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This week, we are joined by Laurie Chiumento, director of federal relations and healthcare policy at UR Medicine, the health system for the University of Rochester in New York. Laurie is an expert on how health systems and hospitals can advocate and promote their legislative priorities to members of Congress. She shares advice to hospitals that are preparing to speak with their elected officials about 340B issues or are considering doing so.
340B Insight provides members and supporters of 340B Health with timely updates and discussions about the 340B drug pricing program. The podcast helps listeners stay current with and learn more about 340B to help them serve their patients and communities and remain compliant. We publish new episodes twice a month, with news reports and in-depth interviews with leading health care practitioners, policy and legal experts, public policymakers, and our expert staff.
Speaker 1 (00:04):
Welcome to 340B Insight from 340B Health.
David Glendinning (00:13):
Hello from Washington DC, and welcome back to 340B Insight, the podcast about the 340B drug pricing program. I'm David Glendinning with 340B Health. Our guest today is Laurie Chiumento, director of federal relations and healthcare policy at UR Medicine, the health system for the University of Rochester in New York. Laurie advocates on the federal level on behalf of UR Medicine and its flagship, Strong Memorial Hospital. She's an expert on how health systems and hospitals can promote their legislative priorities to members of Congress, congressional staff, and other policy influencers. We wanted to hear some advice she might have for hospitals that are talking to their elected officials about 340B issues or are preparing to do so soon.
David Glendinning (00:59):
But before we go to that interview, let's take a minute to cover some of the latest news about 340B. The Department of Health and Human Services is appealing a decision from a federal court in Delaware regarding the ongoing dispute over 340B community and specialty pharmacies. That decision voided a May 2021 enforcement letter the government sent the drug maker, AstraZeneca, order the company to restore 340B discounts on drugs dispensed at these pharmacies. Now HHS is asking an appeals court to overturn that decision. The latest development means that three separate appeals courts will be considering the decisions of all four federal courts that have weighed in on this dispute so far. In the coming months, HHS, drug makers, and other stakeholders will be submitting briefs to these courts and panels of judges will schedule oral arguments to discuss the merits of the cases. Check the show notes for the latest status report on all the court activity.
David Glendinning (02:07):
Registration has opened for this year's annual 340B coalition summer conference, taking place August 1st through 3rd in National Harbor, Maryland, just outside of Washington DC. This is a must attend event for covered entities, service providers, manufacturers and all those who work in the 340B world. Attendees will get up to speed on things 340B through a full slate of session, exhibit hall events, and networking opportunities. And the conference also will provide an occasion to celebrate 340B, which turns 30 years old later this year. Please visit 340summerconference.org to learn more and register today, and we'll see you this August in National Harbor.
David Glendinning (02:59):
And now for our feature interview with Laurie Chiumento. Miles Goldman recently sat down the Laurie to learn more about the government relations work that her team does on behalf of her health system, and to hear what advice she has for 340B professionals who are looking to get more involved in federal advocacy activities. Here's that conversation.
Miles Goldman (03:20):
Thank you, David. I'm joined by Laurie Chiumento from UR Medicine. Laurie, welcome to 340B Insight.
Laurie Chiumento (03:27):
Thanks so much for having me.
Miles Goldman (03:28):
I'm excited to have you joining us today to discuss a number of advocacy topics that we haven't yet discussed on 340B Insight before. But before we dive right into that, tell us about UR Medicine and Strong Memorial Hospital and the types of patients it cares for.
Laurie Chiumento (03:45):
As you said, UR Medicine is our healthcare system. It's the largest healthcare system in Upstate New York. We have a total of six hospitals in our system, four of which participate in 340B. So Strong Memorial Hospital, which you mentioned, is our flagship hospital. It's located in the city of Rochester in New York. We have about 850 beds. It's the only level one trauma center in the Rochester Finger Lakes region. Also, it has the only children's hospital, some of the only organ transplant programs in Upstate New York as well. So Rochester has actually the third highest concentration of poverty in the US, about a third of people what live here live in poverty. And actually, half of children in the city of Rochester are living in poverty.
