by Jessie Zimmerer. This post originally appeared on the Center for Community Engagement in Health Innovation blog.

If health care advocacy were a sport, there’d be no question about our defensive strategy. Much of our collective efforts over the last few years have centered around defeating threats to Medicaid and Medicare, and protecting the Affordable Care Act. Defense is crucial; defense is where games are lost. And defense is exciting. There’s a palpable urgency in the crunch to defend needed programs that piques the interest of otherwise passive spectators, and as our state partners have seen, the threat of losing vital benefits tends to bring out the energy and resources of the broader community.

But what about the offense? How do we gain ground in an unstable health care landscape teeming with legislative proposals and leadership intent on bringing about its demise? How do we harness the same excitement to win the long game? The answer is to invest in and mobilize demand for delivery reform.

While payers and providers have long been directing their efforts toward influencing delivery reform measures, consumer advocates are now increasingly turning their attention to these measures as well, recognizing their critical role in achieving greater access, quality and affordability. This shift requires the development of new strategies for engaging consumers around delivery reform initiatives – which tend to be much more complex than keeping an established program or service off the chopping block – and organizing them to push for change.

The Center for Consumer Engagement in Health Innovation released a guide last month, Where the Magic Happens: A Guide to Grassroots Organizing for Consumer-Driven Delivery Reform, to support consumer advocates in just this kind of work.

Where to Start

Organizng around delivery reform is hard, but the Center’s state partners have demonstrated time and again that it is possible. The first step in the process is listening. People with multiple chronic health conditions interact with the health system often, and this proximity to providers and experience of quality tends to inform their understanding of the health system in ways that are not available to most people.  Organizing for delivery reform, therefore, must begin by talking with them. The guide provides strategies and examples of how to:

• Identify and reach these populations;
• Talk with people about complex health system issues, including specific guidance about what to listen for when talking with consumers; and
• Implement the kinds of organizing tactics that work well on these issues, as well as offering examples of those that don’t work in this context to keep advocates from spinning their wheels.

What Delivery Reform Looks Like

Unlike defensive organizing, where short, distinctive soundbites can effectively get the message across, offensive organizing around delivery reform issues requires a broader and, often, more nuanced understanding of the health care system and its levers. Achieving this understanding requires a more significant investment in a smaller number of people, rather than a shallower investment in a larger number of people. Over time this translates into increasingly powerful and effective consumer advocates who can communicate their needs to decision makers in a variety of settings. The guide offers a number of tools to begin making these investments.

Perhaps most importantly, organizing around delivery reform must aim to sustain and institutionalize consumer perspectives.  Organizers using this guide will find concrete examples of how an informed delivery reform consumer base can be used to effect change, with a particular focus on supporting diverse consumer populations who are participating on Consumer Advisory Councils, governance boards, work groups and other policy-making bodies.

Conclusion

It is clear from the work of our partners that identifying and preparing consumers to meaningfully engage in delivery reform initiatives does not happen by magic. It takes resources and stakeholders in the health system to create a consumer-driven health infrastructure. Both payers and providers have a role to play in supporting the development of this infrastructure, and consumer advocates are critical partners in identifying and preparing consumers to take on more significant roles in shaping a more effective health system, and building an offensive strategy to move our agendas forward.

The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.