Innovation Ecosystem

Charting the rapid learning curve of Gov. Dan McKee

First non-COVID joint news conference with Gov. McKee and Lt. Gov. Matos offers insights into how the new administration is willing to shift policy away from the Raimondo era

Photo by Richard Asinof

Meeting the press. Gov. Dan McKee and Lt. Gov. Sabina Matos answer questions at an April 20 news conference. There were only two women reporters in attendance.

By Richard Asinof
Posted 4/26/21
The McKee administration announced that it is launching an investigation into state contracts with consulting firms – a story ignored by the other news media.
Why did the R.I. Department of Health news release about the latest Governor’s Task Force Meeting on Overdose Prevention and Intervention fail to mention that Ana Novais, deputy director at R.I. EOHHS, is now serving as co-leader of the Task Force? With the surveys for the latest R.I. Life Index now underway, what will emerge as the biggest factor driving health outcomes in Rhode Island? Seven years later, why does the city of Flint, Michigan, still not have access to clean drinking water? When will the House Oversight Committee conduct a hearing on the lack of an accountable entity for long-term services and supports in managed Medicaid care, six years after it was mandated?
Some folks who I follow on Twitter were re-tweeting the recent road trip taken by Alex Goldstein, driving west in Massachusetts on a day trip with his dog, Tillie. Goldstein, the creator of @facesofCOVID, had arrived in Ware, “the town that couldn’t be licked,” at the gateway to the Quabbin Reservoir.
Much of Goldstein’s travelogue was about finding places where Tillie could romp, finding places for great pizza and ice cream along the way. I tweeted back a bit of the history about Quabbin, that it was a reservoir created in the 1930s by damming the Swift River and drowning four towns, Enfield, Prescott, Dana, and Greenwich, in order to provide drinking water for Boston. It was apparently a dark history of which Goldstein was unaware.
Later on, Goldstein described traveling through New Salem on his way to Route 2, heading back home. I tweeted back that he had been traveling on Route 202, the Daniel Shays Highway, named for the farmer who led a rebellion against the tax policies.
The narrative around the Quabbin Reservoir and Daniel Shays are not hidden or unknown; many who are from western Massachusetts, like myself, know them well.
Here in Rhode Island, the narrative around public policy – like the history of the Quabbin Reservoir – often gets submerged in the overflow of breaking news.

PROVIDENCE – There was a big plate of protein to digest after attending the first non-COVID news conference held on Tuesday morning, April 20, by Gov. Dan McKee and Lt. Gov. Sabina Matos, in the second-floor conference room at the Department of Administration building.

The really big news was this: McKee has launched a broad oversight initiative to look at all the state contracts with private consulting firms doing business with Rhode Island. The move comes in the wake of a deepening controversy surrounding the R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals [BHDDH, or “Buddha”] and the agency’s efforts to move patients away from care at the Eleanor Slater Hospital, and the difficulty in uncovering what was actually happening.

R.I. BHDDH had hired a private consulting firm, Alverez & Marshal, in a $1.54 million, no-bid contract, to redesign health care delivery at Eleanor Slater Hospital, in an attempt to shave costs.

Alverez & Marshal, a New York-based consulting firm, had emerged as one of the go-to private consultancy firms hired by former Gov. Gina Raimondo’s administration. The firm had been paid $12.4 million to help with the state’s COVID response. They had then landed a controversial $76,000-a-week, no-bid contract to look at Rhode Island College’s finances, a contract that was abruptly canceled when its details became known.

“We put a hold on [plans to redesign care] at Eleanor Slater,” McKee said, in a response to a question from ConvergenceRI at the April 20 news conference, asking what plans the state had to look into the millions of dollars being spent on private consultants to design and implement public policy. “We’re going to dig into that.”

The investigation, McKee promised, will be “across the board. It’s not just on COVID, either,” apparently referring to the millions spent on private consulting firms, including the Boston Consulting Group, to develop a better coordinated response to the coronavirus pandemic in the spring of 2020.

At that time, the Boston Consulting Group had landed a lucrative contract to embed its own employees remotely, at $25,000 per person per week, within the state agency teams responsible for everything from hospital surge planning to COVID testing and contact tracing, according to reporting by The Providence Journal.

“I have requested [an analysis] of all the money, what we’re paying,” McKee continued.

“I think consulting is important, and I think there are certain benefits there, but you’ve got to evaluate it,” McKee said. “It has been somewhat difficult to get the information, and I have asked several [agencies] for information about every consulting agreement that is currently in place. [I want to] take a look at each agreement to see what was actually invested. That’s ongoing; we’re going to get that [information]; I’m pretty persistent on that. We’re going to get that information and then we’ll make it public, about what’s going on, about who we are paying, and what they’re getting.”

As a caveat, McKee offered the fact that he had just put out an RFP on consultation in education, but that he was adamant. “I want to make sure that we’re getting our money’s worth. We’re going to make sure that oversight is there.” Wow. Wow wow wow.

