Gary Norman works as a senior assistant attorney advisor at the Centers for Medicare & Medicaid Services (CMS) and is a health equity leader and advocate. His journey to helping people with disabilities started when he was a child. As the son of a railroad worker who rose to run the operations of a railroad division of a steel mill in Cleveland, and a mother with chronic health conditions, he observed the complexities and challenges of interacting with the health care system, both from the vantage point of former mill employees, as well as his parents, who accessed health care services toward the end of their lives.
Q: Describe how your work at CMS advances access to care for Medicare beneficiaries who have disabilities?
As a citizen lawyer who is representative of a cross-section of our customers, I try to remember how great our republic is and how we must continue to work to improve health care services.
While I am a person of many talents and interests, I am ultimately a blind person. That means, had I not beaten the employment odds for the blind, I could have qualified for benefits through the Social Security Administration and eventually through Medicare or Medicaid.
Considering this personal background, I have been working to address health care disparities of people with disabilities for a long while—both informally and formally.
In 2017, it was my great pleasure to serve as an intra-agency detail policy advisor with my colleagues at the Office on Minority Health. And in 2016, I worked with the Baltimore School of Law to host a public policy dialogue, which explored the power of housing and health care to improve disparities.
Q: Are there any personal stories that led you to work on health care equity for people with disabilities?
As a person who partners with a service animal, I have enjoyed both positive and less positive interactions with the health care system. Just as a funny example—but one showing the kind of inclusion we hope to develop within the system—a doctor once removed her white coat for my first guide dog. We had always thought the dog had white coat hypertension because of how stressed he was during my medical encounters. I also have had bad experiences with the health care system, but when that happens, I reflect on how well educated and blessed with financial resources I am, and about the need to bring thought leaders together to discuss how to resolve gaps in service.
This drives my passion for public service—realizing that life is even more difficult for those not as fortunate.
In my many years at the agency, I have often encountered the stories and experiences of many beneficiaries from the disability community. Therefore, I know that our system is incredibly challenging. Real gaps occur in service. We have a great opportunity to improve this as health care equity leaders. I feel strongly that this can occur through the use of dispute resolution tools.
Q: What kind of outreach is being done to better educate doctors, hospitals and nursing homes about people with disabilities, specifically the blind or visually impaired?
As a lawyer, I hope we can eventually use the law to spearhead cultural change. While things always move slower than one would hope, real progress is happening. A lot of work has been done to break down disparities.
I admire the work at the Office of Minority Health to facilitate collaboration between providers and a range of communities, including the disability rights community.
If we want to reduce disparities, we need doctors who look like us. That means improving accommodations at law schools and medical schools, powerfully applying this intersection of professional competence with personal experience.
Public health practitioners are exploring ways to design programs, interventions and research to better suit the needs of people with disabilities. I view it as a positive development that the American Public Health Association now has a group or section focused on disabilities.
Q: What special preventive health or home health care considerations need to be considered by or for people with disabilities—or for or by older adults—who want to continue to live independently?
Overall, we must de-link the concept of disability from overall poor health. In the past, there has been an incorrect perception that being disabled means being unhealthy. This misunderstanding has been reinforced by disparities in preventative services and by not being viewed as an integrated, healthy community, although any given disability may indeed involve an underlying medical problem.
To this end, we must organically explore a range of avenues and leverage a range of tools, including developing steps that people with disabilities can take to become healthier. We also need to continuously broker an organic conversation among providers and the disability community.
A real disparity has historically existed in the area of physical fitness for those with disabilities. A lack of accessible machines is a problem since most of them now employ touch screens. This is where I have great hope that we can find the intersection among federal health insurance, community partners and other agencies to enhance access to fitness through education and emerging interactive technologies.
I am interested in the impact of technology in improving health. For blind people who can afford an iPhone, the range of evolving applications—many of which may be accessible—can be a real tool in improving health care access and the management of chronic conditions such as diabetes. Moreover, partners need to continuously collaborate in ensuring accessibility to electronic medical records.
Q: What advice would you give health care providers and quality improvement professionals who want to improve the quality of care for people with disabilities?
Ensuring better services to this population is arguably a helpful and necessary way to improve the health care system. To this end, removing disparities for people with disabilities is a health quality issue and a noble goal for which there is a genuine business case.