Chapter 09: Associate Vice President of the Office of Health Policy
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Description
Dr. Foxhall talks about his role as Associate VP for Health Policy.
He defines the scope of “health policy” and gives examples of policy issues addressed in collaboration with other health organizations. He stresses MD Anderson’s role as a resource and support for public officials who lobby for health policy in the legislature.
Dr. Foxhall next explains the relationship between the Office of Referral Relations the Office of Health Policy.
Dr. Foxhall next talks about the big projects he undertook as Associate Vice President: creating the network of physician referrals; a program to educate physicians about cancer screening; creating an internet based educational outreach program.
Identifier
FoxhallLE_02_20140213_C09
Publication Date
2-13-2014
City
Houston, Texas
Interview Session
Lewis Foxhall, MD, Oral History Interview, February 13, 2014
Topics Covered
The University of Texas MD Anderson Cancer Center - An Institutional Unit; Character, Values, Beliefs, Talents; Institutional Mission and Values; MD Anderson History; Information for Patients and the Public; Beyond the Institution; The Institution and Finances
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
Well, I’d like to turn now, if you are willing, to your role when you stepped into the Associate Vice President for Health Policy. That was in 1994, and I’m wondering if you could tell me how you came to serve that role, first of all.
Lewis Foxhall, MD:
Well, I was hired by Dr. Joe Painter, who was VP for Health Policy at that time. He’d been focusing his career here at the institution on trying to reach out to community physicians, working with both oncologists and primary care physicians, but, in particular, working with various medical organizations and volunteer organizations, so trying to build and maintain strong collaborative relationships with those groups was a part of what he had been doing, and that was a lot of what I was hired on to do to maintain. So this was working with what’s known as organized medicine, which is folks like the American Medical Association, Texas Medical Association, specialty organizations primarily here in Texas, and then also with voluntary health groups such as the American Cancer Society, to find alignments in programs that help fulfill our mission as well as theirs and so forth. And then with public health groups, our state health department, what was then known as the Texas Cancer Council, which was a state agency targeting cancer [unclear] initiatives, and then our regional and public health entities in the Houston community.
Tacey Ann Rosolowski, PhD:
Can you describe for me what is meant by health policy? It may seem like an obvious question, but, you know, I’m curious what the scope of that is.
Lewis Foxhall, MD:
Sure. It’s the realm of legislation and regulatory initiatives that govern, in our case, the delivery of cancer care. So it’s a broad field that can include issues of a public health nature, of a financial nature, or other areas. So there are many things that touch on how we deliver services here at the Cancer Center, how they’re delivered in the community, both cancer treatment as well as cancer prevention. How we value and implement those sorts of services as a society are governed by laws and regulations, and that’s really kind of the area that we primarily work in.
Tacey Ann Rosolowski, PhD:
So I’m curious how your work with these different voluntary organizations in organized medicine kind of fit into that. What were the issues from a policy standpoint that you were addressing?
Lewis Foxhall, MD:
Well, there have been a number of issues over the years, so with the organized medical groups, oftentimes it was related to financial issues, how physicians and hospitals get paid for what they do, how we relate with insurance companies, how we relate with the federal government that provides services through Medicare, through Medicaid, or other programs. So there are all sorts of issues related to how those sorts of questions are decided and how they’re implemented, that we have an opportunity to work with and collaborate with our colleagues in these other organizations that have often—or what we try to find is an alignment of our goals so that we oftentimes may differ on how we approach something, but many more times we can find common ground and work together toward a specific goal.
Tacey Ann Rosolowski, PhD:
Can you give me an example of a project that you worked with?
