How do you get a large group of people with disparate interests — many of whom are filled with trepidation — to agree about the year’s most contentious healthcare issue? That was what Public Sector Consultants (PSC) had to figure out — and quickly — when Gov. Rick Snyder rocked the healthcare community by including Section 298 in his Michigan Department of Health Human Services (MDHHS) budget. In that section, he proposed that the state unify Medicaid’s physical and behavioral health systems. To a casual observer, this may not seem momentous, but to the state’s health organizations, the Michiganders who have behavioral health issues, and the families and organizations who advocate for them, it was a bombshell.
Although there had been some discussion about integrating the two systems under Medicaid, no one expected it come so quickly or in quite this way. Furthermore, there was considerable concern — particularly among people with behavioral health issues and their families — that the organizations charged with handling the task didn’t have the proper experience or perspective; in other words, they hadn’t truly lived in the behavioral health world.
Given the resulting uproar, Lt. Gov. Brian Calley immediately convened a group of stakeholders to explore different ways Section 298 could be modified and implemented. Then, the MDHHS tapped us, Public Sector Consultants, to help identify possible modifications and build consensus around them.
To start the design process, we worked very closely with the MDHHS to understand their concerns and what they hoped and needed to accomplish to move the state forward on this hot‐button issue. We also had to determine what could reasonably be done in such a short timeframe and with such a large group — after all, it’s not easy to get 122 people in a room and come up with meaningful solutions to a complex problem in just ten to 12 hours.
Early on, we recognized that any process we developed had to be effective (the proposed next steps had to be practical and achievable), sensible (given the short time frame, we could only expect to lay the groundwork for change as opposed to redesigning the entire system), and objective (PSC couldn’t have a stake in the outcome, nor could we allow any one group’s desires to outweigh those of others).
The process also had to be inclusive. To that end, we proposed using the “stoplight approach” to facilitate meetings, where participants are given green, yellow, and red cards. Green cards mean “I support it,” yellow cards mean “I support it with some reservations, but I can live with it,” and red cards mean “I don’t support it, we need to talk further.” When PSC is facilitating, this is one way we can ensure that everybody has a chance to express their opinions.
After meeting with the client and meeting internally several times, we mapped out a comprehensive, detailed plan for achieving the agreed‐upon objectives and developed strategies and tactics for ensuring good results.
Meet with client to fully assess their needs and determine what they want to accomplish
Assess what can be done given the time frame, number of participants, desired end‐products, and other project parameters
Determine project objectives and deliverables
Identify strategies and tactics for achieving objectives and developing high‐quality end‐products
Develop a comprehensive, detailed plan for carrying out the project, allowing for adjustments as client needs and circumstances dictate
PSC was uniquely qualified to develop and facilitate this process because we have:
- Extensive knowledge of healthcare
- Specific knowledge of both the medical and behavioral health systems
- Experience with large‐scale facilitation projects (often around contentious issues)
- Experience working with many of the workgroup members, which engendered trust in the quality and objectivity of our work
- Experience using effective tactics and strategies for involving people from all walks of life in the process (from laypeople to medical experts)
- Knowledge of the people in the room, the content, and the situation, which enabled us to adapt quickly and revise the process when necessary
- The ability to write meeting summaries that distill controversial conversations in a clear, organized, and truly representative manner, which helps bring groups more easily to consensus
Most importantly, we didn’t have a proverbial dog in the fight. PSC staff could be completely objective about the outcome; we were there to make sure the process worked, not to prescribe the end game.
In a very short amount of time, PSC successfully guided 122 workgroup members to consensus around viable next steps for unifying the Medicaid physical and behavioral health systems. Although the process was not without its frustrations, the people in the room drafted new language for Section 298, developed a list of core values to guide the MDHHS’ future efforts to merge the two healthcare systems, and prepared a comprehensive list of design elements for an integrated system. We did all of this while making sure that everyone in the workgroup contributed and was heard.
Why It Matters
Being knowledgeable, compassionate, and effective facilitators has allowed PSC to be at the center of many ground‐breaking policy discussions over the years — discussions that ultimately improve the lives of Michigan residents and organizations in important ways. We’re proud that people look to us to help them forge consensus. We’re also proud that we’re not just defending the status quo when we’re facilitating; we’re trying to find a better way forward. Our approach to consensus building encourages people to think about ways to make policies or systems better, rather than finding the least common denominator we can agree on.
In this instance, because we helped more than 100 concerned stakeholders agree on alternatives to Section 298, policy leaders listened to and respected the group’s recommendations.