Innovation Ecosystem

A tale of five urban narratives that never seem to connect

Design is where it’s at, says the Governor, lauding a new training partnership between Infosys and RISD; rental housing in the state keeps growing more unaffordable; EpiVax celebrates its 20th birthday and its move to Olneyville from the Jewelry District; a new anti-drug campaign features disturbing scenes of self-inflicted violence; and the unintended budget consequences of enacting Kristen’s Law – as much as $1 million for every person convicted – remain outside the prevailing conversation

Photo by Richard Asinof

Rosanne Somerson, left, president of RISD, Rajiv Kumar, president and COO of Infosys, and Gov. Gina Raimondo.

By Richard Asinof
Posted 6/18/18
The week of June 11-15 proved to be a contrast of competing narratives, which never seemed to intersect into one coherent story.
When will political reporters and pollsters ask voters about their concerns around health care in advance of the 2018 elections? How disliked is the Trump administration efforts to re-establish pre-existing conditions as a tool of health insurance companies? How much of a factor is the high cost of housing in the inability of many Rhode Islanders to afford their medications? Is there a growing split over policy between the leaders of state agencies and community advocates around harm reduction strategies? Will the leaders of Infosys seek out the EpiVax team to learn about their efforts to design a collaborative neighborhood approach in Olneyville?
In its two-page spread published in the Sunday, June 17 newspaper, entitled “Untangling R.I. Health Care,” The Providence Journal appeared to miss the broadside of the barn in efforts to paint the landscape of the health care delivery system in Rhode Island, compiling a comparison chart of hospitals. First, the newspaper did not identify population health management as the driving force behind the economics of health system consolidation. Second, it chose not to acknowledge the failing business model for hospitals and the growing dependence of federal health insurance programs, Medicare and Medicaid, as the primary revenue sources. Third, it tended to focus on the male leadership of the hospitals, rather than the growing integrated team approach to health care, acknowledging the growing role of nurses in the health care enterprise. Fourth, it made no mention of innovative Rhode Island initiatives, such as Neighborhood Health Stations, Health Equity Zones and the Care Transformation Collaborative. Fifth, it failed to acknowledge that the biggest problem with health care delivery was the ever-increasing medical costs, because the health care system functions more as a wealth extraction system. Sixth, it defined the health care landscape as being derivative from hospitals, without including the important role that community health centers play in the delivery of care. Seventh, the myopic landscape drawn by The Providence Journal appeared to reflect the newspaper’s own apparent failure to invest in health care reporting. Eighth, it failed to talk about the lack of a statewide health plan for how resources should be deployed, a topic that was part of Rhode Island Foundation President and CEO Neil Steinberg’s op-ed in the newspaper that same day.
Of course, also lost in translation was what the patients and providers see as the health care landscape. Note to Dr. Michael Fine: be sure to send editor Alan Rosenberg a copy of your new book, “Health Care Revolt: How to Organize, Build a Health Care System and Resuscitate Democracy – All at the Same Time,” to be published on Sept. 1.

PROVIDENCE – The week of June 11 began with a budget hearing for the FY 2019 city of Providence spending plan at City Hall, at which only one person showed up to testify, following three days of throngs of thousands at PVD Fest. Life is a cabaret, my friend.

It ended Friday night, June 15, with the R.I. House of Representatives passing the $9.6 billion FY 2019 state budget on a 66-7 vote, and with it, the resolution of a legal dispute regarding the continuation of a cut in Medicaid rates to nursing homes that was supposed to sunset in 2016.

What has never been resolved, however, and perhaps never will, was the answer to the question: who made the decision in 2016 to continue the rate cuts after the initial 12 months stipulated in the Reinventing Medicaid Act of 2015 had expired, overruling then R.I. EOHHS Counsel Jennifer Wood, precipitating the lawsuit?

In between there were a series of events, celebrations, votes, and reports and news conferences that illustrated the numerous competing narratives at play in Rhode Island, narratives that never seemed to connect or fit into one coherent story.

At the intersection of innovation and design
First, there was the news conference held on Wednesday morning, June 13, at the Providence City Library that celebrated a new partnership between Infosys and the Rhode Island School of Design, at which Infosys announced that RISD would be training some 1,000 of its employees over the next two years as part of its efforts now underway to establish a design hub in Rhode Island for its U.S. operations.

Commerce RI Secretary Stefan Pryor began the news conference in cheerleader fashion, proudly reciting statistics: “We have the third largest percentage of creative sector jobs per capita in the country,” he said. “We have the third most industrial designers per capita in the country. And, we have the number-one design school anywhere in the world here in Rhode Island, RISD.”

“Design is where it’s at,” said Gov. Gina Raimondo, saying that design is more important than it has ever been as an economic tool, especially, she continued, “as we move toward a more digital economy.”

Raimondo praised RISD, saying the state was “lucky to have one of best design schools in the world here,” and praised Infosys President and COO Rajiv Kumar for his wisdom in choosing to locate his company’s design hub in Providence, which will be headquartered at 75 Fountain St.

