I refer to big political years like 2020 as the “Super Bowl of our industry.” This is our time to shine. All the time, effort, engagement, plans, talking points, strategy, and tweets we have poured our energy into will (hopefully) pay off in 2020. But it can seem totally overwhelming. There are thousands of elections in 2020 – from city, state, and federal; to county, school boards, and park boards; to PRESIDENT! AHHHH! How can your organization break through these big-money competitions? How can you get your issues front and center? How do you get your members to step-up and get engaged in your advocacy efforts? As 2020 approaches, organizations that take note of these advocacy trends will successfully engage their supporters, capture lawmakers’ attention, and have big policy wins. Advocate-centered campaigns Big and small data Captivating storytelling Broad coalitions Innovation ADVOCATE-CENTERED CAMPAIGNS Organizations that listen to how their members and supporters want to be engaged will have winning campaigns. Advocate-centered campaigns will capture the attention of lawmakers – and strengthen your organization for years to come. But the first step is to understand who your audience is. I work with many health care organizations and begin by asking, “who are your advocates? Who is your target audience?” Most of the time, they start rattling off large groups of people: providers, staff, patients, their families, the community, lawmakers, oh my! Yes, they may ALL be your target audiences at some point, but who is your audience for this campaign? Who do you NEED to engage to be successful? Who is at the center of your campaign? Once you properly identify your advocate audiences, pay attention to how they want to be engaged. And then develop advocate ladders so you can grow and increase their engagement over time. Some advocates will jump at the chance to participate in a lobby day. But most will start by signing a petition or writing their lawmakers an email. How are you moving your advocates up the engagement ladder? This relies on collecting data on your advocates – and using it. BIG AND SMALL DATA Effectively using data has been trending for many years now. Organizations that track their advocates’ activity – and know how to use this information - will have a leg-up on their campaigns. Not only will these organizations thoroughly understand their advocates’ strengths and weaknesses (“we don’t have much ground cover in district 18 so we need to build it” and “let’s turn our grassroots on in district 18 to switch that vote”), they will be able to use this information to fundraise. According to Classy (a fundraising platform), “Many nonprofits saw a surge in recurring subscription initiations following the 2016 election, particularly civil rights, social action, and advocacy organizations.” Further, as they analyzed their fundraising data, Classy noted that donors who first gave during an election cycle were 50% more likely to give again. If you are not collecting, tracking, and leveraging your advocate’s data, you won’t be able to ask them to donate to support your critical mission. CAPTIVATING STORYTELLING Storytelling has been gaining the attention of many industries recently – business, retail, nonprofit, etc. And while many advocacy and policy organizations focus on creating white papers, policy papers, fact sheets, and other information to make their case - compelling storytelling can inspire people to take action and join your cause. Connecting your policy priorities to how they impact people’s lives can not only help you grow your influence, it will also help lawmakers remember why your policy advocacy is important. Cognitive psychologist Jerome Bruner suggests that people are 22 times more likely to remember facts when presented in a story than when presented alone. And this makes sense. Lawmakers hear facts and figures every day. They are presented with charts, graphs, and one-pages all day long. But when it comes time to make a decision about a piece of legislation, your advocates’ stories will be what they remember. These stories can move them to vote with you – and may even inspire them to become a champion for your issue. BROAD COALITIONS I predict we will see bigger and stronger coalitions as organizations and sectors tackle our most challenging social problems. As I reflect, I cannot think of a recent winning campaign that did not engage a broad coalition of organizations and interests. Organizations that partner with other organizations that share a common goal are more likely to win. A broad coalition demonstrates that your issue is important to a broad constituency. A great example is the restriction on smoking in public places over the past decade. Had only the American Cancer Society championed this issue, it might not have been as successful. A broad coalition of public health, patients, disease-specific organizations, health care providers, business owners, and bar/restaurant employees banned together to demonstrate that smoking bans are good for our health – and business. When it comes to legislative change, organizations that try to stand on their own are waging a tough battle - and risk being seen as a single-issue campaign with only a few people’s interests in mind. INNOVATION Innovation continues to be on-trend. Organizations that develop creative, innovative campaigns that push the envelope will see more policy success in 2020 than those tired, predictable campaigns. By now, lawmakers and their staff have seen it all. You need to do something to stand out and get your message heard. Don’t take this as doing something gimmicky – although that may work too. But tap into the emotion of WHY this work is so important. Why is access to mental health care services critical for young people? What happens when LGBTQ kids are subjected to conversion therapy? To be innovative, you also need to be flexible and be able to try new things. They may not all succeed, but you’ll find the gems that will and build off of those. 2020 is going to be NOISY! I can barely hear anything already. Organizations that are able to get their message heard will be the most successful. This means building innovative campaigns that create strong advocates, who are equipt with the tools to share your message, and have a consistent drumbeat so your message is remembered when it matters.

