The term patient database should be taken loosely; at any given moment, everyone is a potential patient. To the policymaker, a facility database represents the national facility registry or master facility list and is a tool for supporting health system management and planning.
To the provider, the facility registry includes the locations from which he or she delivers care. On a national basis, the policymaker views the provider database as the provider registry and uses it to support health human resource planning.
For the payor, a subset of this list represents its empaneled list of suppliers. It is interesting to consider the multiple viewpoints on the health transactions database. From the point of view of a policymaker, this database represents a national-scale electronic health records EHR system. Anonymized data from this EHR can be used to generate powerful analytics to inform health system management and planning, support disease surveillance, and generate public health metrics.
In addition, other senior leadership within the State might want to focus the program on a particular population or chronic condition. Implementation and evaluation stages.
Program staff should communicate regularly about program successes and areas for improvement with senior leadership. Keeping senior leaders apprised of issues or situations as they develop will help manage expectations of the care management program and build leaders' support. One strategy for facilitating regular communication is to E-mail regular program updates to senior leaders detailing program successes, issues, and plans.
These updates could also serve as talking points if staff are asked to discuss the care management program. In designing the evaluation strategy and presenting the results, program staff should work with senior leadership to understand their particular interests and program goals and should tailor specific evaluation reports accordingly.
Understanding senior leaders' program goals and subsequently tailoring evaluation results is an effective strategy to build support for the program and manage expectations. Coordination and communication with other State and community programs represents a crucial part of Medicaid care management programs.
Medicaid beneficiaries are more likely to have issues related to poverty e. States should communicate with other State agencies, solicit feedback on program design, and identify any potential synergies between the new care management program and established State programs. For example, synergies might exist between an established Department of Public Health diabetes program and the new care management program targeting diabetes.
The two programs can potentially share lessons learned. Opportunities might exist to coordinate more directly with established programs. During the implementation and evaluation stages, program staff should work with other State agencies to coordinate interventions and outreach materials.
Providers are critical to any care management program; interested providers will endorse the concepts of the interventions with patients, identify interventions needed for patients, and provide valuable program input. By involving providers, States build long-term support for the care management program in addition to improving program outcomes and physician practice. Providers can offer suggestions for program refinements based on their clinical expertise and experience with the care management program.
Finally, provider champions can help secure buy-in for the program from other providers and additional stakeholder groups. States can solicit and garner support from physician and provider organizations and societies e. These organizations can endorse the program to their memberships and affiliations as well as advocate for the care management program to senior leadership, patients, and legislators.
Please go to Section 4: Selecting Care Management Interventions for more information on provider interventions. In addition to identifying provider champions as described earlier in this section, States have succeeded in establishing standing advisory committees. Both strategies offer an effective way to involve providers in a State's care management program.
During the planning and designing stages, program staff should involve the provider community to garner input on clinical aspects of the care management program and to develop champions and others to serve as ambassadors to patients for the program. By involving providers in program planning and design, staff can collect provider feedback and gain provider champions. Early engagement leads to increased ownership and support for the care management program.
Providers should be involved during the implementation stage to achieve early buy-in to the program. To activate providers during the implementation stage, States have formed provider advisory boards or groups to provide feedback on program interventions, measures, guidelines, and strategies.
Providers also should be involved during the evaluation stage to provide feedback on preliminary results, offer suggestions on areas for program refinement, and comment on new initiatives within the care management program. Finally, providers can advocate for the care management program to State legislators and their staff and agency leadership.
States involve providers during the implementation and evaluation stages through their standing advisory committees or targeted outreach to physician and provider organizations and societies, as discussed above. A significant component of a care management program focuses directly on understanding the patient and his or her needs and subsequently providing appropriate interventions. By securing the patient and patient advocacy community's support, States have received useful input on program design and significant support for program sustainability.
Stakeholder lobbying also can influence the legislature and Medicaid agency. A strong lobby might exist for a particular disease e. Communicating routinely with lobbyists regarding program successes, failures, and new initiatives will help manage expectations and build support for the program.
A key ally can be won if program staff identify ways to support advocacy group initiatives through the care management program. By involving consumers during the planning and designing stages, program staff will be better able to gauge the possible impact of certain interventions and will be able to design a better, more effective program overall.
Attaining support from the patient and advocacy community provides insight into the patients' needs and fosters support for program sustainability.
