Author: Supriya Jain

One of the biggest lessons I have learned and am continuing to learn about the world of work and social justice work overall is what it means to be an advocate. Advocacy can be defined in many different ways, but in general, it involves taking action to create change. Through my work with the Center for Medicare and Medicaid, I have seen that truly successful advocacy goes beyond this step of just identifying these weaknesses and flaws in our systems. It involves championing them to change or be uprooted entirely.

In the time I have been with CMS, I have critiqued policies that do not allow for coverage of nearly enough patients, and pushed for new and improved technologies to be available to patients under Medicare. I have questioned outdated standards of care and encourage optimal coverage for beneficiaries to allow all people fair and equitable access to healthcare. Though my tasks have been very detail-oriented and I focus on smaller aspects of access to quality care through recommending new technologies, my hope is that my work as an intern this summer will further my department’s mission to advise policy surrounding coverage and access to technologies to push for health equity within CMS and the U.S. health system as a whole. 

One thing I wish I had known before I began my internship is that progress in many forms is often slow-moving. Although you can approach advocacy with gusto, true and sustainable change often takes longer than you realize. It is frustrating at times to want to see large scale changes in healthcare access reflected in policy and infrastructure changes, but not witnessing it due to things like bureaucracy, red tape, or even just the nature of change in the field overall. However, one of the most beneficial traits of someone entering the field of public health and working towards the pursuit of health equity is understanding the importance of stamina. To anyone else looking to pursue an internship or career in public health, I encourage you to think critically about the ways you can maintain your stamina in your work. Whether you accomplish this through acts of self care, or by setting boundaries in your professional life, maintaining stamina in your advocacy and not burning out when immense changes do not occur immediately is a key factor in ensuring that when the progress actually does occur, it is sustainable and will be upheld by the institution even after you are gone.

I have been honored to work with the Center for Medicare and Medicaid Division of New Technologies this summer. My work this summer has taught me an incredible amount about how different subsections within Medicare work to optimize coverage for beneficiaries to allow all people fair and equitable access to healthcare. All patients, whether they are Medicare beneficiaries or private beneficiaries, deserve access to the same promising technologies and interventions, and watching the DNT push for that by streamlining the approval of technologies under coverage has been a privilege to witness. I hope that my impact as an intern at Medicare will be one step out of many more to come to continue the important progress being made by the DNT towards a larger goal of health equity overall.

Throughout my time at Brandeis, one of the biggest lessons I have learned and am continuing to learn is what it means to be an advocate. Advocacy can be defined in many different ways, but in general, it involves taking action to create change. As a university that prides itself on its mission of social justice, I hear a lot of words akin to the theme of advocacy (such as diversity, inclusion, and equity) discussed in my classes and my roles on campus. I have learned what it means to look at institutions introspectively to see just where they have fallen short of achieving these tenets of advocacy.

However, I have also learned that successful advocacy goes beyond this step of simply identifying these weaknesses and flaws in our systems; it involves pushing for them to change or be uprooted entirely. Medicare and Medicaid as institutions are not exempt from these flaws and weaknesses, and as an intern it is pivotal for me to champion for health equity and challenge existing structures within CMS.

All of my roles at Brandeis involve a personal learning curve for me to see exactly how I can use my voice to champion for these very changes. For instance, as a Head Residential Assistant, I constantly reference concepts of cultural humility in order to foster inclusive living environments and to plan culturally competent events for residents. I then take what I have learned at the Department of Community Living to my role as the president of South Asian Students Association (SASA), where I also push for inclusive programming in order to encourage diversity and accessibility in the events that SASA holds. With each position I hold, I become more capable of advocating for sustainable and intentional change because I am applying the concepts of advocacy I learn from one role to another.

Now, I can see myself applying the same themes of advocacy that I have learned in other roles (particularly surrounding health inequities) to my internship with the Division of New Technology! For example, I find myself critiquing policies that do not allow for coverage of nearly enough patients and pushing for new and improved technologies to be available to patients under Medicare. I question outdated standards of care and encourage optimal coverage for beneficiaries to allow all people fair and equitable access to healthcare. When I submit reviews on technologies to be approved and work to ensure patients have access to technologies that will afford them better health outcomes, I can see that my approaches to my work are shaped by my time at Brandeis, whether it is by my Health: Science, Society, and Policy program coursework or my leadership positions in which I advocate for change! 

Especially after this past year, as a woman of color who has watched COVID-19 predominantly impact and kill marginalized communities both domestically and internationally, I feel an urgency to tangibly contribute to the dismantling of health inequities. Thus, my approach to advocacy within my internship has involved directly questioning and calling out inequities in the structures of Medicare in order to encourage structural change. I work to channel the frustrations I have in the disparities present in our health structures (which have only been highlighted by COVID-19) towards critical change which addresses the root causes of disparities so that I can actually take my advocacy beyond the walls of Brandeis and push for intentional change on a larger scale.

For the past few weeks, I have been working with the Center for Medicare and Medicaid Services (CMS), specifically in the Division of New Technology (DNT). CMS provides health coverage to more than 100 million people through Medicare, Medicaid, CHIP, and other programs. Within the Center, the Division of New Technology is a branch that falls under the Technology, Coding, and Pricing Group, which works to approve new technologies to be covered by Medicare and Medicaid plans for consumers, and has been created to help streamline the process of approving new technologies to be covered by insurance. Some members of my team have called it a hopeful “FDA to CMS pipeline”! 

The main goal of the DNT is to allow beneficiaries (patients) access to new and innovative technologies (e.g.: devices, equipment, etc.) to promote health equity and the overall betterment of health of the U.S. population. As newer and better technologies are developed each year, it is important that all patients have access to these improvements so they see improvements in their health. Medicare and Medicaid beneficiaries deserve access to the same promising technologies and interventions that are afforded to private healthcare insurance beneficiaries, which is why the DNT’s role in streamlining the approval of technologies under coverage is so vital.

As an intern, I have been studying different government healthcare statutes and regulations, and advising my team at the DNT on ways to incorporate new technologies into written Medicare policy. I’ve been reviewing grants and proposals for new technologies, meeting with manufacturers of these new machineries, and ultimately offering feedback to my team on ways we can incorporate these technologies. The small steps that I take behind the scenes (usually in the form of extensive paperwork and many, many zoom calls) will hopefully lead to their ultimate approval under CMS policy, allowing CMS patients access to them. 

I really wanted to complete an internship with the DNT because I wanted to see the process of how health policy is written and how directly it impacts patients, whether that is by increasing access to improved technologies or by changing policy to remove outdated standards of care. Through my work, I have seen firsthand how different subsections within Medicare work to optimize coverage for beneficiaries to allow all people fair and equitable access to healthcare. Many forms of grassroots interventions within medicine and healthcare meant to combat health inequities and disparities are “band-aid” solutions to a larger problem, and I now feel that real progress towards health equity comes in the form of policy changes to address healthcare infrastructure and access. I believe this is encompassed by the DNT’s work to ensure patients have access to technologies that will equip them with better health outcomes. 

My hope is that my work this summer with the DNT will further the DNT’s mission to influence policy surrounding health coverage and access to technologies, in order to ensure that access to new technologies and insurance coverage is more equitable overall. Even the few technologies that I am able to form policy around this summer could be instrumental in shaping the standard of care for CMS beneficiaries in the U.S.