LEVERAGE YOUR KNOWLEDGE. Legislators need – and want – to hear from their constituents. Especially constituents who understand big, complex policy areas (like health and human services, education, the environment, etc.). Over the past decade, legislator and legislative staff tenure are shrinking – due to retirements, a push into the private sector, and a volatile electoral map. This has resulted in less knowledge and understanding of complex budgeting and legislative environments in legislatures across the country. Organizations that have members and supporters with subject matter expertise are invaluable to legislators and their staff. “Direct constituent interactions have more influence on lawmakers’ decisions than other advocacy strategies.” 2017 Congressional Management Foundation survey But your supporters’ expertise is not only valuable during the legislative session. It is particularly valuable during election years. Leverage this moment in time- the best time to educate a lawmaker is when they are a candidate. When they are candidates, you have your future lawmakers’ attention. They WANT to learn from you. They have the time and attention to listen to your concerns as they are forming their policy platforms. Leverage this moment to ensure your policy solutions are front and center. And then, after the election, make sure your advocates reconnect with their lawmakers to remind them of your policy goals.

START 2020 OFF RIGHT! If you don’t have staff managing your advocacy efforts – or even if you do – you might be doing one of these advocacy no-nos. Don’t be ashamed. These are common advocacy mistakes that organizations make every day – that you should stop today. Click here to get your free download There is a lot at stake right now. Is your grassroots program as strong as it could be? After you are sure you aren't making any of these mistakes, take a minute to think about if you are leveraging your peaple power. If you would like a thought-partner or strategic advisor to ensure your grassroots program is as strong as it should be -- drop me a note. I'd love to chat with you about how to make sure your organization isn't ignored by lawmakers this year. LET'S DO THIS!

GRASSROOTS ADVOCACY. Have I scared you off yet? These can be frightening words for some nonprofits — but they shouldn’t be. Most nonprofits, from community groups to social justice organizations, are focused on providing resources and solutions to some of our toughest issues. You’re housing the homeless, feeding the hungry, saving animals, children, babies, and families — helping people meet their basic needs. This is important work — extremely important. But it doesn’t afford you the you the time or space or energy that is needed to focus on how to solve these issues. However, you have the knowledge, expertise, and real life experience to help solve these tough problems. You see the solutions, you see the possibilities, but you need space and guidance to get this info to the right people — the people who make decisions about laws and policies. ADVOCACY AFFORDS YOU THE OPPORTUNITY TO USE YOUR EXPERTISE TO HELP SOLVE BIG PROBLEMS. By engaging in advocacy, even in small ways, you can help find solutions to the toughest issues our society faces. And the best part? You can even use this strategy to raise more money! Want to find out how, and what you can do to help? In this post published by Wild Apricot, I’ve detailed what exactly advocacy is (and isn’t) and six easy steps you can start following today to get more involved in making change happen.

