Delivery of Care

A change is going to come

R.I. EOHHS Secretary Womazetta Jones brings a refreshing, direct new approach to her role

Photo by Richard Asinof

R.I. EOHHS Secretary Womazetta Jones

By Richard Asinof
Posted 9/2/19
The one-on-one interview with R.I. EOHHS Secretary Womazetta Jones reveals that her approach will be centered on three pillars: community engagement, racial equity, and working with the whole person.
How will the various agencies under the umbrella of EOHHS respond to Secretary Jones’s desire to engage with the community? How will the efforts now underway to craft a statewide future health plan respond to the initiative to link accountable entities with health equity zones? What are the opportunities for EOHHS to engage with DataSpark at URI to develop more effective storytelling around data? What kinds of uncomfortable conversations will be encouraged to take place, beyond racial equity?
The conversation with Secretary Jones is still reverberating as ConvergenceRI prepares to enter the seventh year of publishing a weekly digital newsletter on the convergence of health, science, innovation, technology, research and community. The desire of Secretary Jones to become a member and a proponent of an engaged community, to welcome conversations with stakeholders and providers, to listen as well as to talk, to address uncomfortable topics such as racial equity, represents a remarkable sea change in the political winds of government.

CRANSTON – What a remarkable, surprising, refreshing, candid conversation it was when ConvergenceRI sat down to talk with the new Secretary of the R.I. Executive Office of Health and Human Services, Womazetta Jones, on Thursday morning, Aug. 29, in her office at 3 West Road, on the sprawling 325-acre campus at the John O. Pastore Complex.

In the last decade, ConvergenceRI had interviewed three other R.I. EOHHS secretaries: Steve Costantino, Elizabeth Roberts, and Eric Beane, each with their own challenging portfolio of issues, programs and pending crises to oversee, each with their own expertise they brought to the table, each with their own personal style of communications. Nothing compared to the conversation with Secretary Womazetta Jones.

First, the meeting happened on time. Second, it turned out, the sit-down interview was the first Secretary Jones had conducted with a member of the news media in her office. Third, it quickly evolved into a conversation as much as an interview, with Secretary Jones asking numerous questions and listening carefully to the responses. Fourth, information requested by ConvergenceRI during the interview had been sent promptly to him, on the same day, immediately following the interview. Fifth, a full 45 minutes had been allotted for the interview.

Sixth, there was the content of the conversation, in which Secretary Jones laid out a vision far, far different than her predecessors, ushering in a new approach to engagement with the community.

“My pillars [in the job], for me, are community engagement, racial equity, and working with the whole person,” Jones said, summarizing her vision succinctly. “And, how to do that in a way that is beneficial to all Rhode Islanders.”

We have to ensure, Jones continued, “that we are giving up power. We need the community to know that their voices, those voices, are the ones that need to lead how we do this work, to help us shape this work.”

Jones acknowledged that yes, there were certain statues and federal requirements that the state may not be able to change in how it manages its ongoing responsibilities. But in the techniques used, Jones emphasized, need to be in a strong relationship with the community.

“During my tenure in this position,” Jones said, “we will have a very, very, very strong focus on who we are here to serve.”

Becoming comfortable with the uncomfortable
At a reception held at the Rhode Island Foundation the previous week, on Thursday, Aug. 22, Secretary Jones had made, once again, in ConvergenceRI’s experience in covering Rhode Island, a remarkable observation: we need to become more comfortable in having uncomfortable conversations about racial equity. [See link below to ConvergenceRI story, “It is time to have some uncomfortable conversations.”

During the interview with ConvergenceRI, she expanded on exactly what she meant.

“First, let me say, that this is an important conversation to have nationwide,” Secretary Jones said. “It’s not just specific to Rhode Island. It’s something that is very much a reality in every single state.”

Further, she explained, it was a conversation that needed to be had in a way that allows for the acknowledgement of the fact that it’s going to be an uncomfortable conversation for some.

The “some,” Secretary Jones continued, “does not mean, solely and simply, white people. It’s also an uncomfortable conversation at times for people of color. Because, in our world, in our society, power does not rest or lie within communities of color.”

To move work on race equity forward, sometimes, as a person of color, Jones said, “You have to look at how do I best do that. Sometimes, you have to gauge: do you pull back, should you be more aggressive, less aggressive. That ‘uncomfortable-ness’ is not just one-sided. But, obviously, it’s more uncomfortable with those who have power.”

At the event, Secretary Jones said that she had met a young man had told her: “You eat the state; don’t let the state eat you. Remember who you are here to serve.”

That approach, she explained, has to remain a constant. “Even when it may lead some to struggle with my approach, I want them to know, it is always rooted in what I must do best to move this mission forward.”

As Secretary Jones closed the interview, when asked if there was anything she wanted to talk about that had not been asked, she talked about what attracted her to come work in Rhode Island.

