Let's start here: Abortion is one of the most emotionally charged and divisive issues in American society. It elicits intense feelings shaped by strongly held moral, religious, and philosophical beliefs.
So you as an individual undoubtedly had your own, deeply personal reaction to this week's leak of a draft opinion suggesting the Supreme Court will soon overturn Roe v. Wade.
And because you work in health care, your personal reaction is likely accompanied by new challenges and uncertainties in your professional life. Abortion is a procedure provided by the health care system, so changes to the accessibility and legality of abortion will have implications for your patients, your organization, and your industry.
Advisory Board exists to offer practical guidance to leaders grappling with some of the biggest issues in health care. This is one of those issues.
You have a window in the next few months—before the Supreme Court formally rules in the pending case, Dobbs v. Jackson Women's Health Organization—to prepare for the implications for patients and the industry.
To help, we've outlined initial steps to take and key questions to answer before the decision is finalized. Keep an eye out in weeks to come for further analysis and guidance as our researchers dig more deeply into the implications for patients and population health, as well as the ripple effects on the delivery of health care across the ecosystem.
First, take the pulse of your staff and leadership
Leaders must start by getting a pulse check of their staff.
We don't suggest trying to match your position to the feelings of every staff member—that is likely impossible.
But if you understand your staff's feelings and fears, you can better anticipate needs and determine next steps, especially given that that these changes are happening during immense change fatigue, burnout, and rising turnover.
Questions for leadership teams:
- Do current employees have a clear and accurate understanding of the impact that Dobbs will have on their state and organization, and potentially on their team?
- Do the opinions of a significant group of our employees differ widely from our organizational stance?
- What policies, if any, would we be willing to modify based on what we hear from our staff?
- How can we (re)articulate our organizational stance on this issue, and who does that message need to come from?
- How can we proactively address the needs of our workforce, whether it is increased demand for behavioral health services, concerns for personal safety, or providing legal guidance?
- Will we deploy system-level strategic planning support that anticipates the needs of individual programs and service lines?
Anticipate your states' policies and model the business impact
Because no federal law protects or prohibits abortion, overturning Roe v. Wade would leave abortion laws to the states, about half of which are expected to ban or place varied restrictions on abortion. Multistate organizations will have to deal with a patchwork of varying regulatory and enforcement environments.
You'll need to understand the legal environment in the states in which you operate—as well as in surrounding states, which may send patients to or draw patients from your region. Then you'll need to model out the business impact.
Questions of particular relevance to provider leadership teams:
- Is our data and analytics infrastructure set up to track changes in outcomes, mortality, and morbidity, including how those changes break down across demographic segments?
- Is our government relations team resourced to understand and potentially engage on changes to policy at the state level, including implications for operations, reporting, and liability?
- What volumes may we lose or gain based on policies in surrounding states? Can we anticipate how those volumes might change across different service lines (women’s health, behavioral health, the ED, etc.)?
- How can we prepare our workforce for potential moral distress from carrying out decisions that may, or may not, match their individual ethical stances?
- How will we manage patient situations where abortion is a part of life-saving treatment? What tools do we have to predict patient migration as access changes?
Provide a single source of truth for questions on abortion access
Now is a strange, uncertain moment: It appears likely Roe v. Wade will soon be overturned, but abortion remains a legal right in the United States. Your patients are likely to be confused, especially if they already have appointments for abortions or may need to make them in the coming months.
Organizations that offer or cover abortions should ensure patients understand where the law stands today and prepare to communicate where it will likely stand tomorrow.
Questions for leadership teams:
- Do we have scripting for front office staff, clinicians, and member services representatives who may get questions in the coming weeks?
- If Roe v. Wade is overturned, how do we prepare staff to appropriately and legally deal with questions from patients or members seeking access to abortion?
- What level of formal guidance can we provide on our publicly accessible platforms?
- What processes do we have in place to gather questions and concerns from staff?
- Does our communication strategy address the practical needs of our employees?
Expand your organizational approach to women's health (whether you are a provider or not)
No matter what the Supreme Court ultimately decides about Roe v. Wade, the leaked draft has fueled a public debate that will prompt many people – in their roles as patients, employees, and community members – to cast a critical eye at the ways that organizations support women's health more broadly. Providers must be equipped to take an integrative view of women's health, where maternal and reproductive health is just one way of supporting patients across their life span.
It's also worth considering whether your organization can take steps to support women more comprehensively—including the women on your own staff. Are you offering parental leave, for instance? Do you offer child-care subsidies and flexible working arrangements? These are by no means just "women's issues," but they are of particular importance to many women.
Questions for leadership teams:
- Do we have disaggregated results by gender about patient outcomes and consumer experience across all services, not just those related to reproductive health?
- How do we use our maternal and reproductive health services to promote holistic women's health and ease patient access to other services?
- How do we configure our servicing offerings to create a dedicated, consumer-driven experience for women?
- Do we offer competitive benefits and supports to address the well-being, both at home and in the workplace, of our female staff?
Our biggest advice: Be proactive
The next few months will be challenging for health care leaders. You must navigate not only charged emotions but also legal uncertainty, your staff's concerns, and potential impacts on your organization's strategy and operations.
Our most urgent advice is this: Be proactive. The next two months are your best opportunity to equip your organization to constructively address the potential consequences of a decision to overturn Roe v. Wade. We'll be there along the way to support you with actionable guidance.
Sarah Hostetter, Darby Sullivan, Natalie Trebes, Emily Heuser, Thomas Seay, and Tara Viviani contributed to this post.