Originally published by Harbage Consulting (July 7, 2018) On July 1, 2018, the California Medicaid program launched its Health Homes Program, which provides a new set of health care services at no cost to beneficiaries with certain chronic health conditions and/or a serious mental illness. San Francisco County is the first county to roll-out the program, with 28 other counties implementing in two phases over the next year. California joins 22 states and the District of Columbia in operating health home initiatives – in total there are 34 initiatives underway, as some states have designed health homes for more than one target population. The goal of the California Health Homes Program is to coordinate and promote access to the full range of physical health, behavioral health, and social services for Medi-Cal (California’s Medicaid program) beneficiaries with complex needs and empower them to play an active role in their own care. Medi-Cal managed care plans are leading the development and implementation of the Health Homes Program. The plans contract with community health care providers, known as Community Based Care Management Entities (CB-CMEs), to engage eligible Medi-Cal patients and provide health homes services. Target Populations To qualify for the Health Homes Program, Medi-Cal beneficiaries must: Be enrolled in a Medi-Cal managed care plan; Have certain chronic health conditions (e.g. asthma, diabetes, kidney or liver disease, heart failure, etc.); and Meet certain acuity criteria (e.g. have had emergency room visits, hospital stays, or be chronically homeless). In January 2019, the program will expand to include Medi-Cal beneficiaries with a serious mental illness. Medi-Cal health plans contact the members who qualify for the Health Homes Program and connect them with a community provider to deliver the services. Health care providers can also refer patients to the health plan to see if they qualify. Joining the program does not take away or change any of the person’s Medi-Cal benefits. Core Services People who join the Health Homes Program are assigned a care team – including a care coordinator – that works together to help them get the health care and social services they need. The care team is composed of the person’s current and new health care providers, as well as case managers or others from community organization that serve the patient. A key focus of the HHP is connecting people who are experiencing homelessness with housing supports. The Health Homes Program provides access to six core services: Develop and maintain a Health Action Plan to help them meet their health care goals and stay healthy; Keep all providers coordinated and up-to-date about members’ health care needs and the services they receive; Provide information and tools to inform people and their family members on the best ways to manage health conditions; Help people move safely and easily between different care settings, such as entering or leaving a hospital or nursing facility and returning to their own home; Include family or friends on the care team if the person chooses, so they have up-to-date information on their conditions and ways to support them; and Help people find and apply for needed community and social services, including housing. My Role On behalf of Harbage Consulting, Bethany Snyder worked with the California Department of Health Care Services (DHCS) to design and execute a comprehensive engagement, education, and communications strategy to support implementation of the HHP. Bethany led the Harbage Health Homes team as they developed strategies, materials, and messages for a range of stakeholders including managed care plans, health care providers, Medi-Cal beneficiaries, and community-based organizations. These materials include a Member Toolkit, a Provider Guide, and a fact sheet for health plans to use to educate their members and community providers on the program. We also have outreach staff on the ground in the counties that are connecting directly with participating providers, beneficiaries, and community-based organizations. Additionally, we supported the development of a Program Guide, which identifies the HHP requirements. I will continue to follow DHCS' implementation of the Health Homes Program and its transformation of how medical and social service providers work together to ensure that the most vulnerable Medicaid beneficiaries have access to the care and support they need.

Originally published for Harbage Consulting (June 27, 2018) Pride month is a time to honor the achievements and contributions of the LGBTQ (lesbian, gay, bisexual, transgender, and queer) community. Marked by the Stonewall Riots in June of 1969, the month provides the opportunity to celebrate the unprecedented gains in LGBTQ equality, while also reflecting on the work left to be done. The LGBTQ community has experienced a monumental expansion of rights and equality over the past decade, including marriage equality and official recognition of LGBTQ partnerships, however access to health coverage and care continues to be a challenge. The LGBTQ community has poorer health outcomes and greater health care needs than their straight counterparts. LGBTQ people also have higher poverty rates and less access to private health insurance and are therefore more likely to rely on Medicaid and other public programs. Due to the historical lack of access to state and federal marriage recognition and the rights and benefits provided by it, until 2013, LGBTQ people had not been able to secure health benefits through their spouse’s or partner’s employer benefits. Still, in 2014, almost 9% of LGBTQ couples reported being denied when trying to add their partner/spouse to their employer-sponsored health plan. Employment discrimination has also impacted the insurance rates of LGBTQ people. Currently, only 22 states and the District of Columbia have non-discrimination employment laws that protect LGBTQ people from being fired based on their sexual orientation and only 20 states include gender identity protections. The lack of employment protections has pushed many LGBTQ people into low-wage jobs that do not offer health insurance or unemployment benefits. Underscoring all of these statistics is the fact that the LGBTQ community is also more likely to live in poverty. 