Lewis Foxhall, MD:
Well, you know, there are things like how we get coverage for payment of individuals who are participating in clinical trials. So a person in the Medicare program, for example, might not be able to receive payment for their routine care if they’re participating in that clinical trial, so the carrier may deny coverage for any of their treatment. So we worked to help establish a principle that the patient was going to get cared for anyway, the costs of the trial are separate and covered by the trial itself, but the trial shouldn’t pay for what was going to happen anyway, which was the routine care, which seems like an obvious thing, but, surprisingly, it was very difficult [unclear]. (Rosolowski laughs.) And commercial entities were [unclear], you know, “This is an experiment. We’re not paying for an experiment. You can take care of that yourself.” So the vast majority of the costs were routine costs that occurred anyway, so the patient was in the hospital, say, getting treated, and [unclear] whether or not they were getting an experimental drug was a secondary issue. So it took things like that, which seem very simple and obvious, often take years to eventually resolve and take collaborations across many interested parties to try to make a change, which is very important whether people can access clinical trials and the oftentimes very beneficial treatments that they get. So that’s sort of an idea of the work that I did. In the public health arena, we have been involved in a number of different issues in being sure that we have adequate funding for things like tobacco control or that we’re providing immunizations that may help reduce the frequency of cancer. So there are a number of issues there that we can provide support for. We’re a state institution. We can’t and don’t lobby per se, but we act as a resource and provide information and support for elected officials and for other groups that we work with who do direct advocacy work. So by working together, we can accomplish much more than just each of us [unclear].
Tacey Ann Rosolowski, PhD:
And what sorts of initiatives would elected officials take up using MD Anderson resources?
Lewis Foxhall, MD:
Well, you know, it could be things like that. We’ve had coverage of various preventive services addressed at the state level. We’ve had issues around, most recently, these regulations around tanning beds, which we worked with our colleagues in Government Relations to address. We’ve worked with a number of communities on their tobacco-control ordinances. So there are all sorts of areas where we try to provide resource and information and give support to those that need the knowledge of the impact of these things on their constituents. So we think that’s a valuable service that we can provide there.
Tacey Ann Rosolowski, PhD:
So you became associate vice president in 1994, and you became VP of the Office of Referral Relations in the same year. Now, was the Office of Referral Relations within the Division of Health Policy or Department of Health Policy or—
Lewis Foxhall, MD:
Well, first we had the Referral Relations Program established, so it was just a really [unclear]. I’m not sure where you [unclear] the VP bit, but the Health Policy bit was the VP. So I was the director, then director of the Office of Health Policy, so initially had that as sort of our administrative designation, and then eventually we split that off. We continued to have the Office of Physician Relations, which Mr. Green [phonetic] heads up today, and then we formed the Office of Health Policy as a separate area. So those are really kind of our administrative departments, if you will, so other than a title.
Tacey Ann Rosolowski, PhD:
Okay. So they’re separate entities.
Lewis Foxhall, MD:
Today they are.
Tacey Ann Rosolowski, PhD:
Yeah, today, but they were [unclear].
Lewis Foxhall, MD:
That was all part of the same thing.
Tacey Ann Rosolowski, PhD:
Okay. Okay. And that’s right, because I have a note here that in 2001, the Office of Referral Relations became the Office of Physician Relations. It was renamed?
Lewis Foxhall, MD:
Yeah, sorta kinda. (laughter) It’s had its designations over the years.
Tacey Ann Rosolowski, PhD:
It’s amazing the name changes at MD Anderson.
Lewis Foxhall, MD:
Right. Yeah, I know. Got to be changing something.
Tacey Ann Rosolowski, PhD:
Yeah. So could you tell me some more about what you felt when you became Associate VP? What were some of the big projects you worked on? Because you talked about establishing these networks, but it sounds like that was part—so was that the time when the referral relationships was folded into Health Policy so when your work on establishing the community networks was part of your role as associate vice president?
Lewis Foxhall, MD:
Well, now, I mean, really, the new thing that we developed was this Referral Relations Program, so that was sort of the initial administrative task that I was assigned to do. So in addition to that, I helped manage for Dr. Painter some outreach programs that were funded by PRS at that time, outreach in the Rio Grande Valley for cervical cancer screening, and also we had one for sun protection and then had a program in collaboration with the medical schools and the primary care organizations to educate physicians on cancer screening that we initiated. So those were some kind of the things that we began to do and pursued for some time. We also had an Internet-based education and outreach program that collected data and information around cancer statistics and cancer providers across the state and shared that out. That was initially Texas Cancer Data Center. It was funded through the state and then subsequently by [unclear] as the Texas Cancer Information website, which we still have today.
Tacey Ann Rosolowski, PhD:
Right. I had it on my list to ask you about that. Yeah.
Recommended Citation
Foxhall, Lewis E. MD and Rosolowski, Tacey A. PhD, "Chapter 09: Associate Vice President of the Office of Health Policy" (2014). Interview Chapters. 858.
https://openworks.mdanderson.org/mchv_interviewchapters/858
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