McKee, in a somewhat rambling manner that is his speaking style, had announced a tectonic shift in public policy in Rhode Island, promising to investigate, make public, and hold accountable the private consulting firms that have been feasting at the state government trough during the Raimondo administration.

The question is: Why was this investigation not reported by other news media covering the news conference?

The bigger question is: How much state investment has been diverted from paying for the direct care of patients into the pockets of private consulting firms?

The biggest question is: Will Gov. McKee – and the R.I. General Assembly – be willing to hold the culprits accountable, once the information is made public?

Changes in attitude
Before delving deeper in the budget ramifications of Gov. McKee’s investigation in how much is being spent on state contracts with private consulting firms, it is worth taking note of a couple of other “changes in latitude, changes in attitude” moments revealed at the news conference.

McKee listens – and he also listens to Lt. Gov. Sabina Matos. At a big presser the day before, featuring the state’s congressional delegation, announcing some $1.4 billion in new construction money to support rebuilding highway projects, there were a number of protesters at the event; instead of ignoring them, McKee apparently engaged with them.

As much as McKee said at the April 20 news conference that he was eager to move ahead with the project to transform Kennedy Plaza, “to pull the trigger,” he added: “If a number of people think it is inconvenient for them, make it convenient for them,” regarding problems raised with bus transfers.

Further, McKee addressed complaints about public bathrooms being closed in Kennedy Plaza. “Open up the bathrooms that are closed right now,” he said. “I can’t understand why they have bathrooms that are closed right now at the bus stop. Train stations have bathrooms, airports have bathrooms; let’s open up the bathrooms at Kennedy Plaza.”

Matos seconded that emotion: “If you are a person in a wheelchair, there are not that many places in downtown Providence that you can have access to bathrooms. So, these are things that we need to keep in mind when we are actually redeveloping the plaza – or development at any construction [site].”

Matos added: “We have to make sure that there is equity in the redevelopment of [Kennedy] Plaza. One of the issues that has been brought up is about transfers – how are going to be able to make sure that people are going to be able to get from one stop to the next. That is something we’re continuing to have conversations with the [R.I. Department of Transportation] director about.”

Translated, as McKee demonstrated with the signing on the Act On Climate legislation, the Governor is willing to listen – and to change his mind.

Will that willingness to listen by McKee and Matos result in major changes in R.I. DOT's plans for Kennedy Center? It is unclear.

That kind of “nimbleness” moving forward, particularly with budget issues, and specifically with information uncovered in his newly launched investigation into how much the state is spending on private consulting firms, may change the equation when it comes to future investments in health care delivery.

McKee also signaled his willingness to engage around plans to envision the future of Rhode Island – what he referred to as efforts to create a vision of what Rhode Island will look like in 2030 – and what kinds of big investments need to be made to secure that vision. “We don't print money; Washington prints money," McKee said, saying he favored using the approximately $1 billion in discretionary funds from the American Rescue Plan  to invest in three or four big projects.

Opening up a big can of worms
The new McKee investigation into private consulting firm contracts with the state of Rhode Island promises to open a big can of worms, one that may tarnish the Raimondo legacy of alleged competence and innovation in public policy.

One of the signature programs of former Gov. Gina Raimondo’s first term was the alleged “reinvention” of Medicaid. To date, despite having been mandated in the 2015 law enacting such a reinvention, no “accountable entity” has ever been established for the delivery of Medicaid long-term services and supports, as best as can be determined.

To put this in proper context, approximately two-thirds of the state Medicaid budget, including both federal and state dollars, goes to pay for Medicaid long-term services and supports. In turn, the funding of Medicaid, including both federal and state dollars, represents about one-third of the overall state budget.

The problems with accountable entities for long-term services and supports is intimately connected to the disastrous United Health Infrastructure Project, or UHIP, which operated under a flawed software system built by Deloitte. [Deloitte had provided “free” consulting services in facilitating the final report of the Reinvention of Medicaid working group.]

One of the biggest flaws in the Deloitte-built system under the botched rollout of UHIP was an unworkable online platform to determine Medicaid eligibility for patients in nursing homes. The failure to determine eligibility in a timely fashion – with thousands of such determinations delayed for months – led to the state having to make emergency payments to nursing homes to keep them from going bankrupt. [See link below to ConvergenceRI story, “Deloitte apologizes but skirts responsibility for UHIP debacle.”]

The McKee difference
The recent news conference by Gov. McKee and Lt. Gov. Matos – and his announcement of an investigation into state contracting with private consulting firms, with a promise to make the results public – stands in sharp contrast to his predecessor.

As ConvergenceRI reported in March of 2019, when Gov. Raimondo held a news conference to announce her decision to renew the contract with Deloitte, a separate embargoed briefing for a select group of reporters had been held in advance of the actual news conference:

“In many ways, the embargoed briefing for a select group of reporters provided an apt metaphor for the UHIP boondoggle: it mirrored a culture of arrogance reflected in the design of an expensive, flawed IT software system in order to make the process of delivering benefits to the most vulnerable Rhode Islanders allegedly more cost-efficient, from a top-down perspective. The human cost was never part of the equation, never calculated, never reimbursed.”