In her conversations with Gov. Gina Raimondo, Secretary Jones explained, that it was her perception of the Governor’s dedication and commitment to people which proved to be one of the reasons she really wanted to come and work in Rhode Island.

“Rhode Island has done some amazing work, and I believe it takes someone who isn’t a Rhode Islander to remind you all, you all have done some things here that folks around the country wish they could do, that they could come here and say: OK, how can we duplicate it.”

A second factor, Secretary Jones continued, was the sense that Rhode Island, for all of its good work, was not OK with the status quo. “The status quo is not good enough.”

Here is the ConvergenceRI interview with R.I. EOHHS Secretary Womazetta Jones, which included David Levesque, director of Public Affairs, and Patrick Tigue, director of the R.I. Medicaid office.

ConvergenceRI: I was very impressed by your comments at the Rhode Island Foundation last week.
LEVESQUE:
Were you there?

ConvergenceRI: No, I didn’t get an invite. But Angela Ankoma, whom I know, tweeted it out, if you were wondering how I learned about what was said. I am well connected.

It was the first time that I had heard a high-ranking government official in Rhode Island say that in public: that we needed to become more comfortable about having uncomfortable conversations about racial equity.

Let me begin there, and ask: How important is that conversation to have here in Rhode Island, particularly with your work as secretary for what is one of the largest departments?
JONES:
First, let me say, that this is an important conversation to have nationwide. It’s not just specific to Rhode Island. [More of Jones’ direct response is quoted earlier in the story.]

We have to become, everywhere – but specifically to Rhode Island, comfortable having that uncomfortable conversation.

If we really want to help all Rhode Islanders, we have to lead with each piece of work that we are doing by asking ourselves that question: how have we engaged all communities? And, have we used a racial equity lens? Are we conscious of those inequities?

I don’t think Rhode Island is in any different struggle than any other state. It’s a process of beginning those conversations. And being respectful.

Everybody must be respected. Not just one versus another. And, we need to have those conversations in the way that’s respectful, where we can work together to actually address racial inequities.

ConvergenceRI: [Conversation follows up on some suggested contacts that Secretary Jones may want to pursue, such as with Amy Nunn, the director of the R.I. Public Health Institute, and the new LBGTQ health clinic that they are opening up in Rhode Island.]
JONES:
I am definitely becoming quite well versed on a number of new initiatives, and trying to see where they connect and where they have gaps. I truly enjoy and absolutely need to have relationships with our stakeholders and our provider communities. It’s equally important to me to be involved or close to the community as I can, and to be as close as possible to those who are doing grassroots type of work.

ConvergenceRI: Let me ask some questions about specific ongoing initiatives. I see that you have included Patrick [Tigue, the director of the R.I. Medicaid office], in our conversation. I have a lot of questions about how Medicaid fits into the future you are doing. Such as, how are accountable entities moving forward? I have heard that April 1, 2020, is the date when the data from certified accountable entities will become “actionable.” Is that accurate?
JONES
: I definitely can let Patrick go further with you. I do know that in terms of that program, it’s a critical vehicle as it relates to delivery and our payment system, in terms of the data.

Patrick has been doing an extraordinary job. I have only been here now for five weeks, this is my fifth week.

The span and sphere of this office is vast, and Patrick and his team have been doing a really great job getting me up to speed in manner that is succinct and logical.

TIGUE: Thank you, Secretary Jones. I’m happy to speak to that, Richard.

To answer your direct, factual question, the accountable entity program is now in its full implementation. As you know, it ran in sort of a pilot phase for several years.

From an official program perspective, it runs now on a state fiscal year basis, meaning that the program years for the program are the same as the state fiscal year, so it runs from July to June.

So, the first official program year of the full program began in fiscal year 2019, so we concluded that first program year this past June.

We are in the first few months of programming in year two, what we envision to be a five-year initiative.

To your question, the date that you gave as April 1, 2020, [I am not sure where that fits in.]

But I think where it is probably directionally correct is, that it is around that time when we will have the ability to really look backwards in terms of the data from the first year and understand, in a more concrete way, how did the accountable entities perform, in terms of both total cost of care, and improving quality outcomes, directionally, given the claims lag and the time [it takes to do] the analytical work.

ConvergenceRI: Is that the rough date for the first time that you will be able to implement any of the findings from the data analysis?
TIGUE:
The way I would say it more actively is that every year, we promulgate new program requirements for the following year, so right now, we’re developing [requirements] for program year three, which starts on July 1 of next year.

We just started a stakeholder process this week, where stakeholders came together and we gave our first sort of open look at some of the changes we are looking at a very high level. Then we’ll begin to refine that with feedback, then post some requirements for comment, and then finalize them for the year.

But, as part of the program, year three is going to be a really critical year, [when we] really [begin] looking at the accountable entities’ ability to assume not only upside risk but also downside risk, and hopefully drive them toward more incentives to produce better quality and lower costs.