2013 data showed that 20.8% of LGBTQ adults lived in poverty, compared to 16.25% of the general adult population. And this statistic becomes even more dire for children in LGBTQ families. Children in same-sex couple households are almost twice as likely to be poor as kids in married, heterosexual couple households. For these populations, access to Medicaid is a life-saver. ACCESS TO MEDICAID CRITICALLY IMPORTANT TO LGBTQ COMMUNITY According to the Williams Institute, about 1.2 million LGBTQ adults are enrolled in Medicaid as their primary source of health insurance. And due to the Affordable Care Act’s Medicaid expansion, the uninsured rate of the LGBTQ population decreased from 27% to 17% since 2014. Following are several key reasons why Medicaid’s role in the health care system is so critical for the LGBTQ community: LGBTQ People Have Greater Health Care Needs. The LGBTQ community experiences more physical health challenges and is more likely to rate their health as poor than straight or non-transgender people. They also have higher rates of risk factors for chronic conditions, such as higher obesity rates, smoking rates, and drug use. Furthermore, HIV and AIDS continue to impact gay and bisexual men, as well as transgender women. Medicaid is the largest source of health insurance coverage for people living with HIV and AIDS, covering more than 40% of the population. Several states implemented specific Medicaid waiver programs to provide additional services for people living with HIV/AIDs. As of 2012, 13 states had home and community-based services (HCBS) waivers that expanded health care services for people living with HIV/AIDS, and four states included HIV/AIDS as a qualifying condition for their Medicaid health homes programs, which provides extra care coordination and care management services. Medicaid expansion also significantly increased access for people living with HIV/AIDS. Finally, the Ryan White HIV/AIDS Program plays an important role providing access to critical HIV care and treatment services to those who are uninsured and underinsured. LGBTQ people also experience greater incidences of mental illness. According to NAMI, LGBTQ individuals are almost 3 times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. They also have higher rates of suicide; it is estimated that 30-50% of transgender people attempt suicide in their lifetime. Due to the discrimination and stigma LGBTQ people face, in addition to a lack of family support, ensuring access to mental health services is one of the most pressing issues facing the LGBTQ community, especially for transgender individuals. LGBTQ People Experience Ongoing Barriers to Access to Care. Despite their greater health care needs, LGBTQ people have more challenges accessing health care services than non-LGBTQ people. This is due to several factors, including discrimination and lack of cultural competence among providers, as well as lack of coverage of specific health care services and availability of providers. Fear of discrimination also leads LGBTQ people to not seek care, postpone care, or hide their sexual orientation or gender identity from their health care providers. Transgender people overwhelmingly face this challenge, as many providers are unsure how to treat transgender people, from basic interactions such as using the correct name or preferred pronouns, to more complicated issues, such as screening transmen for cervical and breast cancer (if relevant). One study noted that almost 40% of transgender people have faced some type of harassment or discrimination when seeking routine health care, and many report being denied care outright or encountering violence in health care settings. Even when LGBTQ people have Medicaid or private insurance coverage, specific health care services may not be covered by their policy. This is especially true for transgender people. For example, in 2017, about half of the insurers in the marketplace excluded specific treatments or services that transgender people may seek when medically transitioning. Or insurers may not cover a “gender-specific” screening or treatment (for example, for prostate or cervical cancer) when the patient’s gender marker differs from the gender typically treated. While the Affordable Care Act included a slate of anti-discrimination reforms that have improved access to health care services and treatments, LGBTQ people continue to be impacted by discrimination and stigma in the health care sector. MORE WORK TO BE DONE While Medicaid provides a critical pathway to health coverage for LGBTQ people, offering high quality, timely access to needed services — including eliminating discrimination and stigma — will need to be addressed to improve health care outcomes for the LGBTQ community. Harbage Consulting is committed to ensuring that Medicaid and the health care safety net remain strong for the LGBTQ community and the millions of others who rely on it.

Excerpt from blog post originally published by Harbage Consulting (June 12, 2018) In recent years, there has been an increasing emphasis on improving health outcomes by addressing the social determinants — the environmental and social conditions, like access to safe and affordable housing, education and employment opportunities, and good nutrition – that influence people’s overall health. While siloed programs and funding streams, conflicting priorities, and lack of coordination and communication across agencies have historically impacted the ability of public programs to work together effectively to address social determinants, Medicaid programs across the country are beginning to tackle the challenge. Over the past several years, Harbage Consulting has supported clients in implementing innovative Medicaid initiatives that address the social determinants in an effort to improve health outcomes. California's Medicaid Health Homes Program is an exmaple of a program we have been proud to contribute to that link people to the social supports they need to lead healthier lives. CALIFORNIA'S HEALTH HOMES PROGRAM The California Health Homes Program (HHP) is designed to connect Medi-Cal patients who have multiple chronic conditions and/or a serious mental illness to an enhanced set of care management and coordination services. One of the core services provided under the HHP is ensuring that patients are connected to community resources and social service agencies that help them address their non-medical needs, such as accessing nutrition programs, employment training, and legal services. The HHP also places a strong emphasis on connecting patients to housing and transportation supports, as these are major barriers to improving patients' health. The HHP is in its early stages and Harbage Consulting is supporting the California Department of Health Care Services (DHCS) with program design and implementation. This includes policy analysis as well as developing communication and outreach materials for providers, Medi-Cal members, and community-based organizations.

