PROVIDENCE – That was the week that was. On Monday, Care New England and Southcoast Health called off their merger, without fully sharing the reasons behind the decision to call off the engagement.

The future of health care delivery systems in Rhode Island, in an age of consolidation and out of state colonization, needs to become one of the state’s top economic priorities. Is anyone at CommerceRI paying attention?

Perhaps, the lack of attention is due to a large number of distractions. Such as what happened on Tuesday, when Curt Schilling, breaking his silence after agreeing to settle the civil suit brought by the state against him, spent three hours answering questions on WPRO, attempting to explain what caused the downfall of 38 Studios, casting blame in any number of directions – but not necessarily sharing any of the blame himself. [It followed a lengthy op-ed in The Providence Journal, attempting to explain things in his own words.]

[Three days later, showing a proclivity to step into deeper and deeper piles, Schilling told CNN’s Jake Tapper, who is Jewish: “I don’t understand how people of Jewish faith can back the Democratic Party, which over the last 50 years has been so clearly anti-Israel.” Really?]

In the meantime, also on Tuesday morning, the launch of a new traffic pattern on Route 95 through downtown Providence by the R.I. Department of Transportation caused the morning rush hour to devolve into a snarled nightmare.

On Wednesday, Donald Trump and Hillary Clinton met in the third and final presidential debate in 2016, with Trump refusing to say he will concede if he loses, saying he wanted to keep everyone in suspense. Comments by Trump about the need to get rid of “bad hombres” and his labeling Clinton “such a nasty woman” became instantaneous memes, even becoming the title of a new musical spoof of the debate by Weird Al Yankovic.

On Thursday, in response to a letter to the editor published in The Barrington Times saying that women over 20 should not wear yoga pants, outraged women in the town began organizing a yoga pants parade to march in front of the letter-writer’s house. The story went viral on Friday, with hundreds of women joining the parade on Sunday.

On Friday, Dyn, a company whose servers monitor and reroute Internet traffic, was hacked, interrupting service for several websites, including Twitter, Netflix, Spotify, Airbnb, Reddit, Etsy, SoundCloud and The New York Times.

On Saturday, the Chicago Cubs, under the direction of Theo Epstein, the former Red Sox general manager, clinched a trip to the World Series, where they will face the Cleveland Indians, whose current manager, Terry Francona, is a former Red Sox manager.

All the news that fits
Even with all that jazz in the news cycle, a truly remarkable event took place in Room 35 at the State House on Thursday afternoon, Oct. 20: a joint hearing by the House Finance and Oversight committees that lasted for more than four hours, asking pointed questions about the roll out of the state’s $364 million Unified Health Infrastructure Project, known as UHIP, which had been rebranded as RI Bridges.

At the beginning of the jam-packed hearing, there were some 21 legislators attending, more than a quarter of the total 75 elected members of the House.

In a R.I. General Assembly that has prided itself in fiscal budget austerity, cutting taxes and reducing government spending, angry legislators sought to demand accountability from R.I. government officials for a “botched” Sept. 13 implementation of UHIP, saying that they were acting on behalf of the poor, the needy, the frail and the disadvantaged Rhode Islanders whose services and benefits had been disrupted.

The legislators grilled Elizabeth Roberts, secretary of the R.I. Executive Office of Health and Human Services, Michael DiBiase, director of the R.I. Department of Administration, and Melba Depena Affigne, director of the R.I. Department of Human Services, putting them on the hot seat.

Depena Affigne, ill, could barely talk above a whisper, making it painfully difficult to listen to her straining, squeaking voice as she answered questions.

[For the record, ConvergenceRI chose not to attend in person, opting for a technological fix, watching the event live on Capitol TV, while at the same time following the steady stream of tweets from hardworking reporters Alisha Pina from The Providence Journal and Ted Nesi from WPRI, who were actually sitting next to each other at the hearing, and who often retweeted each other tweets. Did you hear the one about two reporters who walked into a hearing room and sat next to each other, laptops and smart phones in hand?

ConvergenceRI also followed tweets by reporter Susan Campbell from WPRI, who had been granted an exclusive one-on-one interview with Gov. Gina Raimondo to talk about the “botched” implementation of UHIP a day before the hearing.]

The trio of reporters has been doing an excellent job of covering the continuing soap opera of snafus encountered with the implementation of the new technology system. #astheworldturns.

The tweets provided a running commentary on the proceedings, like an ongoing conversation between distracted drivers stuck in a traffic jam on Route 95.

“Pretty rough day at the office when you don’t remember what, and how many, tweets you did #UHIP #the struggleisreal #reporterlife,” Pina wrote at 9:05 p.m. It was more than 50, by ConvergenceRI’s count.