In terms of health equity, the lens that I think really intersects critically, and we are working with the Department of Health closely to look at the formal integration of the health equity zones and the accountable entities program. We see that not as a tangential or extra thing, but [something] that the program should do, something really integral to what the accountable entity is trying to accomplish.

It’s always had a focus on what we now call the social determinants of health; we all know that to get to the true quality outcome, the biggest driver of those are things outside the health care system. That is a well-known, documented fact, nationally and in Rhode Island.

I have talked with Dr. [Nicole] Alexander-Scott, [the director of the R.I. Department of Health], and it is certainly consistent with the secretary’s priorities, that focusing on how that plays out, and leveraging the infrastructure that has been built up through the health equity zones

[The goal] is to have the actual accountable entity partner with the community-based organization. I recently met with ONE Neighborhood Builders, which, you now, is the backbone agency for the Olneyville HEZ.

ConvergenceRI: The director is Jennifer Hawkins…
TIGUE:
I asked her to take me on a full walking tour. I was blown away by the thoughtfulness and the scope of the work that’s happening.

Our teams are now figuring out how accountable entities at the Providence Community Health Centers or at some of the hospital-based ones that touch the community, how they can partner together. The long and the short of it is, I think you’re going to see more integration there, both formally and informally.

JONES: What I have definitely learned in my first few weeks is that this is complicated. But it has to evolve. We have to ensure that it can evolve. This is one [program] that we can’t let a day go by that we’re not looking at [the possibilities for collaboration].

ConvergenceRI: I met yesterday with Scott Fraser, the new president and CEO of the Rhode Island Health Care Association, who took over for Virginia Burke after she retired in December.

I told him, I’m going to be meeting with Secretary Jones, do you have any particular questions you would like me to ask.

He told me: “It’s still all about UHIP.” There was a problem with the backlog being created with new applications coming in the door.

Fraser said he believed that it was not a people problem, but rather, a system problem with Deloitte. He suggested that the number of current applications for Medicaid eligibility pending longer than 90 days was about 1,000. Is that accurate?
TIGUE:
Yes, that is directionally correct. We track that number weekly, and so we can provide you with that information.

Director Hawkins and I have publicly continued to acknowledge that the long-term services and supports application process, which you are referring to, is the last area where we have material backlogs in applications. Certainly, it is a priority for both EOHHS and DHS. We are making progress; we are seeing productivity on the backlog begin to decline, but it is something absolutely that there is work that needs to happen.

The only piece that I would clarify is, that like all issues, they are multifaceted. And that the process is both a people process and a technology challenge.

And, we have to make improvements. In the past, it’s fair to say that RI Bridges [UHIP] was a drive of that, but I think it is really important to acknowledge that we have to make operational productivity improvements and business practices improvements, we have to continue to hone the technology to ensure that we are getting out of it what we need. We have to ensure that we have the right human resources on it.

It is going to take all of those things to continue the progress. But we fully acknowledge that this is an area that continues to need improvement.

I would also like to acknowledge that Scott, since he’s taken over the leadership of RIHCA, he’s been an incredible partner; he’s worked with us in good faith, and he’s been the number-one reason why we’ve been able to make the progress on operational issues as well as financial ones.

ConvergenceRI: One last question about accountable entities: Is there an accountable entity that’s been created for long-term care services and supports yet?
TIGUE:
No.

ConvergenceRI: The governor’s Task Force Drug Overdose Prevention and Intervention has proven to be successful in many of its initiatives. One area where I believe it has struggled with is, because of its focus on the opioid epidemic, to see what is happening as part of a broader problem, what researcher Shannon Monnat has called the diseases of despair – deaths from alcohol, suicide and drugs.

One of my persistent questions has been how to create an accessible, transparent database that tracks the data for the impacts of the diseases of despair in Rhode Island.
JONES:
Interestingly enough, I was meeting with the person here at EOHHS, looking at an expansion of our data analytics across our entire secretariat. How we can build a data system that is a public system, where it can be seen, to understand what has been collected, and what data we still need to collect, because we can’t be comfortable in believing that the status quo is sufficient.

With our data analytics, we have to keep pushing and asking and digging, and looking at how do we stretch that across the entire secretariat. And, how do we make it public-facing, so it isn’t just an internal database.

ConvergenceRI: I second that emotion, borrowing what I believe was a Smokey Robinson lyric.
JONES:
We need to ensure that this data analytics will be across all the spheres of our work, further broken down by race and age, and if we can, capture even more nuances about the data. We need to get much more into those weeds.

Because, I think that much of the public-facing data analytic stuff out there is not done in a way that really tells a story, to engage with all the communities.

We need to make sure that we are telling the story, so that all Rhode Islanders know what the state of affairs are, and how we can help one another get through it.

We also have to treat the whole person. When you’re treating the whole person, it means that you’re treating the whole family.

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