PROVIDENCE – Here is a look ahead to some of the real news stories that will demand our increasing attention in 2017. ConvergenceRI has reported on many of these stories during the past year as they developed.

1.  DEATH BE NOT PROUD. The toll of overdose deaths from substance use will continue to climb in Rhode Island, with the likelihood that the total could reach or exceed 300 for 2016, driven by increased use of fentanyl.

That would be at least a 16 percent increase from 2015, despite the best efforts of the Governor’s task force, with its goal of cutting the rate of deaths by one-third by 2018.

During the weekend of Dec. 2-4, there were some 18 overdoses that swamped Rhode Island Hospital’s emergency room, with fentanyl the major factor, and with emergency room personnel saying that they had never seen it so bad, according to sources. [Exactly how many of these ODs resulted in death has not yet been shared publicly; we may not know until next April.]

Here are the numbers: in 2015, the total number of confirmed deaths from overdose was 258; in 2016, the total number of confirmed deaths through June 30 was 161, when you add in confirmed deaths for July and August, it was 205.

[Because of the way that the health department now reports the data, only “confirmed” deaths are given, with data for the preceding three to four months listed as preliminary.]

The total number of “confirmed” overdose deaths in 2016, reported as of Nov. 30, 2016, was given as 226 by the R.I. Department of Health.

But the actual total of “confirmed” deaths will not be known until sometime in March or April of 2017.

Will it still be news four months later?
If you take the total amount of “confirmed” deaths for the first nine months of 2016 [even though the data for September still considered “preliminary”], that total is 220.

The average number of “confirmed” deaths per month for the first 9 months of 2016 is 25.5. Even if you round the number down to 25 as the average per month, it results in a projected 300 “confirmed” deaths in 2016, a 16 percent increase.

The deaths resulting from the 18 overdoses that occurred in just one weekend in December, once “confirmed,” could drive that number well past 300.

Accountable to whom
For Gov. Gina Raimondo’s action plan, the pledge to reduce the number of deaths by one-third in three years, from 258 to 172 by 2018, will have gotten to be a much, much steeper climb to achieve.

Translated, if and when the “confirmed” death toll hits 300 or higher for 2016, achieving the goal of reducing the number of deaths by one-third will not be 86 over three years, but by 128 over the next two years.

[For the record, ConvergenceRI had suggested this as a topic of discussion for “A Lively Experiment” for the Dec. 9 show; it didn’t make the cut, this go-around. Perhaps next time.]

“The difference between a dream and a goal is a deadline,” Raimondo had said at a news conference when she set an ambitious goal to improve third-grade reading scores in Rhode Island. “To make the dreams come true, we need to set ourselves goals and deadlines, and to hold ourselves accountable, starting with me.”

Raimondo and her team took full ownership of the action plan preventing overdoses, without offering any acknowledgement, credit or even thanks for previous efforts. Will she also now take full responsibility and accountability when the overdose toll hits 300? Good question.

Reporting real news, in real time
Will the emergency in the rising death toll be enough to convince the R.I. Department of Health to go back to releasing data on “suspected” deaths so that the public is kept current on the crisis? When 18 overdoses occur in just one weekend, doesn’t the community have a right to know that the crisis is escalating? Good questions.

Will any of the $129.7 million in new Medicaid funds announced at the Nov. 28 State House news conference be repurposed toward the continuing emergency of Rhode Island’s overdose crisis? Good question.

Finally, when will peer recovery coaches become fully integrated into the approach, recognizing the value of peer recovery coaches is much, much more than serving “as a bridge” to physicians and other “professional” providers? Who better than peer recovery coaches to understand the pain and other root causes that drive addiction as well as the pathways toward recovery? Good questions.

In a recent discussion by a health workforce working group, the “stigma” of those in recovery somehow got projected onto peer recovery coaches: “One of the barriers discussed is that there can be a stigma that these workers need to overcome – that they may not be reliable due to their past experience with SA and that they do not have a solid work history,” according to the minutes of the meeting. Really?

The bottom line: the Governor’s action plan, with its heavy emphasis on medication-assisted treatment, a clinical approach, appears to be failing. Without the necessary supports for recovery, a long-term process, and more emphasis placed on the social determinants of health outside of the clinical model, the number of deaths will continue to rise.

The rise in the death toll here in Rhode Island is not occurring in a vacuum.

In 2016, life expectancy in the U.S. dropped for the first time since 1993.