“Based on the current temperature, I think it’s about to snow in Room 35,” wrote Nesi at 6:36 p.m., complaining about the conditions in the hearing room.

Amy Kempe, the current spokeswoman for Attorney General Peter Kilmartin, tweeted back at Nesi, asking: “Actual temp or the temp of the tenor and tone of hearing?”

Nesi answered the former spokeswoman for Gov. Donald Carcieri, infamous for the phrase in an email she sent out in support of 38 Studios, “In Schilling we trust”: “Actual. #frostbite.”

Nesi also shared a photo of Rep. Patricia Serpa, Oversight Committee Chair, scowling as she listened to Roberts’ testimony, tweeting: “Rep. Serpa’s face as she listens to Secretary Roberts start talking UHIP…”

Call it the virtual subtext to covering the news these days: a first person, blow-by-blow account of what occurs, in real time, with personal commentary, often far removed from the third-person narrative that gets written, edited, published, aired or posted as news.

Irony abounds
In the world we live in, reporters are often deemed heroic, the Clark Kents, Lois Lanes and Jimmy Olsens, fighting for truth, justice and the American way, for trying to translate what is going on in the world, telling the stories that otherwise would not get told beyond news releases and managed, scripted communications events by corporate and elected officials.

Was there not a bit of irony about complaints about the temperatures in the hearing room, or the length of the hearing and the work day, compared to the problems faced by many of Rhode Island’s poorest and most frail residents trying to navigate a system where they have to wait hours in person to be seen, or hours on the phone to talk with someone?

In turn, legislators are often deemed courageous for attempting to hold elected officials and agency directors to task when things go wrong, asking angry, pointed questions, and demanding accountability, expressing outrage.

Was it also a bit ironic that Republican Representatives Patricia Morgan and Michael Chippendale decided to go on their own visiting tour of a DHS office to talk with frustrated customers the day before the hearing, something that they had apparently failed to do as a regular part of their job representing their constituents during the last few years?

Why had these same legislators failed to demand accountability for UHIP after some $9.7 million in additional costs at HealthSourceRI in 2014 were documented and identified as a result of glitches in the system designed by Deloitte?

Distressway
A traffic jam is an apt metaphor for what has happened to a number of customers that are trying to navigate their way through the new single port entry technology system launched on Sept. 13 for those Rhode Islanders who are poor, elderly, needy, or frail who depend on the government to provide them with services and benefits.

Complicating the story has been the aggressive way that the Raimondo administration team has attempted to spin the narrative, claiming that most of the some 318,000 customers – one third of the state – have not experienced the problematic glitches reported, and that, by and large, the system is working. [See links to ConvergenceRI stories below.]

At the Oct. 7 briefing, Roberts ducked answering questions about what kinds of concerns may have been voiced by federal partners in the project.

Four days later, when letters sent on Sept. 2 and Sept. 6 by Kurt Messner, the regional administrator of the U.S. Food and Nutrition Service, were published by WPRI, urging the state to delay the implementation on Sept. 13, warning of a potential loss of federal funds, legislators then jumped into the fray, scheduling the Oct. 20 hearing. Why hadn’t legislators themselves demanded to see such information earlier?

In terms of transparency, some things have changed: the folks at the Department of Human Services are now providing daily updates of data to the news media, in addition to a weekly briefly. A new emergency hotline will be in operation shortly. Coordination is being planned with 211’s RV to help with triage of the demand from customers seeking service in person at offices.

Roberts announced, following the hearing, in response to a legislator’s suggestion, that she is planning to conduct a listening tour, traveling to numerous DHS offices across the state.

There are still some unresolved questions, including: What did Gov. Gina Raimondo know and when did she know it? Turns out that the letter sent by the Centers for Medicare and Medicaid Services, cited by both the Raimondo team and the Governor, did not actually provide the go-ahead for the system to go live on Sept. 13; it only authorized the transfer of data with HealthSourceRI.

Another question: How involved was Michael Raia, the communications director under Raimondo, in designing and managing the communications strategy pursued at the Oct. 7 briefing? Whose decision was it not to share the letters from federal authorities raising concerns?

DiBiase attempted to answer the questions around the decision to move ahead on Sept. 13 by saying at the hearing it was “prudent” choice, because the planned annual renewal of enrollment for HealthSourceRI, scheduled for Nov. 1, would have been affected, resulting in additional costs and further disruption.

Dark side of the moon
In the world of immediacy that governs most of our news coverage, drawn like moths to the latest outrage, event, crisis or scene of mayhem, the past quickly becomes murky ancient history.

