Innovation Ecosystem

If not now, when?

An in-depth interview with Neil Steinberg, the president and CEO of the Rhode Island Foundation, who is driving the discussions of future health care and educational planning in Rhode Island

Photo by Richard Asinof

Neil Steinberg, president and CEO of the Rhode Island Foundation, being demonstrative during the interview with ConvergenceRI.

By Richard Asinof
Posted 6/3/19
Neil Steinberg, the president and the CEO of the Rhode Island Foundation, is piloting the boat that is turning to address Rhode Island’s future efforts to develop long-term planning for the state’s education and health care policies. In his in-depth interview with ConvergenceRI, Steinberg discusses the focus and the projected outcomes from such work.
Will the future of women’s health care be addressed as part of the ongoing discussions regarding statewide health planning in Rhode Island? Will there be an aha moment when access to safe, affordable healthy housing becomes an integral part of the conversation around future education and health planning? What role will patients and students play in informing the discussions around health care and education? Will CommerceRI consider investing in the development of an Index of the Rhode Island Innovation Economy, as a way to create an annual benchmark measuring Rhode Island’s performance against other technology states, following the lead of Massachusetts, which has been publishing such an index for more than 20 years?
The impending threats from climate change to Rhode Island’s future seem overwhelming to talk about in a cogent, direct fashion. The subject is not dinner table conversation, for those families that still have dinner together. The idea of making it part of the everyday weather reports, on radio and TV and in digital formats, seemed like a brilliant way to translate the information into accessible sound bites, where everyone could become part of the conversation, without feeling overwhelmed.
As a public health service, weather reports now include the UV safety factor for how long you should stay in the sun without protection. They also often feature pollen counts and ozone levels as helpful consumer information. Why not include data and information about climate change as part of each weather report?
The best way would be for one TV or radio station, in order to gain a competitive advantage, to begin to include such information in its weather coverage. What kinds of information could be broadcast? Perhaps the best way to determine that would be to engage with students at colleges and universities in Rhode Island to conduct research and develop a series of pilot programs.

PROVIDENCE – The person at the helm attempting to turn the ship that is Rhode Island through the rough waters around future educational and health policies is Neil Steinberg, president and CEO of the Rhode Island Foundation, the community foundation with $1 billion in assets and a growing wish list of investment demands.

In the apparent absence of leadership by the state’s business community, along with the apparent failure of the R.I. General Assembly to drive the future policy agenda, Steinberg and his team of philanthropists have decided to tackle two major gaps tied to Rhode Island’s future economic prosperity: creating a statewide, long-term plan for both education and health.

At the Foundation’s recent annual meeting, Steinberg shared the vision of a planning group consisting of 30-something members to make Rhode Island the healthiest state in the nation. The focus, which represents somewhat of a sea change in policy, will put the focus on health outcomes, not health care. [See link below to ConvergenceRI story, “The time has come today.”]

Leading the planning process on these two initiatives, Steinberg explained, is much different than being an advocate for specific outcomes. He said that it was a natural evolution of the work of the Foundation.

“I don’t think of us as advocates,” Steinberg told ConvergenceRI in a recent interview. “We’re leading the planning effort. We don’t have any of the answers. We don’t pretend to have any of these answers; but we think there is a need for answers and directions.”

What the Foundation is doing, Steinberg explained, is leading the process: getting a bunch of people together, the leaders in the field, the stakeholders, whether it is in education, health or health care. “It’s not like we’re standing up, with a banner, and saying: ‘Here’s what needs to be done.’ What needs to be done is the planning.”

Steinberg likened the process to something similar to “Middle East shuttle diplomacy” – getting the participants to talk to each other, to be respectful of each other, to look long-term, and “to leave your stripes at the door,” a reference to the idea that rank and position should not interfere with the discussion.

The interview with Steinberg was wide-ranging – about the limitations on the Foundation to tackle all the urgent demands that Rhode Island is facing, and instead to focus on what the Foundation believes can be achieved, looking to get 80 percent of the way there. The future policy decisions around planning in health and education, Steinberg promised, will be driven by data and evidence.

Here is the ConvergenceRI in-depth interview with Neil Steinberg, president and CEO of the Rhode Island Foundation, at a critical juncture for the state’s future long-term vision in health and education policy – and how philanthropic investments can help to shape and drive that policy.

ConvergenceRI: How were members of the planning groups chosen?
We’ve got stakeholders representing natural groups. In education, it is superintendents, principals, and a host of others. On the health care side, it’s the hospital CEOS and the insurance companies, all representing constituencies.