Miles Goldman (04:28):
Thank you for providing us with that overall context. Want to now move into discussing government relations. What is the role the government relations team plays for a hospital or health system?
Laurie Chiumento (04:40):
So we really serve as the system's primary line of communication with our elected officials at the federal, state and local levels of government. It's my job as the director of federal relations to advocate with our members of Congress, specifically focusing on federal funding, our legislative priorities, and other issues that we have concern with, or may support. We also provide updates to our members of Congress on our institution and respond to regulatory issues and things like that. So it's really my job to keep a good working relationship with our members of Congress and their staff, so they know to turn to us when they have questions, to gauge our opinion on issues. And kind of on the other side, it's also my job to keep our leadership informed on what's going on in Washington in terms of legislative funding and regulatory policies that impact our hospital.
Miles Goldman (05:29):
Thinking about 340B, what are the different ways you and UR Medicine have advocated for the program?
Laurie Chiumento (05:35):
I'd say the most visible way we have advocated for the program is through participating in the 340B Health Hill Days each year. I know I've consistently met with our delegation as part of these opportunities at least twice a year for the last 10 years or so. And it's really been helpful in terms of helping our delegation understand 340B and how it works and what it means to our facilities as well. We've developed 340B Health's 340B impact document. We've kept that up to date every year over the course of the past decade, which is really helpful both in terms of working with our congressional delegation, but also internally as well, just to kind of gauge where we are.
Laurie Chiumento (06:15):
Outside of that, I really do stay in close contact with our congressional delegation on 340B issues. We also do a fair amount of letter writing to our congressional delegation. We've certainly written on some of the 340B relevant legislation over the years. And we also use the expertise of our pharmacy department to offer them up as experts to our congressional delegation of they are in need of a resource on 340B or other pharmacy issues.
Miles Goldman (06:43):
Tell us more about the preparation that goes into these Hill Days and what the experience is like.
Laurie Chiumento (06:48):
Well, as a government relations professional, it's actually really easy because 340B Health does a lot of the work for you, which is another great reason I think to participate. So 340B Health schedules all of the meetings. There's typically an advocacy webinar that happens a few days before, where they talk about the issues that you'll be discussing and help you prepare talking points and think about how to prepare with your group for the meetings. Another nice thing about the hill visits is that we go in typically with a larger group from across New York state, which not only makes the conversation a little bit easier so it's not just you on your own meeting a with member of Congress or their staff member, but it also helps to demonstrate the impact of 340B across the member's district or across the state. Different types of facilities, different geographic areas, they're getting a lot of different perspectives that they wouldn't necessarily get if you were to meet on your own.
Laurie Chiumento (07:44):
I really think meeting with members of Congress or their staff either in person or via Zoom, as we have done over the course of the past two years makes a difference. I started participating in the 340B Hill Days back in I think 2013. And back then, staff didn't know what 340B even was. I can remember going into meetings and you would just kind of get a blank stare on the other end. And now we go into meetings, we say, "340B," and they say, "Ah, yes, 340B. I know all about 340B." So I think it really just is a testament to how important it is to stay in regular contact with your members of Congress and their staff on this issue.
Miles Goldman (08:22):
You mentioned about really having a strong knowledge base of the program. 340B professionals of course have that strong knowledge base. So how can they work with government relations to advocate for the program?
Laurie Chiumento (08:37):
First, I would say, if you don't know your government relations team, reach out and introduce yourself. I would be lost without my colleagues in pharmacy. They know so much and they have really great connections externally and internally that have been incredibly helpful to me over the years. A lot of us as government relations professionals are really kind of Jacks of all trades. We have to know a little bit about everything, so we don't have a chance to delve as deeply into this issue as a lot of us may like. And also, if we're not hearing from our folks internally, we may not necessarily know that 340B is a big issue for us. So reach out and make yourself available to your government relations team if you haven't done so.
