Delivery of Care

Annual cap of 3.2 percent put on health care costs in RI

Raimondo signs an executive order to seal the deal on the voluntary cap on spending, in an effort to control escalating health costs in RI

Photo by Richard Asinof

Gov. Gina Raimondo signs an executive order placing a voluntary cap of the annual growth of health care spending at 3.2 percent.

By Richard Asinof
Posted 2/11/19
Gov. Gina Raimondo signed an executive order putting her seal of approval on a voluntary pact by the health care industry in Rhode Island to adhere to a 3.2 percent annual cap on health care spending growth.
How will a potential national economic downturn change the economic equation around health care costs? What gaps exist in the Rhode Island marketplace around uninsured and under-insured residents, such as dental care for seniors? More than keeping health care costs down by capping the rate of growth in the health care spend, how much new investment will be focused on prevention of chronic diseases before they flower and peak in older residents? What kinds of increases in public health costs will be precipitated by climate change, and how will such costs be factored into the cap on spending? Does there need to be a better definition of what population health means in the context of how neighborhoods are defined, not just provider practices?
Aaron Robinson has been chosen to succeed Lou Giancola as the president and CEO of South County Health, and Robinson will assume his new role beginning on April 1.
More than 80 applicants applied for the job. Robinson will relocate from Florida, where he had served as CEO of Community Hospitals and an executive for Health & Vascular Services at Health First in Rockledge, Florida.

PROVIDENCE – It was a really big deal, but even Gov. Gina Raimondo was amazed at the turnout, because, as she put it, “I think it is pretty incredible that we could pack a room for an announcement of this nature.”

Clearly, big health policy announcements were not a big media draw; only two other reporters besides ConvergenceRI showed up to cover the event. Raimondo said that she had teased her staff, asking: “Is anyone going to be here? Because I’m really excited about this, but I’m kind of nerdy.”

Yet the gathering on the third floor of the School of Public Health at Brown University on Wednesday afternoon, Feb. 6, to witness the signing of a new executive order by Gov. Gina Raimondo that set a voluntary cap of 3.2 percent annual growth for the health care spend in the state, drew an impressive number of health care industry and business leaders in Rhode Island.

Many of the grand poobahs were there: Dr. Tim Babineau, president and CEO of Lifespan; Dr. James Fanale, president and CEO of Care New England [they sat next to each other]; Teresa Paiva Weed, the president of the Hospital Association of Rhode Island, Dr. G. Alan Kurose, president of the Coastal Medical Group; Kim Keck, president and CEO of Blue Cross & Blue Shield of Rhode Island; Neil Steinberg, president and CEO of The Rhode Island Foundation; Al Charbonneau, the executive director of the R.I. Business Group on Health; John Simmons, the executive director of the Rhode Island Public Expenditure Council; Marie Ganim, R.I. Health Insurance Commissioner; and Anya Rader Wallack, the program director at the Center for Evidence Synthesis in Health at Brown University, among others.

The watchwords of the day were accountability, consensus and transparency. The executive order culminated some 10 years of discussions, under different groups and commissions, to develop a strategy to control the growth of health care costs.

“I think [this agreement to put a cap on the growth of health care costs at 3.2 percent for the next four years] reflects something about our community,” Raimondo said. “How when we are serious in tackling big issues, such as the growing health care costs, people of Rhode Island come together,” to figure out how to control health care costs at a system-wide level while maintaining care and investing in quality in outcomes.

Economic vitality
Keck said that she was proud of the leadership that was demonstrated by the steering committee, a leadership that was embodied and championed by all the members.

“As president of Blue Cross,” she said, “I am in Rhode Island, for Rhode Island, all about Rhode Island. We’re about to have our 80th birthday, so economic vitality is very important to Blue Cross and Blue Shield of Rhode Island. When we do well collectively, Rhode Island does well.”

Keck continued, saying that when it came to health care costs, “We don’t want to crowd out other investments in the state. I know, if health care costs are unabated, that could happen.”

The big pool
Ganim emphasized that all the health care costs were part of the pool: Medicaid, Medicare, self-insurance, commercially insured. “Everybody’s claims are in the pool,” she said.

Concrete and specific

Kurose touted the agreement, saying the kind of concrete and specific commitment was unique in the 10 years that he had been part of the public discussion about health care and payment reform.

Kurose also praised the kind of accountability and transparency that were part of the agreement, when it came to public reporting on cost performance.

In addition, Kurose gave a shout out to Steinberg and The Rhode Island Foundation for convening a group to help to prepare a long-term state health care plan.

Where innovation fits into the picture
After the event, ConvergenceRI spoke briefly with the Governor.

ConvergenceRI: How does innovation in the marketplace fit in with the new compact?
Like what?

ConvergenceRI: Health equity zones. Neighborhood health stations.
It’s all related, really. The goal of all of this work is to make health care less expensive, more affordable, more accessible for the people of Rhode Island. And so, that means keeping people out of hospitals and nursing homes whenever possible, because that is the most expensive setting. And, investing in primary care, investing in the community, so that people can stay healthy.

And, holding health care institutions accountable. We’re going to make everything public, we’re going to know, hospital by hospital, doctor by doctor, who is living within their means, and who is spending more than everyone else. Which is going to enable us to keep health care costs lower for everybody.

ConvergenceRI: There are a number of efforts underway called “paying for success,” one involving housing, another involving emergency rooms. There is currently money proposed in the budget of housing; is there a similar interest in investing in the paying for success model that Clinica Esperanza is operating in Olneyville?
I am not deeply familiar with that model. In general, I think it’s a good model, The concept is by providing care at the right time, you can actually save money later. So, if somebody can go see a doctor, and not get sicker, and avoid going to the emergency room, it saves money and it’s better for them.

It’s the same thing with homelessness. You know, if we can find somebody a home and keep them out of the emergency room, it’s better for them and it saves money.

Editor's Note: For more information about the Paying for Success initiiative, Dr. Annie De Groot suggested sharing this link:

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