Originally published by Harbage Consulting (April 3, 2018) Since the implementation of the Affordable Care Act, states have been creating new health care initiatives or expanding benefits and services of public health programs. Educating consumers – as well as providers, advocates, caregivers, and other stakeholders serving them – about these new public health care programs or benefits has been a critical element of success. In today’s world, having an easy-to-navigate website with clear and understandable information is an important tool to support that education work. Harbage Consulting originally developed CalDuals.org in 2012 as one piece of a broader outreach and education campaign to help dually-eligible beneficiaries in California navigate changes in how they receive their Medicare and Medi-Cal (California’s Medicaid program) benefits through the Coordinated Care Initiative (CCI). Last year, Harbage Consulting redesigned the CalDuals website into a more user-friendly and modern resource hub. To ensure the website meets the needs of those who use it, we used the following best practices to guide the redesign. ENGAGE STAKEHOLDERS EARLY AND OFTEN A defining feature of our work on CCI has been the early and frequent engagement of stakeholders. Our website redesign was informed by a specially-created workgroup consisting of active stakeholders with first-hand knowledge of how the website was being used and how it could be improved. The CalDuals workgroup consisted of advocates, providers, and stakeholders who met regularly to help determine the goals, primary audiences, layout, and other key features for the new site. The workgroup was engaged throughout the entire process, from reviewing wireframes to testing the site before it launched. IDENTIFY TARGET AUDIENCES Identifying our target audiences dictated the layout, priority content, and features for the new website. We had the benefit of stakeholder feedback, as well as several years of anecdotal feedback and analytical user-data. We had several target populations for the new CalDuals website, all with different information needs. CalDuals’ target audiences, like many other health care programs, are: 1) consumers, 2) health care providers, and 3) advocates and other stakeholders, such as the public and lawmakers. With our target audiences in mind, we organized the site by population, to give each audience their own navigational pathway, landing pages, tailored menus, button items, and submenus. ENSURE ACCESSIBILITY Since CalDuals’ target population includes both people with disabilities and beneficiaries from diverse communities, physical and language accessibility were a top priority throughout the site redesign. In addition to meeting the accessibility requirements required by law, we recommend going beyond the basic accessibility rules to design a truly tailored and accessible site. Physical Accessibility: To ensure people with visual impairments or other disabilities would be able to use and navigate the site, we used 14pt or larger font. In addition to a high-contrast color scheme, we also included a contrast tool that readers can use to improve readability. We also tested the site using adaptive technologies, such as screen readers. Language Accessibility: We developed a dedicated page for each language within the site for CalDuals users speaking one of 13 threshold languages. Because language accessibility is a high priority for the populations served by the CCI program, we chose to place access to the language options at the top of the page for maximum visibility. We hired a professional translation company to translate the content on our site, and we recommend not relying on auto-translation tools. FOCUS ON STRUCTURE AND NAVIGATION Today’s consumers want less text-heavy pages and more graphic-focused, simple pages. During the redesign, we carefully balanced the need to provide key information without overwhelming visitors with unnecessary or irrelevant information. Create Landing Pages: We prioritized the topics of importance to the readers (identified by our stakeholder workgroup) in the menus and left less important pages to a submenu. We also used buttons to highlight individual items that are important or new that otherwise may not make sense to include in the menu. Leverage Analytics: We used analytics data to determine the most popular content and frequently visited pages and prioritized content for each audience. Pages that were no longer visited or infrequently used, but that needed to be available for transparency and historical purposes, were filed into an archive section. CalDuals continues to be an important source of educational resources for the CCI, sharing enrollment information, serving as a policy archive, and as a mechanism for stakeholder feedback. We continue to add resources and program information as the CCI evolves and reaches more consumers.