Rosanne Somerson, the president of RISD, talked about the role that design will play in answering what the future will look like, and in how RISD can help “industry tackle the problems of the 21st century with elegant solutions,” employing innovation, creativity and design as the tools.

Kumar, in turn, said the new design training partnership with RISD “will help close the global design talent gap,” citing the convergence needed to “prepare our designers to create client solutions at the junctures of several siloed disciplines, including the humanities, liberal arts, public policy, economics and engineering.”

RISD said that it was designing a dedicated space on campus to host the immersive training program for Infosys employees.

Growing tensions on policy?
At the monthly meeting of the Governor’s Task Force on Overdose Prevention and Intervention, held later on Wednesday morning, June 13, on the second floor of the R.I. Department of Administration, there was a definite tension in the air regarding the upcoming vote before the R.I. House of Representatives on Kristen’s Law.

Many of the public health professionals who worked closely with the task force had signed a public letter, on the letterhead of the Rhode Island Medical Society, opposing the proposed law.

[Despite the outcry and the letter, Kristen’s Law easily passed the House by a vote of 55-14 on Thursday, June 14, Gov. Raimondo has indicated that she will sign the bill.]

At the meeting, the chairs of the Task Force shared an upcoming advertising campaign, Know The Truth, which showed actors committing violence against themselves, allegedly based on true stories, to keep being able to secure prescription painkillers, including one ad which portrayed a young man smashing his hand with a hammer. [See link to the video of the ad below.]

In public comments, many of the members of the Task Force objected to both the tone and content of the ads, saying that they believed the ad campaign would prove counter-productive.

Some members of the Task Force literally turned in their chairs so as not to watch, finding the content so objectionable and disturbing.

In discussions with community advocates following the meeting, among the questions raised with ConvergenceRI were the disturbing way that self-destructive violence was glorified, and the missing connection to domestic violence and sexual assault as part of the equation.

In a follow-up question to the R.I. Department of Health, ConvergenceRI asked if anyone from the agency had previewed the storyboards for the campaign before they went into production, and if the ads had been tested out before focus groups of 18-35 year olds, the target audience, to learn what their response to the messaging was.

Andrea Bagnoll Degos, a spokeswoman with the R.I. Department of Health, responded by saying that agency staff did preview the storyboards for the campaign when Truth was still testing multiple concepts, as did the agency staff at the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals.

“Truth [the marketing group behind the campaign] talked to more than 6,000 people in the target audience during the formative phase of the campaign and tested over 150 ideas that measured attitudes about prescription opioid misuse and dependence,” she said.

“The pre-market testing looked at receptivity to this particular concept and did include focus groups of 18-34 year olds, four of which took place in Rhode Island, Bagnoll Degos continued. “There is another concept that will be used in phase two of the campaign, but that won't launch until sometime in August most likely.”

Out of reach
On Thursday, June 14, the National Low Income Housing Coalition released a national report detailing the ever-increasing gap in affordable rental housing on a state-by-state basis. [See the link below to the report.]

The numbers were not encouraging: 40 percent of Rhode Island households are renters, and to afford a two-bedroom apartment, a person would have to work 58 hours a week at the mean renter wage. The fair market rent for a two-bedroom apartment is $1,038; the annual income needed to afford a two-bedroom apartment is $41,526.

Working at a minimum wage job in Rhode Island, at $10.10 an hour, each week you would have to work 66 hours to afford a modest one-bedroom rental home at fair market rent.

Clearly, the numbers do not add up for families living below the federal poverty level.

The hub of innovation in Olneyville
The move by EpiVax of its headquarters in the former Jewelry District to its new location at Rising Sun Mills in Olneyville was celebrated, along with the firm’s 20th birthday, on Friday evening, June 15. [See link to ConvergenceRI story below, “Writing the next chapter at EpiVax.”]

Last week, EpiVax also closed on its bridge funding of $1.2 million for its spinoff, EpiVax Oncology.

At the celebration were a number of notables, including Sen. Sheldon Whitehouse, Rep. David Cicilline, Treasurer Seth Magaziner, City Councilor Sabina Matos, and Providence Mayor Jorge Elorza, along with more than 75 other guests.

The success of EpiVax, one of the pioneering Rhode Island biotech firms, and its ability to navigate the often choppy waters of the biotech industry and emerge as a company with a national and global market, represents a different economic model of building its success as a local hub of innovation technology.

The state of the state budget
Some of the notable achievements within the state budget process was the success of advocates to restore disability services funding, increase the age of services from 18 to 21 for children, eliminate the proposal to charge Medicaid members a co-pay for services, and resolve the lawsuit about Medicaid reimbursements for nursing homes over the apparently illegal efforts to continue rate cuts after the cuts were supposed to sunset after 12 months.

One interesting budget item that did not draw much attention this year was the decision to approve the cut of $13 million from Neighborhood Health Plan of Rhode Island because of its inability after five years to achieve the desired outcomes under the Integrated Care Initiative for dually eligible members of Medicaid and Medicare.

Still to be reckoned with as part of the Reinvention of Medicaid is the implementation of accountable entities, which were originally supposed to begin on July 1 but have been postponed to Aug. 31.

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