Miles Goldman (09:18):
I know one of the ways professionals can advocate for 340B is by hosting a policy maker. Can you tell us about the importance of these site visits at your hospital? How does that help with your 340B advocacy?
Laurie Chiumento (09:32):
Yeah. I think firsthand visits are incredibly important and make a huge difference in terms of how well a member of Congress understands what you do at your institution and how 340B impacts the programs and services you provide. It's also another great way to help establish that relationship with them if you haven't done so already, and creates a visual for them the next time you put in a call, or you meet with them in DC, they can say, "Oh, yeah. I remember when I came out there to visit and saw X program, or met with so and so." You can set this type of visit up in a number of different way. You can tour units, let them see firsthand the services that you provide. You can also have them sit down and meet with your leadership. This is a great time to get your leadership group together and have a deeper conversation about your priorities and how 340B fits into that.
Laurie Chiumento (10:19):
It's not an opportunity that a lot of them get all the time because for the CEOs, CFOs, and the like, a lot of them have very busy schedules. And when you can get a member of Congress to come in and talk to them, it makes it easier than trying to arrange travel for them to DC. We try to do it as often as we can. It's also a great thing to try in August when Congress is in recess. A lot of times you'll find that their schedules are a little bit more free than other times in the year.
Miles Goldman (10:43):
Can you walk us through the overall steps involved in these hosting events? What are some best practices?
Laurie Chiumento (10:50):
Sure. First, talk to your government relations team. You may also want to loop in public relations or communizations and also notify your leadership that you've gotten this request. If you have flexibility around a date to have them visit, you may want to use that to think about how you can best show off your institution, make sure that you have the right advocates, or the right ambassadors I should say, are available to help lead the visits. You may also want to think about whether you have patients who would be good ambassadors for your institution. And then finally, make sure you have things well organized and prepare an agenda for the day that goes through start to finish. I always also prepare a background document for the folks at my institution who are participating that outlines kind of what's going on in Congress, what questions may come up, and some general talking points so that they're well prepared for the day of the visit.
Laurie Chiumento (11:45):
I will say it's a lot of work the first time you do it, but once you've done it, you'll have a framework together that you can use in the future. And like I said, once your member of Congress comes to visit, it's something that they'll remember. And the next time you meet with them, they'll have that visual to go along with your meeting.
Miles Goldman (12:02):
Sounds like a really rewarding experience. And when you're preparing for whether it's a Hill meeting, or whether it's a site visit meeting, with a policy maker, are there guidelines you tell advocates to keep in mind in terms of just from a communications standpoint?
Laurie Chiumento (12:18):
Absolutely. First and foremost, maybe it goes without saying, but I always tell people, "Make sure you're respectful." Even if they disagree with you on this issue, there may be opportunities down the line to find some common ground, so always be respectful of the person you're meeting with. The key really is to start out by developing a good working relationship, be a resource to them, and you can build on things from there.
Laurie Chiumento (12:42):
Second, I think it's really important for folks to go in without assuming the person you're meeting with is familiar with the issue, particularly for 340B. I always start a meeting with a general overview of the issue, or simply ask them if they're familiar with it. I know back when I was a staff member, I was in my early to mid 20s and didn't want to admit that I didn't know something, so I would just kind of sit there and nod and pretend as best I could. And I think at the same time that probably lessened the value of the meeting to me. So don't be afraid to ask the person if they're familiar with 340B. It's also important not to talk in acronyms. I know in healthcare especially, we're so used to doing this, it's like second nature, but you want to keep in mind that the person you're meeting with may not be familiar with those acronyms, so keep the conversation as high level as possible, so that you don't create confusion or have them, like I said, scrambling in their notes to write down things that they'll Google afterwards.