Overdose deaths in 2015 rose 11 percent, to 52,404; heroin deaths rose 23 percent, to 12,989, higher than the number of gun homicides; and deaths from synthetic opioids, such as fentanyl, rose 73 percent, to 9,580. Deaths from prescription painkillers, such as OxyContin, rose 4 percent, to 17,536.

2. CUE THE MUSIC. The musical chairs that have been part of the consolidation of the health care delivery system in Rhode Island will continue, with Care New England actively conducting a search for a new partner, perhaps a for-profit private equity system, after the deal with Southcoast went south.

The demands placed on the future of hospitals to manage population across a continuum of care as reimbursements move from fee to service to bundled payments, with the risk placed on hospital systems, makes future consolidation inevitable within a regional framework. The financial future appears difficult for acute care community hospitals that do not have at least $1 billion in annual revenue.

Rhode Island, with its relatively stable 1 million population and its current competing alignment of six health systems – Lifespan, Care New England, CharterCARE, Prime, Yale New Haven and the last remaining unaligned acute care community hospital, South County Health – remains a target for future consolidation and colonization by out-of-state health systems, by both not-for-profit and for-profit entities.

That trend will continue, regardless of what happens with the incoming Trump administration and the Republican Congress, hell bent on disrupting Obamacare and privatizing Medicare.

At the same time, the emergence of a new model, Neighborhood Health Stations, in Scituate and in Central Falls, working with existing community health centers, may prove to be a more viable alternative, focused on what the community actually needs vs. what the provider or insurer desires.

Rhode Island still lacks a comprehensive, statewide health-planning document to serve as a benchmark for making decisions around future health care needs. Without such an overarching policy direction, the director of the R.I. Department of Health and the advisory Health Services Council will always be placed in a reactive mode, responding to requests on a first-come, first-serve basis, without having clear policy benchmarks to guide the decision-making around unmet needs.

There is a statewide population health plan under development, tied the to social determinants of health. But whether or not that can serve as a future statewide health-planning document to determine the need for new health care facilities remains to be seen. For instance, how would the planned Medical Tourism facility proposed in Warwick next to the Crowne Plaza, be viewed under the population health rubric?

While there has been much effort being put into the State Innovation Model planning effort to harmonize metrics around the integration of behavior health and community health needs and healthy equity, the reality is that Neighborhood Health Stations were originally excluded from the initial configuration of SIM, for political reasons.

And, as the R.I. Department of Health recently discovered, applicants such as Neighbors Emergency Center for its freestanding emergency care facility in West Warwick did not reveal the whole truth about their actual ownership and management structure until after a decision has been made about licensure.

Disliked facts
Call it a disliked fact, but Memorial Hospital is still hemorrhaging money. As a business model, the acute care community hospital no longer works, reflective of the changing realities of health care delivery in the 21st century and the steep economic decline of the industrial manufacturing economy in Pawtucket and Central Falls.

If and when part of the physical campus at Memorial Hospital is proposed to be repurposed, because only some 50 beds are being used daily in a nearly 300-bed hospital, how will the unions respond? How will regulators respond? How will the R.I. General Assembly respond? Good questions.

Sen. Joshua Miller, chair of the Senate Committee on Health and Human Services, recently received the Francis R. Dietz Award for Public Service from the Hospital Association of Rhode Island.

Does that award make it less likely that legislators will look into how Dietz, as the long-time president and CEO of Memorial Hospital, managed to spend down some $50 million in unrestricted endowment funds in the two years preceding Memorial’s sale to Care New England? Or, why Dietz hired a director of the hospital’s OB unit at some $350,000 a year, who could not touch a patient because he was unable to obtain medical malpractice insurance?

When it comes to health care and health innovation, we are all both participants and observers. Health is personal; if your own personal story is the most valuable possession you carry with you, there is a lot of value and wealth to be found in capturing and sharing those stories.

As critical as much of the dialogue around the future of health care in Rhode Island may be, it is now mostly a conversation happening between policy wonks and regulators, government officials and health care practitioners – with patients and consumers on the outside looking in, noses pressed against the waiting room windows.

3. HOUSING FOR THE WEALTHY. With much fanfare, playing to a tame news media, Gov. Gina Raimondo proudly served as the maestro at the groundbreaking ceremony on Dec. 7 for the first project under the state’s Rebuild Rhode Island to receive tax credits, worth $5.6 million.