A deeper dive by legislators may be warranted, given that Serpa, chair of the House Oversight Committee, promised that it would not be “a one and done” hearing.

For the record: the UHIP project was originally championed by former Gov. Lincoln Chafee along with his director of the Department of Administration, Richard Licht, who is now serving as an associate justice on the Rhode Island Superior Court.

It was part and parcel of the efforts under the Obama administration to promote health care reform, with financing provided to help build out the technology infrastructure for a state’s health insurance benefits exchange, with the feds providing the bulk of the funds.

It was Licht’s deputy director, Ken Kirsch, who was responsible for leading the state’s efforts on two controversial, problematic IT infrastructure projects: the effort to replace the legacy R.I. Department of Motor Vehicles IT system, and leadership of the evaluation committee and negotiating team that selected Deloitte to serve as the systems integrator for HealthSource RI to build out the exchange in the first phase of UHIP.

Kirsch, who was paid an annual salary of $142, 818, was laid off from his position as deputy director in the spring of 2015, having served more than four years. His position was eliminated by the Raimondo administration.

Perhaps, at the next oversight hearing that Serpa has promised to hold, the legislators might want to consider requesting that Licht and Kirsch testify, to illuminate the origins of some the structural problems with the UHIP system and the alleged lack of accountability by the contractor.

Here are some questions for legislators to consider asking: Was there a national search conducted for the Deputy Director position? What were the original contract stipulations around financial liability for Deloitte for glitches in the system? What were the reasons why Deloitte was not held liable for some $9.7 million in costs as a result of manual overrides and staff time devoted to fixing glitches?

Profiles in courage
One of the legislators who stayed to the bitter end of the Oct. 20 hearing was Rep. Eileen Naughton, who lost her primary election in September and will not be returning to the R.I. General Assembly.

Naughton urged the Raimondo team to put the emphasis on people, not technology, saying: “The technology, we will work on, but we need to take care of people first.”

Naughton also criticized the failure to establish an emergency hotline to deal with problems caused by the implementation of UHIP.

When Depena Affigne said that they were working on such an emergency hotline, Naughton took umbrage.

“It’s now Oct. 20,” Naughton said. “When did UHIP go live?”

Depena Affigne answered: “Sept. 13.”

Naughton called the delay unacceptable, saying that “telephone companies are pretty fast” in responding to such requests.

[Naughton will be honored as a lead prevention hero at the 24th anniversary celebration of the Childhood Lead Action Project to be held on Nov. 17. Naughton will also receive the Mental Health Association's Clarice Gothberg Award for advocacy on Nov. 16.]

The latest glitch

One apparent UHIP glitch that has yet to make the news or to be shared with legislators is the failure of the online application process for long-term care coverage under Medicaid for patients in nursing facilities.

Since UHIP went live on Sept. 13, many nursing facilities, working on behalf of their patients, have attempted to sign up for long-term care coverage, carefully following the instructions, according to Virginia Burke, president and CEO of the of the Rhode Island Health Care Association.

“Facilities have been trying for a couple of weeks, following instructions, going to the portal, but so far, no one’s being able to do it,” Burke told ConvergenceRI.

On Friday, Oct. 21, Burke received an email from an agency official confirming that the online application doesn’t work, telling Burke to tell her members to stop trying to us it, saying that EOHHS is working to develop an interim process.

The glitch is especially worrisome, Burke continued, because the backlog of pending cases keeps growing for the agency to make a determination whether Medicaid will accept the application for long-term care. Until a determination is made, the nursing facilities provide the care.

If the application is approved, payments are made retroactively. If not, the facilities have to eat the costs as uncompensated care. Decisions are supposed to be made in a timely manner, but the backlog in the last year has often stretched from six months up to a year.

Since the implementation of UHIP on Sept. 13, the backlog of pending cases has grown, according to Burke. "Faciltiies are already carrying an intolerable burden of uncompensated care," she said. "They are obviously and understandably worried that this new system is going to make things worse."

What’s at stake?
To some extent, partisan politics have entered the fray around the problems with UHIP. In response to the story by Pina in The Providence Journal posted late Friday night, Oct. 21, “Federal letter wasn’t ‘blanket’ OK to launch R.I. computer rollout,” state Sen. John Pagliarini, Jr., tweeted to reporter Katherine Gregg that: “Director Roberts needs to be terminated immediately. Poor response to crisis; failure to grasp magnitude & affect on customers.”

Gregg responded, asking Pagliarini: “Have you conveyed that to anyone outside Twitterverse? Who? In what manner? Response?”

Pagliarini did not respond.