Laurie Chiumento (13:41):
I always go into a meeting still having done this for 10 years with a set of talking points for myself, so that I don't get off topic. Last but not least, I always recommend you prepare leave behind materials. If you bring a folder for them, make sure you hand it to them at the beginning of the meeting, open it, point to things during the meeting so that they understand the value of material that you're sharing with them. They'll probably get 10 other folders during the day, but if you don't open it and show it to them, it's going to end up in a pile on their desk, and will probably ultimately end up in the garbage without being opened. But if you open it up to them, show them how important the information is in there, and how it can be useful to them, it really does make a difference.
Miles Goldman (14:16):
Thank you for sharing those best practices with us. I want to switch gears now to thinking about the midterm elections. This is an election year for both the House and the Senate. How did the midterm elections this fall affect how 340B professionals should think about advocating for the program?
Laurie Chiumento (14:37):
We're likely to see a lot of new members come into Congress after the midterm elections. And the key here will really be for hospitals to get in and educate new members early, so that they understand the issues that are of concern to us. Sometimes we at UR Medicine will even meet with members before they take office, as they're preparing to take office, just so that they can come in January familiar with our institution, understanding our legislative and funding priorities, and we can really hit the ground running at the beginning of the year.
Miles Goldman (15:10):
The term political action committee often is heard during election season. What are political action committees? And what role do political action committees, also known as PACs, have in advocacy efforts?
Laurie Chiumento (15:23):
Yeah. Political action committees are organizations that support or oppose a certain issue or issues, and they raise money to support the election of certain candidates that support their cause, or they try to defeat candidates that don't necessarily align with their cause. PACs can really have a lot of influence in terms of affecting elections. The way they operate allows them to take smaller donations from individual donors and kind of pool that money together to make a bigger donation, so that political actions committees give issues a seat at the table, more or less. One thing I recommend to you if you're interested in donating to a PAC is first, talk to your government relations office or your general council. There's a good chance your institution may have a lobbying and political action policy that you may need to consult before doing so.
Miles Goldman (16:20):
When you think about all the different types of advocacy you have led, what would you say is your greatest success story?
Laurie Chiumento (16:28):
Well, one that comes to mind just happened recently, and that's related to the 340B pandemic eligibility issue. This is something that we pushed hard on for months last year. As I mentioned, we have four hospitals that are 340B eligible, and three of them were in great danger of losing their 340B eligibility due to drops in DSH percentage as a result of changes in payer mix during the pandemic. So starting I'd say in July of 2021, I was in weekly contact with our congressional delegation informing with our DSH percentage and what we thought the financial impact would be.
Laurie Chiumento (17:08):
As it turned out for us, we were lucky and at the last second, all three of our hospitals that were in danger were able to pull just above the threshold. In each case, it was by a fraction of a percent. And I know coming into this year as well, we have continued concerns because of COVID and we've had to cancel procedures and surgeries due to rising COVID numbers. And there are continued concerns that this will be an issue for us going into the next year as well. So just having that flexibility or that bit of relief, I guess I should say, is a great relief to our folks.
Miles Goldman (17:44):
Well, I think that really demonstrates the power of advocating for 340B and how it's so important in the effort to protect 340B for hospitals and patients. Laurie, thank you so much for taking the time to speak with us today. We really appreciate it.
Laurie Chiumento (18:02):
It was my pleasure.
David Glendinning (18:04):
Our thanks again to Laurie Chiumento for taking the time to share her government relations expertise with our listeners. You heard Laurie mention 340B Health Hill Days as one of the best ways to advocate for 340B to members of Congress and their staff. If you are a 340B Health member, be on the lookout for our emails about the next virtual Hill Day that we have planned. We would love to have you on board for this event, especially if it's your first time signing up. If you have questions about 340B advocacy or any of our episode topics, or if you have suggestions about topics we should cover on future episodes, please email us at podcast@340Bhealth.org. We will be back in a couple of weeks. As always, thanks for listening, and be well.
Speaker 1 (18:55):
Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340Bpodcast.org. You can also follow us on Twitter at 340B Health, and submit a question or idea to the show by emailing us at podcast@340Bhealth.org.