The project, known as The Commons at Providence Station, straddles the narrow strip of land between the railroad tracks and the Moshassuck River in the shadow of the State House. It will be a six-story building apartment building, with rents for one- and two-bedroom apartments ranging between $2,000 and $2,700 a month.

No one, it seemed, asked the impertinent question: who is the target audience for this residential development? It is certainly not the middle class in Rhode Island. If anyone, it is upper middle class folks that make more than $112,000 a year, just to be able to afford the rent.

The price for a two-bedroom rental apartment in The Commons is said to be $2,700 a month, or $32,400 a year. These aren’t being marketed as condos; they are rental properties. And that’s before utilities.

To be clear, someone making $15 an hour doesn’t even earn that much in a year: $31,200.

With 169 units, the tax credit of $5.6 million breaks down to $33,135 an apartment – more than a year’s rent.

If the rule of thumb about housing costs is that they are supposed to be 28 percent of your monthly income, that means your yearly salary would need to be some $112,000 a year.

And, you are not earning any equity.

So, who is the targeted audience for this project? Families with young children? Not likely, given the lack of safe space: busy railroad tracks on one side, a polluted river on the other side, with busy thoroughfares surrounding the building on three sides.

As much as Raimondo and Stefan Pryor, secretary at CommerceRI, proclaimed that it was about rebuilding Rhode Island, a more accurate view is that the project reinforces housing inequality and income disparity in Rhode Island, supported by our tax dollars, hard at work.

Combined with the recent proposed development by Fane to build three residential towers on a parcel within the former Route 195 land, the effort may indeed reshape the skyline of downtown Providence, providing the illusion of rebirth, the reality is that both projects will reinforce the existing crisis in affordable housing in Rhode Island. Yes, voters did authorize some $50 million for affordable housing over five years in November; by comparison, the new Commons at Providence Station is a $55 million development.

Rhode Island had the fifth highest percentage of residential properties underwater in the third quarter in the nation, at 10 percent, according to a recent report by CoreLogic.

In November, more than 13,000 people applied for housing vouchers in less than a week, when Rhode Island Housing and the Providence Housing Authority jointly opened their waiting lists. The lucky ones will be those 5,000 chosen to be added to the “waiting list.” About 300 received vouchers every year.

The last time Providence Housing Authority opened its voucher waiting listed was 1998. It took 18 years to work through that list.

Nationwide, there are some 10.5 million renters who pay more than 50 percent of their extremely low incomes for rent.

Here in Rhode Island, according to the 2016 Housing Fact Book produced by HousingWorks RI, the average rent for a two-bedroom apartment in Providence for the first six months of 2016 was $1,301, requiring an annual income of $52,054 to be affordable, with some 57 percent of the renters being cost burdened.

[HousingWorks RI also broke the statistics for the East Side of Providence: the average rent was $1,516, requiring an annual income of $60,621 to be affordable, with 50 percent of the renters being cost burdened.]

Housing is at the center of health equity, all the presenters at the 2016 Health Equity Summit’s panel on housing stability agreed. They included: Joe Garlick, the executive director of NeighborWorks, Blackstone River Valley in Woonsocket; Raymond Neirinckx, the coordinator of the Office of Community Development for the R.I. Housing Resources Commission; Jessica Mowry, from Rhode Island Housing, and Brenda Clement, the director of HousingWorks RI.

Return on investment
What is an example of a better investment? A project like Sankofa in the West End, with affordable apartments built around an urban farming initiative, in an existing neighborhood.

The project, developed by The West Elmwood Housing Development Corporation, created 50 units of affordable housing in 11 different buildings, including one-, two-, three- and four-bedroom apartments.

There were some 1,049 applications for the 50 apartments, with the 50 newly constructed affordable apartments now fully enrolled.

4.  REMEMBER THE GREEDIEST. This was the name of an annual column created by the late, great Jack Newfield in The Village Voice. In his annual list, Newfield sought to call attention to those who made the annual list as a way of calling attention to their pursuit of money and power at the expense of others.

That phrase, “remember the greediest,” has seemingly been turned on its head, made into a badge of honor by President-elect Donald Trump, who has chosen for members in his cabinet many billionaire corporate leaders that have personified the pursuit and lust for money in their careers.

They include:

• Wilbur Ross, a billionaire investor and founder of the investment firm W.L. Ross and Co., to serve as Commerce secretary. Ross has been described as the “King of Bankruptcy” for his work restructuring failed companies in steel, coal and textiles. The 79-year-old Ross was recently praised by Trump, who said: “This guy knows how to make money, folks.”