[See link below to ConvergenceRI story, “When it comes to UHIP, money talks, and the needy walk.”]

The story continued: “Translated, in the age of surveillance capitalism, the “haves” designed the flawed computer system, and the “have-nots” had to jump through the hoops to secure benefits that they depend on to survive.”



Further, the story reported: “As the popular advertising slogan goes: What’s in your wallet? For most reporters and top administrators in the room, it is not an EBT or a Medicaid membership card. They do not have to wait for two or three hours, on hold, on the phone, attempting to get answers from a customer service representative who never picks up. They do not have to wait in line for hours to try to resolve issues around their health care plans for themselves and their families, such as the unexplained cancellation of their Medicaid health coverage.”

And, further, the story drew the sharp contrast: “Translated, the Raimondo administrative team, her communications staff, and the news media often seem to behave as privileged members of the luxury class on the cruise ship of life, while the rest of us toil away in steerage, leading lives of increasing desperation to make ends meet.”

And, finally, the ConvergenceRI story reported on the fact that the new contract with Deloitte had been a done deal, already shown to the director of Centers for Medicare and Medicaid services weeks in advance for her stamp of approval:

• “The contract renewal was fully cooked; it was a done deal. It had been shared with, and reviewed by, the Centers for Medicare and Medicaid Services Administrator Seema Verma a few weeks before the news conference.” The back-door channel to Verma may prove to be a very salient bit of evidence as new evidence emerges in the reasons why the state stopped billing federal Medicaid for patients at Eleanor Slater Hospital, despite such a request apparently never having been made by CMS.

Co-dependent relationships
The connection between private consulting firms and the former Raimondo administration [and now the McKee administration] runs deep. Take, for instance, Ben Shaffer, the current R.I. Medicaid director. He first worked for the Boston Consulting Group, before being hired as the director of Performance Management and Budget at the R.I. Office of Management and Budget, then as director of the Project Management Office at UHIP, then as COO at the R.I. Executive Office of Health and Human Services.

Shaffer had replaced Patrick Tigue, who left his job as R.I. Medicaid Director in January of 2020, to take a job with Health Management Associates in Boston. Tigue had departed in the midst of a raging controversy over the outsourcing of a contract regarding patient transportation. Today, Tigue serves as the R.I. Commissioner of Health Insurance, replacing Marie Ganim, who retired.

Then, there is Lisa Vura-Weiss, who served as the Senior Deputy Chief of Staff for Gov. Raimondo, and before that, Acting Secretary of the R.I. Executive Office of Health and Human Services, before becoming vice president of HR Operations at FM Global. Vura-Weiss, too, is an alum of the Boston Consulting Group, where she served as the project leader on “improving patient satisfaction scores at a major health system through operational improvements and using insights from consumer market research.”

Further, there is Jamia McDonald, the former director of the R.I. Department of Children, Youth and Families, who left her position to work in the Public Sector Strategy and Operations at Deloitte.

Beyond the bingo card of revolving door employment between state agencies and private consulting firms, connections which no doubt will be revealed in the comprehensive analysis being undertaken by the McKee administration, some of the contracts that may prove worth looking are those that have explored data mining in health care delivery.

• There is the statewide Health Information Technology Roadmap and Implementation Plan, one with huge potential risks and implications for how health care is delivered in the future in Rhode Island, based on the work of Briljent, LLC, a privately held consulting firm headquartered in Fort Wayne, Indiana.

The HIT Roadmap, as it is being called, is being managed by the R.I. Executive Office of Health and Human Services, in a three-year effort described as “developing a shared, statewide strategic roadmap to guide public health information technology across the state over the next three years,” in the executive summary of the initial planning document.

Talking budget blues
At the heart of any budget discussion for FY 2022 will be how money from the American Rescue Plan can be spent by state governments, both for targeted and discretionary accounts.

The problem with the investments in private consulting firms to design and implement public policy by the state of Rhode Island is all about equity: instead of directly investing in direct care for the most vulnerable residents, the money has been diverted into the pockets of wealthy consulting firms that feast upon state governments, in the misguided belief that that there are technological solutions to human problems, in ConvergenceRI’s opinion.

None of the savings envisioned by UHIP have ever been achieved. Few if any of the savings envisioned by the Reinvention of Medicaid have ever been achieved.

Instead, the delivery of health services – by nursing homes, by mental health and behavioral health providers – have been squeezed financially.

As we have witnessed with the coronavirus pandemic, the folks most at risk – vulnerable children and families of people of color – have been victimized anew. In turn, the expertise and decision-making that should reside in state policy makers has been outsourced to private consulting firms.

Translated, no algorithm could have predicted the success of a wire-mesh free Wi-Fi system that was built out by ONE Neighborhood Builders in Olneyville, a bottom-up solution to help vulnerable residents survive the coronavirus pandemic.

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