinder progress because, you know, we've got some of that inner fighting, you know, just people not wanting to give in, not wanting to listen to one another. So, you know, be aware of the political gridlock. Funding and resources, you know, it's a challenge to obtain funding sometimes for advocacy efforts and campaigns. This is why it's so important that you donate to your PACs or you donate to those congressmen or you donate to whatever legislature you may support or has your interest at heart. I can tell you that, for example, for us, Terry Johnson as a DO in the state of Ohio usually is in line with most of our views, and we make sure that Terry Johnson gets donations from our PAC, and we're going to talk about the PAC here in a second. Public perception, overcoming misperceptions and misinformation. You know, this was rampant during COVID. We're still having some backlash, honestly, from vaccines. We're assuming this is why our vaccination rates have started to go down is because of that public perception. So, again, that can be a challenge. Communication gaps, making sure that these complex medical topics are communicated clearly and effectively to lawmakers. Again, this is where reaching out and speaking to them in layman's terms is really helpful. And then advocacy fatigue. I mean, we all work 40, 50, 60 hours a week, and then we do advocacy in addition. So this can also result in some fatigue for this. Next is staying resilient and advocacy. You know, recognizing the importance of perseverance, having a long-term vision, collaborating, not expecting results overnight. I mean, if you know how bills work, none of them go through usually overnight to begin with. So, you know, it's having that game plan that's a long-term game plan. Learning from setbacks. You know, we're all going to make mistakes. We're all going to step in things that we don't mean to sometimes. You know, sometimes I'll tell you it's good to know sometimes people's relationships that you're with as legislators. You know, if you're going into a legislator and his wife happens to be a nurse practitioner, you're going with a scope of practice issue with nurse practitioners, you want to be very careful of that. So sometimes it's important that you do some research on these legislatures so you know a little bit about their history and kind of where to come in. Because if you just go in and tell them, I think nurse practitioners should never get to practice on their own and his wife's a nurse practitioner, that's not going to go so well. So making sure that you know who that audience is as well. So again, advocacy is challenging, but persistence and collaboration can help overcome these barriers. So hopefully we've given you a lot to think about today with all of this, but there are many, many ways to speak out. The QR code here is looking at our Ohio Osteopathic Association and our advocacy efforts and tools, but certainly the AOA has their own, your state organizations should as well. But all of these are ways that you can be part of the advocacy effort, whether it's writing them actually with pen and paper, whether it's sending that email through the speak out sites that you'll get occasionally, or even just simply calling them or visiting with them at their local office or their office at the state house or on the national stage. Thinking about from an organization, writing position papers on how you as an association feel about a certain piece of legislation. If you're willing to testify, this is a great pathway in order to be able to really get yourself out there and to be somebody that they can call on to do that. Writing letters to the editor, it's a great pathway. But I think one of the biggest parts that we sometimes don't think about is just simply registering to vote. And it's not just registering to vote, because we also need you after you've registered to actually go to the ballot box and vote. That's the important part. And that's something where we as physicians can encourage our patients to do as well. We can lead efforts within our office to get patients to register to vote. We can talk with them about how important it is, no matter which way they vote on an issue, that it's important to have a voice. There's a lot of skepticism that exists, especially depending on the community in which you practice. Jen talked about the Appalachian community. I practice within the inner city population, where we have a very large majority of African American patients. There's a lot of skepticism that exists about the political system, about the healthcare system. We need to all work to help overcome that, to really help to make the United States and the world, for that matter, a better place for all of us to live. And, you know, we'd be remiss if we didn't mention the importance of your financial support as well. So, the best way that I have found to give is through the political action committees. So, for example, I donate to the Osteopathic Political Action Committee, that's not affiliated with the AOA for all intents and purposes, but it is the AOA, so I donate to that. I also donate to the Ohio Osteopathic Political Action Committee. So, let me tell you a little bit about that and why I give. So, you know, your dues will be separate from this. So, you're going to pay your Ohio osteopathic dues, and then you're going to pay PAC, which is separate. And PAC is not tax deductible, and you actually need to make this donation as a personal donation from either your credit card or your check. This money, though, engages and gives me the opportunity to discuss issues with those who receive your support. So, it gives our PAC the ability to meet with representatives, legislators, et cetera. We actually are very bipartisan for the Ohio Osteopathic Political Action Committee, or OOPAC. We give to both Democrats and Republicans. We don't have a straight down the line that we do. We donated last year to over 35 individuals and just over $20,000. A lot of times we look to give to the leaders. So, maybe the Speaker of the House, we make sure that we donate to them. We also try to attend their events, because a lot of times, if you can take that check in your hand and hand them the check, that means a lot more. So, yeah, so we make the contributions to both sides. And, you know, our OOPAC does several different things. They address the critical health needs of Ohio. They protect that physician-patient relationship. And most of all, they really, we are advocating for them to protect the osteopathic profession. Next slide. So, certainly, we've given you, hopefully, a lot to think about today. But it's certainly not the end-all be-all as far as learning more about how to be an advocate. So, for those in the family medicine realm, STFM is probably an acronym you know, but it's the Society of Teachers of Family Medicine, for those that are not. They also have put together an advocacy course. This is one I use for our residents to make sure to give them additional tools to be able to think about what it's like speaking to a legislator, what it's like to actually write something, whether it's just hitting that take action button and putting that in. But it really gives them additional tools. So, I'm always a fan of sharing information that already exists. There's no sense in making up something new when something already exists for a realm. This is a great tool also for medical students to think about how do we educate ourselves in order to be able to talk to our legislators, think about legislative issues. So, certainly, I think it has been Jen and I's pleasure to have this conversation with you today. Hopefully, you will be able to take something from this. Hopefully, you will either click on that take action button the next time or make a phone call to your legislator's office, set up a meeting with them. Certainly, I know we've been happy to answer questions throughout today's presentation with you. We'd be happy later if you have any questions to please reach out. But thank you so much from the bottom of our hearts. We appreciate your time spent with us today and have a wonderful rest of the day. Thank you.

advocacy

osteopathic medicine

health policies

patient care

population health

legislative changes

education

collaboration

Ohio University

political action committees