By establishing infrastructure such as standing committees or focus groups, program staff can plan the care management program and identify areas for program improvement. Engaging patients during the implementation and evaluation stages of a care management program can also help program staff understand the program's effects on patient behavior and identify areas for program improvement.
In addition, engaged patients are more likely to follow providers or care managers' recommendations. Finally, patients can advocate for the care management program to State legislators and senior agency leadership. Involving the patient community through committees and focus groups can represent an effective strategy to build support, increase awareness of the program, and improve program outcomes.
Similar to senior leadership, the State legislature retains the ability to influence the care management program significantly. Legislators are unique in their capacity to influence program design and budget allocation through the legislative cycle. Program staff should work with State legislators and their staff during all stages of a care management program to understand their goals for the program and ensure support.
Since legislators might lack the necessary information to realize the impact of certain design features, program staff should coordinate and communicate regularly regarding the care management program. Specifically, program staff should understand the State legislature's expectations of the program, program design requirements, and whether a mandatory savings requirement exists. In addition, since State legislators and their staff will not necessarily approach program staff for input, program staff should remain proactive and set up meetings to exchange ideas.
Program staff should become the key contact for questions surrounding the care management program for legislators.
Once the program is implemented, program staff should involve the legislators on an ongoing basis; periodic briefings can help build support and manage expectations in case the program progresses more slowly or has different outcomes than anticipated.
State legislatures often require savings guarantees from care management programs. However, because cost savings might be an unrealistic expectation for the program's first few years, communication with the legislators and senior leadership can help establish realistic expectations for care management programs.
Demonstrated results, such as improved health outcomes, lower program costs, or higher beneficiary satisfaction, can and should be communicated to the legislature and other stakeholders whenever possible. Placing these results within the context of the program and not "overselling" the results is important. Program staff should carefully explain the changes that have occurred and why they matter. When discussing outcomes with elected officials, telling the story succinctly and avoiding jargon is especially important.
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This study was conducted as part of the politics and governance theme work package 3. It is the second of a series of WP 3. GCRF did not influence any aspect of this work. Sarah C. You can also search for this author in PubMed Google Scholar. AM conducted and transcribed the interviews. SM analysed the data and drafted the manuscript. JG and FC edited the manuscript. All authors read and approved the final manuscript and agree to be personally accountable for their contributions, and for the accuracy and integrity of the work.
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Skip to main content. Search all BMC articles Search. Download PDF. Research Open Access Published: 18 September Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi Sarah C. Abstract Background Inclusive engagement in healthcare policies and decision-making is essential to address the needs of patients and communities, reduce health inequities and increase the accountability of the government.
Methods A qualitative study design was used. Results Stakeholders perceived barriers to inclusive and meaningful engagement in the health policy process. Conclusions Serious challenges to the meaningful and equitable engagement of local level stakeholder groups in the health policy process were identified.
Background Stakeholder engagement throughout the policy development cycle problem identification, agenda setting, policy formulation, adoption, implementation, evaluation is essential for understanding the needs of different groups and communities, such as civil society organisations and donors who may have different priorities, and for increasing equity in policy [ 1 , 2 , 3 ]. Methods This study arises from our work on challenges to effective governance of the Malawian healthcare system, where we first identified a potential gap between being consulted and influencing policy decision-making for these stakeholder groups [ 17 ].
Participants We used a purposive sampling strategy following a mapping exercise to identify health stakeholders working in decision-making roles at the local or service level of the government-funded health system or who have advocated for change in the health sector. Data analysis The analysis was performed by SM using inductive thematic analysis [ 18 ]. The analysis was performed between November and January in NVivo 12 software.
Discussion We have identified that local level government and civic and social organisations in Malawi want to be meaningfully involved in central government health policy processes and believe that they should be. Inclusive engagement National health policies and accompanying strategic frameworks are used to give direction and coherence to national efforts to improve health [ 7 ].
Meaningful engagement We understand meaningful engagement as opportunities for communication, consultation and participation that diverse stakeholders consider accessible, timely, and through which they are as able to exert influence. Conclusion We have identified high levels of dissatisfaction in local level stakeholders with issues of meaningful and inequitable engagement of multiple stakeholder groups throughout the health policy process. Availability of data and materials The datasets generated and analysed during the current study are not publicly available as analysis is ongoing for additional publications but are available from the corresponding author on reasonable request.
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