Robert M. La Follette School of Public Affairs
Wednesday, February 10, 2010

Shields tackles complexity of health care systems


Lilly Shields became a manager with Avalere Health in the Washington, D.C., area. She advises clients on developments and trends in the post-acute and long-term health-care sectors.

La Follette School photo taken December 17, 2009, by Andy Manis

Lilly Shields

At the macro level, good health policy is a matter of choice for Lilly Shields. At the micro level, choices may not be so clear.

As a public affairs and law student at the University of Wisconsin–Madison, Shields has spent a lot of time thinking, researching and writing about the potential and actual effects of health-care legislation and policy.

Her nearly four years in Wisconsin have only solidified her belief that the policy a society enacts is a matter of choice. "The way a policy is now is the way that we, as a society, have chosen for it to be," Shields says.

One result of that choice for people in Wisconsin is a myriad of health care choices and financing that patients must navigate as they seek the best treatment options and health-care coverage. As a patient advocate, Shields saw how legislation and regulations affect people daily. "Rather than reading articles that health-care delivery and financing are complicated, I experienced it firsthand by navigating insurance appeals and Social Security applications, researching clinical trial options and looking for health coverage for patients," Shields says.

She worked first with nonprofit public interest law firm ABC for Health and then enrolled for credit with the Center for Patient Partnerships, a campus unit that helps patients with life threatening or serious chronic illness make informed decisions and get health care. "The experience was very humbling and forced me to realize the real-world implications of the law and policy that I study," Shields says. "The experience added a great deal of depth to my studies and to my appreciation for the complexity of a thorough policy analysis that considers the implications for all stakeholders, including the patients.

"Those implications become more apparent if analysts and policymakers understand the different policy options that exist. "I believe that policy can only be understood through comparisons," Shields says. "Understanding the policy alternatives to a private-market employer-sponsored health-care system is very difficult if you do not understand publicly funded systems in Great Britain and Canada or mixed public and private systems in Germany and Japan. By understanding how others have chosen to do it, ideally we can cherry pick the best ideas to put together a health-care delivery system that best fits our values and our heterogeneous country."

What different states are doing is another level of comparison Shields has examined. During an internship with the U.S. Government Accountability Office in Washington, D.C., in the summer of 2009, Shields work on a team compiling a description of how states handled premium assistance as part of their Medicaid and State Children Health Insurance Program. Premium assistance uses state funds to subsidize the purchase of private health insurance for low-income people. "This report will allow state officials to see what other states are doing and to evaluate which policy alternatives might work best for each particular state," Shields says.

While at GAO, Shields worked with another team to research the effect of the increased Medicaid matching funds the federal government provides states through the 2009 American Recovery and Reinvestment Act. "We tried to discern whether the funding increase allowed states to make more people eligible for Medicaid or to increase the benefits, or whether the funding simply allowed states to maintain the status quo in light of severe budget constraints." The GAO found that the federal funds allowed states to keep the same benefits and eligibility levels, but did not result in any states increasing their Medicaid program.

Shields will return to GAO in July as a health policy analyst, joining more than six recent alumni in that unit. She won't be working as an attorney, but if her career winds toward working as one in a federal agency, she can reactivate her Wisconsin license that becomes valid once she graduates and is sworn in by the Wisconsin Bar Association.

At UW, Shields held project assistantships with the Population Health Institute and with the Evidence-Based Health Policy Project. The latter is a partnership of the institute, the La Follette School and the Wisconsin Legislative Council. She organized several briefings and other events for legislators, and researched answers to questions from legislators. For the Population Health Institute she calculated the percentage of eligible people who enrolled in Wisconsin's Medicaid after a 2008 reform to expand eligibility.

Shields spent part of her winter break working on a brief for the Evidence-Based Health Policy Project. She is exploring Wisconsin's new regulations to curtail the practice of insurance companies to retroactively rescind coverage after a patient submits a claim. La Follette School alum (1998) and state insurance commissioner Sean Dilweg helped to write the legislation.

Shields looks forward to returning to Washington, D.C., and reuniting with La Follette friends. She also is excited to start putting her four years of graduate training to use, she says. "My experiences at La Follette, with its with great training in program evaluation and public management, will help me dive right into my work at the GAO."

Policymakers can hear about one model for a new health-care system, February 16, 2010, La Follette School News

Grad to brief legislators, staff on benefits of health-care data, September 29, 2009, La Follette School News

State tries to limit insurance recission, May 16, 2009, Milwaukee Journal Sentinel

— updated February 24, 2010

Last modified on Saturday, November 15, 2014