• Steve Mnuchin, former partner at Goldman Sachs, founder of the hedge fund Dune Capital Management, and co-founder of One West Bank, which has been described by critics as a “foreclosure machine,” as Treasury secretary.

• Rex Tillerson, the CEO of the Exxon Mobile Corporation, one of the high corporate priests of the oil industry, to be Secretary of State.

• Andrew F. Puzder, CEO of the company that franchises the fast-food outlets Hardee’s and Carl’s Jr., and an outspoken critic of worker protections, to be Secretary of Labor.

Further, Trump has named corporate champions to other key cabinet posts, including: Betsy DeVos, Amway heiress, a driving force behind charter schools in Michigan, to serve as Education secretary; Linda McMahon, the professional wrestling magnate who is co-founder and former CEO of WWE, to run the Small Business Administration; and Scott Pruitt, a climate change denier and strong ally of the Koch Brothers, to run the Environmental Protection Agency.

Trump’s goal appears to be to bring in people who will disrupt and dismantle the federal government’s attempts to govern in health care, in public education, in housing, in the environment, in banking regulations, in small business development, you name it.

Note to Trump and his advisors: You may want to recall what happened to Rita Lavelle and Anne Gorsuch Burford when President Ronald Reagan installed them in 1981 at the EPA to gut regulations. Lavelle was convicted of perjury and served six months in federal prison, while Burford was the first agency head to be cited for contempt by Congress for refusal to turn over documents. Burford was forced to resign in scandal as details of her inside dealing with corporate interests became public.

Here in Rhode Island, there are those who often promote the political ideology about the government that governs least governs best. It will be fascinating to see how that ideology gets spun as the state is forced to respond to a Trump Cabinet that promotes the government as a source for greater personal profits and self-interest over any effort to promote the public interest, common good or general welfare.

There are forces of resistance being galvanized by folks like Rep. Aaron Regunberg: a gathering at Hope High School to “resist hate in Rhode Island” drew more than 800 people on Saturday, Dec. 10, building organizing teams and developing action plans, in response to the Trump presidency.

It might be helpful to remember the speech given by the character, Gordon Gekko, in the 1987 film, “Wall Street”: “The point is, ladies and gentleman, that greed, for lack of a better word, is good. Greed is right, greed works. Greed clarifies, cuts through, and captures the essence of the evolutionary spirit. Greed, in all of its forms; greed for life, for money, for love, knowledge has marked the upward surge of mankind. And greed, you mark my words, will not only save Teldar Paper, but that other malfunctioning corporation called the U.S.A.”

5. MANAGING THE NEWS. This week, there promises to be some news coming out of the Commerce Corp. regarding the proposed Wexler development on the former Route 195 land, just in time change the focus of the last dismal news cycle for Gov. Gina Raimondo.

The bad news included: a class-action lawsuit brought by the Rhode Island branch of the American Civil Liberties Union against the state for its botched handling of the $364 million Unified Health Infrastructure Project, with Lynnette Labinger as the lead attorney in the class action lawsuit.

With the lawsuit will come discovery, which may prove more damaging to Gov. Gina Raimondo and her team than the potential loss of federal funds.

Raimondo’s vaunted management style will be under renewed scrutiny in the coming months, as budget questions promise to poke holes in some of her claims of prowess. What will happen, for instance, with Rhody Health Options, a program the budget folks at R.I. EOHHS recommended for elimination, cutting some $35 million in administrative fees for Neighborhood Health Plan of Rhode Island, because of poor outcomes?

Three key empty directorships have not been replaced: the director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, the director of the R.I. Department of Children, Youth and Families, and the director of the R.I. Medicaid office. For BHDDH and for DCYF, there are no active searches underway, according to sources.

Who, if anyone, will take the fall and plunge on their sword for UHIP? In a recent radio interview with Gene Valicenti, Raimondo attempted to shift the blame onto former Gov. Lincoln Chafee, saying she had inherited a pile of you-know-what. Really?

The problem with selling that story is that there had been a constant drumbeat by her communications team about how everything was going swimmingly with the launch of UHIP.

Raimondo’s communication team keeps evolving. First, Joy Fox left, replaced by Michael Raia. Ashley O’Shea was transferred to R.I. EOHHS. David Ortiz was brought on board. Now, Marie Aberger is leaving.

With the 2018 election season fast approaching, the ability to promote Raimondo’s leadership may become more difficult as the problems become more visible, despite the successful ways to date that her image has been managed.