Delivery of Care

An exit interview with Eric Beane, who is stepping down at EOHHS

Almost two years after being handed the hot potato that was the UHIP disaster, Beane stabilized the state’s ship around health and human services

Photo by Richard Asinof

Eric Beane, the outgoing secretary of the R.I. Executive Office of Health and Human Services, has announced he will be leaving his position in mid-December.

By Richard Asinof
Posted 11/26/18
Convergence RI interviewed Eric Beane, the outgoing secretary of the R.I. Executive Office of Health and Human Services, talking about accountable entities, health equity zones, UHIP, health IT and population health management.
Why is it that members of the R.I. General Assembly, when asked, seem to know so little about accountable entities? What is the intersection point between health equity zones, accountable entities and neighborhood health stations when it comes to population health management? How difficult would it be to create a public, unified database measuring deaths from suicide, alcohol and drug ODs in Rhode Island, showing the dimensions and demographics of the diseases of despair. How will efforts to conduct new research on gun violence in Rhode Island by emergency room physicians be integrated into existing community health databases? What is the status of the 3,000 fentanyl test strips that have been ordered for distribution to Rhode Islanders? Will there be an objective, third-party evaluation conducted of the $20 million SIM project?
Now that Massachusetts has launched the legal recreational sale of marijuana, beginning initially at two sites, one in Leicester, the other in Northampton, it would be seem appropriate to launch a series of public health longitudinal studies related to the consumption of marijuana by adults. So much of what gets reported in the news media is based upon anecdotal information and catch-as-can interviews.

CRANSTON – We may never know the full story of exactly what happened that led Elizabeth Roberts, the former secretary of the R.I. Executive Office of Health and Human Services, to resign, and her top aide, Jennifer Wood, to be demoted, in the aftermath of the botched rollout of the Unified Health Infrastructure Project in September of 2016.

But the story behind the decision made by Eric Beane, who had replaced Roberts as secretary of R.I. EOHHS, to leave the agency in mid-December, is straightforward and transparent.

As Beane told ConvergenceRI in an exclusive, one-on-one interview a few days after this decision to leave had been announced on Nov. 16: “The decision to leave was mine,” he said. After eight years of state government service, in two different states, Rhode Island and Maryland, Beane explained, he was ready to step off the treadmill, in order “to take a little time, step back, and think about how I want to contribute moving forward.”

Both Beane and his boss, Gov. Gina Raimondo, were effusive in their praise of each other, as reported in the news release.

“Working for Gov. Raimondo has been the thrill of a lifetime,” Beane said. “Over the last four years, we have expanded access to high-quality health care, reduced the number of overdose deaths, controlled health care costs, strengthened DCYF and turned a corner on UHIP.”

Beane continued: “I’m proud of our accomplishments and have deep faith that the Governor and her team will continue to build on that foundation. I will be forever grateful that Gov. Raimondo has given me this opportunity to serve.”

Raimondo, in turn, lauded the work of Beane, saying: “Eric has been a part of my team from the day I was first inaugurated, and I am forever appreciative of his efforts and commitment. He is driven by public service and leads with compassion.”

She also gave credit to Beane for his direction in reforming DCYF, improving customer service at DHS and implementing a nationally recognized action plan to address the addiction and overdose crisis that is saving Rhode Islanders’ lives.

A full plate of challenges
Beane’s interim successor, Lisa Vura-Weis, currently deputy chief of staff in Gov. Raimondo’s office, will serve as the acting secretary while a comprehensive search for a permanent replacement is conducted, according to the news release.

Vura-Weiss will have a full plate of challenges before her, including: managing what happens when the Deloitte contract expires in March of 2019; the reconciliation of advance payments made to skilled nursing facilities with the feds; the launch of accountable entities as the backbone of the Reinventing Medicaid initiative; and the development and implementation of a new strategic plan for the Governor’s Task Force on Overdose Prevention and Intervention.

The disliked fact, if that is the right phrase, is that few legislators have any idea what an accountable entity is, how it is supposed to work, where the funding comes from, how the program is the bedrock of Reinventing Medicaid, the reasons why long-term care services were not included as part of the current accountable entity initiative, why data to calculate projected cost savings will not be used until April of 2020, or the fact that many of the accountable entities and managed care organizations may need to build out additional health IT infrastructure to participate in the program. [That would seem to make reading this interview with Beane a recommended exercise for elected officials, policy staff, public health agencies and health care reporters. Nuf said.]

Here is the ConvergenceRI interview with Eric Beane, outgoing secretary of the R.I. Executive Office of Health and Human Services, which takes a deep dive into the sometime murky waters around the delivery of health care, human and social services, and the desires to find common ground between health system leaders, government agencies and community agencies.

ConvergenceRI: Was your decision to leave a mutual decision? Did you feel it was time to move on?
BEANE:
The decision to leave was mine. For me, this is eight years of state government service, in two different states.

I have tremendously enjoyed working as a member of Gov. Raimondo’s team. But I’m ready to take a little time, step back, and think about how I want to contribute moving forward.

