The Loneliness of the Bipartisan Collaborator

Anand Parekh, MD, MPH ’02

Chief Medical Advisor, Bipartisan Policy Center

December 11, 2019

Where did you grow up, and what first got you interested in public health?

I was born in Detroit, Michigan, and grew up in its suburbs. The field of health was part of my childhood, with quite a number of physicians across my extended family. I took the same path, though I increasingly found myself interested in government, history, public affairs, and political science. I merged these interests with my commitment to medicine and essentially found myself gravitating toward a desire to improve the health of populations, which is the purview of public health.

What drew you to nonprofit work after your long tenure in public service?

We are not always able to make healthy decisions on our own, and that's why public policy is so critical. Politics, as we know, has a profound influence on health policy. After a decade of service at the Department of Health and Human Services (HHS), I found my way to the only entity in all of Washington, DC, with the word “bipartisan” in its title—the Bipartisan Policy Center. I was intrigued by the idea of bringing partisans together and taking the best ideas from both sides to promote health, security, and opportunity. The opportunity to work with former public servants and elected officials was also very appealing.

What are the biggest challenges today in developing health care policy with bipartisan perspectives? Is the robust national discussion around universal health care providing fruitful insights for policy change?

I joke around sometimes that it’s a bit lonely to wave the bipartisan flag. But in all seriousness, I think most people want more bipartisanship and understand the importance of it for a fully functioning democracy. There’s a lot of “noise” in DC right now—particularly leading into another presidential election—and in that context, it can be difficult for bipartisan solutions to gain traction. The challenge is to get beyond the noise. When you do, people on both sides of the aisle agree on many things and want to work together. A group of our bipartisan health policy experts lead an initiative called the Future of Healthcare, which will soon be releasing recommendations related to health insurance coverage. I hope this will be a helpful addition to the debate. 

I’m hopeful that we can improve health care coverage and outcomes together. Personal responsibility is important but needs to be supported through policy, systems, and environmental changes to make the healthy choice the easy choice. It’s not enough to inform people to eat well, be physically active, maintain a healthy weight, drink in moderation, and not abuse substances. Policies have to support these behaviors. I remain optimistic that universal primary care, affordable insurance coverage, and addressing social needs will improve health in the US and improve the value of our current spending levels.

How do we make healthier choices easier for people?

There are no easy answers here, but programs that align policy change with the ability to implement it broadly in clinical settings have been successful in creating population-wide interventions that work and save money.

In the US, a successful intervention has been ensuring that all Medicaid beneficiaries who smoke have access to comprehensive, barrier-free, evidence-based smoking cessation therapies. In 2006, for example, Massachusetts mandated coverage for two types of smoking cessation treatments: behavioral counseling and any medication approved by the Food and Drug Administration. Beneficiaries were heavily incentivized to utilize these services. They made sure prior authorization was not required and that copayments were minimal. They launched a broad promotional campaign to smokers in the Medicaid program.

In the first 30 months of the new benefit, approximately 37 percent—more than 70,000—Medicaid smokers used the benefit. Smoking rates decreased from 38 to 28 percent, representing a decline of 26 percent. Participation in the program reduced hospitalizations for heart attacks by 46 percent and for other heart disease by 49 percent. For every $1 spent on program costs, there was an associated $3.12 in medical savings—a $2.12 return on investment to the Medicaid program for every dollar spent. This program was a tremendous success financially and is going a long way in terms of preventing diseases associated with smoking and encouraging people to lead healthier lives.

Policymakers have tremendous opportunities to improve population health across the nation and around the globe, especially when they work with and listen to practitioners in public health and in personal prevention, such as physicians and nurses.

How can personal prevention stakeholders like physicians and other practitioners collaborate with policy makers to advance disease prevention in the US?

The public policies we develop must reinforce healthy decision making in ways that prevent disease. And the policies must be integrated across all sectors of society—wherever we live, learn, work, play, and pray—and must be communicated to clinicians and beneficiaries alike.

A recent example of a successful multi-sector collaboration is the translation of the Diabetes Prevention Program from a clinical to a community-based intervention. Unfortunately, 84.1 million adults in the US have prediabetes, and nine out of ten people with prediabetes don’t know they have it. While some private payers covered the program, until 2018 Medicare did not. But a successful demonstration project with community-based providers conducted by the Centers for Medicare and Medicaid Services (CMS) found that beneficiaries lost sufficient body weight in the program, which reduced their chances of developing diabetes and reduced costs to the program. An independent evaluation confirmed the program’s success, and the Secretary of Health and Human Services then expanded the program to all eligible beneficiaries. This is one of the first times the CMS is paying a nonclinical provider—a recognition that community-based services are important in achieving the public payer’s vision of success.

Promotion of the program to both clinicians and beneficiaries and a continued commitment by CMS to engage with community-based organizations will be critical to realize the promise of this prevention-first opportunity. Throughout my career, I have argued that prevention must be at the center of our nation’s health policy. In my book Prevention First: Policymaking for a Healthier America, I share my experiences as a clinician, public servant, and policy advisor to unpack just how important disease prevention is for individual and population health as well as for economic prosperity and national security. My goal in writing the book was to galvanize policymakers, appeal to individuals working in health care and public health, and resonate with all those in the general public who share a vision for a healthier America.

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