ConvergenceRI: Will you stay in Rhode Island?
BEANE:
I love Rhode Island. My plan is to stay here, in fact. I’m going to be doing some traveling for a couple of months. But my intention is to look for opportunities here in Rhode Island.

ConvergenceRI: You have an open invitation to write something for ConvergenceRI sharing your reflections of what you have learned from public service.
BEANE:
Thank you. One of the things I look forward to is having more time and space to read and write, to think and reflect upon what is going on, not only in Rhode Island but in our country and the world.

As someone who [studied] public policy and international relations, this is a rich time to analyze what is happening and think about what I might want to say and what my voice might be in the ongoing debates our country is having.

ConvergenceRI: Let’s jump right in to the conversation. I still admit to being puzzled by what is happening with accountable entities. I believe that I have a good grasp and understand health policy. But I have no clue about how these things are going to work. Can you enlighten me?

My understanding is: accountable entities will have to file health transformation plans by April 1, 2019, yet none of the data will “count” for another year. So, officially, none of the cost savings that were to be achieved through accountable entities will actually occur until April 1, 2020, which is five years after the Reinventing Medicaid law was passed.

Why has it taken so long to implement?
BEANE:
We knew that it would take a long time to stand up this program, just to back up a couple steps.

This administration has gotten $130 million in new federal resources.

The [expenses] that the state was able to get new federal matching dollars for, those are being evaluated year by year.

We have already accumulated some of the matching federal funds. And, we’re doing it by looking at a lot of higher education expenses that are building the workforce we need for a modern health care system.

There are two different things: one issue is how we are getting the federal dollars. CMS [the Centers for Medicare and Medicaid Services] has authorized us to count as matching state dollars expenses [items] that do not normally apply. Those are the higher education expenses.

And then, we are allowed to get up to $130 million in matching federal dollars. How we spend it is another matter.

Some of the new federal dollars we are going to spend on workforce development programs.

A big portion is going to support these newly formed accountable entities. We finished the first pilot year of the program and did a follow-up…

ConvergenceRI: [interrupting] Wasn’t it two years ago, because the pilot program began in January of 2016?
BEANE:
Right. We just had our first stakeholder meeting to go over a qualitative review of that pilot year period, and then starting in July, this is the first actual full year of the program, we have five different accountable entities, some led by health centers some led by hospitals systems, and one led by a provider group.

ConvergenceRI: The provider group is Coastal Medical, is that correct? Was their approval conditional?
BEANE:
Actually, Coastal Medical may not be moving forward in this first year.

One of the things that is interesting about the program from a research perspective, and I think from the CMS perspective, is that we’re going to see how differently organized accountable entities perform, and what the strengths, advantages and challenges are for each of them. I think we’re going to learn a lot by seeing what develops as a success in each of these different programs.

They are soon going to be receiving some incentive funds for this year, which hopefully they will be investing in addressing social determinants of health, hiring community health workers, nurse care managers, and spending more time analyzing their data to find out which of their members could benefit form more intensive case management and oversight and care coordination.

There’s a lot of exciting work happening, but it’s still in the early stages. I think it is a little too soon to draw any conclusions from [the work]. Right now we’re focusing on the design and on supporting the accountable entities as they begin their work.

ConvergenceRI: As I understand it, the major expenditure of Medicaid dollars, both in state dollars and federal matching funds, is to provide long-term care services. Yet, apparently, there is no accountable entity being developed for long-term care services. What proved to be so difficult about creating an accountable entity for long-term care services?
BEANE:
There was an assessment [done] but we were not confident enough in the design of the program to move forward at this stage.

I supported that decision. What we’re going to do is to take a step back to provide an opportunity for more public input – and input from the existing accountable entities – on whether the idea makes sense, and if so, what the right way to structure it would be.

The team that is running this program has committed to making this the topic of a public meeting to get input on it.

So the idea is not off the table; we just thought we weren’t sure enough about the design of it to move forward yet.

ConvergenceRI: Another question goes to the ways in which data will be managed and analyzed by accountable entities. My understanding is – and, please correct me if I am wrong – that there is only one or two current accountable entities that have built out a sophisticated enough operational population health management data analysis system to hit the ground running, and that includes Blackstone Valley Community Health Care, [and Integra at Care New England].

Will other accountable entities have to revamp their health IT data systems to do the kinds of data collection that are going to be required?
BEANE:
First of all, let me offer that Blackstone Valley is very well positioned to be successful in this program. I visited them; I think it is really exciting what they will be able to do with [population health data management].

In our first public meeting, one of the issues that came up most frequently was the issue of data, and the need to make sure that the accountable entities have the information they need to successfully manage their population.

So, we’re going to be working closely with the accountable entities and the managed care organizations to address any barriers that are there, because you can’t intervene effectively if you don’t have a good sense of the population that you’re trying to serve. We take that as a challenge that needs to be a priority.

ConvergenceRI: Who becomes the final arbiter of the numbers and data? What role will state government play?
BEANE:
You’re really getting at an issue that has come up a lot in our internal conversations.

There are different players in the system that have different strengths, and access to different kinds of information, and the challenge in overseeing the program is to make sure that we are capitalizing on as many of the strengths as possible – and trying to empower as much information sharing as we can.

So the people who are in that critical [position] to intervene in order to provide care for somebody have [access] to the information they need. That may require changing some of the incentive structure to make sure nobody is holding cards that the public would benefit from sharing.

ConvergenceRI: Does EOHHS have the health IT capability to crunch all these numbers?
BEANE:
We do have standard data reporting requirements. My understanding is that we will be able to analyze what we need. But you are pointing to a challenge that is common across the health systems: technology is advancing so quickly; it is both time-consuming and expensive to upgrade to new systems. And, in a competitive market, you’re never going to have everyone with the same system.

ConvergenceRI: Is it accurate that the federal money for the State Innovation Model program will come to an end in June of 2019? Is there any anticipation of plans where the state will pick up the tab for that work after the federal funds end?
BEANE:
There are two things I would say about that. One, the projects that are being funded right now will need to have to find some other funding source if they are to continue.

After that, I think that it will be evaluated on a case-by-case basis. But, in terms of general infrastructure, the forum for collaboration among health and human services agencies and the collaboration between the government and health system leaders, we want that to continue, in my view.

We want that to continue, in my view, it is important for EOHHS to have a unit, a small team of people, that are focused on long-term health system planning, and that are available to help lead transformational projects in collaboration with health system leaders.

ConvergenceRI: Which gets us to UHIP.
BEANE:
I’m happy to answer questions about UHIP, the project, and the role that I played in it.

ConvegenceRI: What happens in March of 2019 when the contract with Deloitte is up?
BEANE:
When I leave, Courtney Hawkins, the director of the R.I. Department of Human Services, will be stepping up to be the overall lead in projects involving UHIP. She is extraordinarily talented, with really strong leadership skills. I believe she will be effective in stepping in to deal with UHIP systems challenges.

She also has a much broader vision of human services and sees the opportunity that access to quality childcare creates for families. She’s the right leader to take on this challenge, in my view. She will remain as the director of the Department of Human Services after I leave.

ConvergenceRI: Some of the highest praise that you have gotten is from long-term care service providers, you have been complimented on your ability to listen and engage with them. One of the biggest problems still outstanding is the reconciliation of advanced payments made to skilled nursing facilities because of the backlog in approvals for Medicaid eligibility determinations. Do you anticipate that there will be a problem from the federal government in how they respond?
BEANE:
Let me step back a little bit. There is a state law that requires us to make advanced payments to long-term care providers if a completed application has been pending for 90 days or more. This law was passed before UHIP, because there were challenges even before the UHIP launch in making timely determinations on these applications.

So, we had no choice but to ensure that long-term care providers were getting the funding they needed to continue to provide these services; state law required it.

We have been working really closely with CMS on the process for making these payments and for reconciling them. CMS has assured us that they are comfortable with the processes that we have in place.

What we learned through conversations with the nursing homes is that there are a lot of issues beyond whether somebody is eligible or not that needed to be resolved.

We thought that each provider needed to have an individual set of conversations about their cases that need to be resolved and reconciled.

We have been working through a series of one-on-one meetings, where we have been going through to diagnose the extent of the outstanding issues and coming up with paths for resolving all of those.

Ultimately, it means clawing back the advance payment and then substituting it for payment through the claims system.

ConvergenceRI: Are the feds on board with what you’re doing?
BEANE:
They are. There may be a few cases, here and there, where we don’t have enough information to support an eligibility determination; we’ll have to work through those. In the context of the caseload estimating conference, projections have been made about what percentages of cases may have challenges where we would be eligible for this match, but we have estimated that in 90 percent of the cases, we would be able to resolve the issues.

ConvergenceRI: Where does the work of nine health equity zones in Rhode Island, developing community-based solutions to social determinants of health, fit into the equation of managing health and human services and the development of accountable entities?
BEANE:
Let me first say that the concept of the health equity zone is really a good one, it’s the direction a lot of national leaders would hope to move local systems in.

The R.I. Department of Health, under Dr. Nicole Alexander-Scott and Ana Novais, are the leaders who have been doing the work.

There’s a dynamic tension between the state that comes in, and is willing to invest and steer grant dollars toward these entities, and the community leaders, who want to build it from the ground up, responsive to the needs they see in the community.

You can’t start something like that and expect that you are going to have perfect coverage with all the health equity zones, and everyone who would be a strong partner already a partner.

I think we need to build upon the strong foundation that we have right now and make sure that the partnerships are as inclusive as they can be to address whatever the community needs are.

To the extent that there are some key partners who are not engaged yet, I would say: have those conversations with the local leaders and find a way to get involved. I do think that there is a lot of future potential in having community-driven, community-led solutions to these tough problems.

The state can play a role in helping to steer things in the right direction, but we need local leadership to be successful.

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