There are pluses and minuses to that. I know on education, there were a few people who pushed back, who said that you’ve got all the same people who got us where we are now.

The answer is: they are still in charge. They are still the ones who are the influencers; they are still the decision-makers. And, if we can get the ship turned, and get their support, then you really can get something done.

One of the mantras [of the planning process] is: look long-term, and leave your stripes at the door. We’re looking at this, as much as it sounds idealistic, for the benefit of Rhode Island and all Rhode Islanders. So, [we ask the participants to] leave your stripes at the door and think 10 years down the road.

ConvergenceRI: When you say, “leave your stripes at the door,” what do you mean?
Your affiliations.

ConvergenceRI: That you are not a sergeant or a lieutenant?
Correct. Everyone is equal under the tent. Nobody is a general and nobody is a corporal.

ConvergenceRI: In the last year, the Rhode Island Foundation has made an enormous sea change – you’ve begun to invest in health equity, rather than just in health care, in terms of the kinds of investments that you’re making.

At the annual meeting, you talked about the similar recognition that when it comes to long-term planning for health, you had to make a similar change in direction.

How much of that philosophical change will influence the work? Will you also address the fact that the current business model for health care does not appear to be sustainable, and the recognition that health care is not a commodity?
You got “a lot a lot” in there.

ConvergenceRI: You can take it apart anyway you want.
Let me start with the equity side. Because I think that is a bigger umbrella. I think we’ve recognized over all, that the equity lens, the inclusiveness lens, is more important.

So, we have heightened that importance. And, that is across many things that we do, not just in these two initiatives.

No doubt, looking at the disparities overall, looking at people’s destiny, dependent on their zip code, looking at the income inequality, all of those things are getting magnified, and they run across much of what we do, much of what we support in our funding. So, I think that’s a broader lens.

I think in health care, especially, I think I mentioned it [at the annual meeting] that it was not something planned; it was a big aha! More profound to some than others, when we pivoted from health care to health, that there was this realization for people in the health care industry, who were working in this system that you described, that yes, there may be a need for a change in the model, but we need to drive it by health.

There are different views on social determinants, life determinants, social influences, whatever; but it is the 80 percent of what matters to our health, not the 20 percent in that system itself.

So, we are trying to straddle that, not really looking at that short-term health care system, does it look like this or that, but what does that start to look like and where does that blend together.

[We are having] discussions about telehealth, and where does technology come into play. These could be huge disruptions, they could be minor, I don’t really know. But I think there is a lot of openness to how do we look at these determinants, [and where we can achieve] the biggest bang for the buck.

The overall goal is to get 80 percent of the way there, wherever that is, not 100 percent. You don’t want to go down in flames trying to hit 100 percent on everything.

Similarly in education, [the question is]: where do we need to get to?

What do we need to do to get a world-class education, to get the best outcomes, what do we have to do to make those changes, and can we figure out how to change systems, can we figure out how to afford them, can we change culture and behavior, that’s what we’re looking at, all very big things.

ConvergenceRI: One of the proposals that has come up repeatedly, in the context of both health and education, is access to affordable, safe, healthy housing. Do you think that you may reach a similar aha! moment, that to achieve the goals that you seek in health and education, you may need to focus on housing?

And, what will convince people to make that change? Is it data? Is it arguments? Is it persuasion?
I think there’s housing, there’s nutrition, there’s food insecurity, there’s a whole bunch of things, and you can’t “boil the ocean.” That’s the risk of an effort like this – that we end up trying to cure the common cold and achieve world peace all at the same time.

And, you can’t do that. When we start to look at these issues, I think the core is going to wind up to be the data. You’re telling me that housing impacts health. I believe you 100 percent.

ConvergenceRI: I can show you the data.
That’s what we need to do. That’s what will convince us. And, we’re working on that. We’ve got people working on that.

Those are the types of data points that drive economic discussions that, in turn, then drive persuasion.

Right now we have a very expensive health care system that sucks dollars that could go for education, for social services, everything. It would be wonderful if we could squeeze some of those dollars out and use them over here. Chances are you have to do both at the same time. We don’t have the luxury of waiting.

ConvergenceRI: What type of data do you think would be most important to have?
We’ve got people looking at that right now. We’re looking at data, what do we want to aspire to? What is the metric data benchmark for that?

And, then, what are the cause and effects? For housing and food insecurity, what are the compelling data points, to say: if you have this, achieve this, do this, how will it translate?

ConvergenceRI: I sat in on the discussion with the cost trends compact steering group, reviewing preliminary trends identified. One question that was not addressed was the enormous cost expense related to health IT, and the fact that is not “transparent” as part of the claims datasets.

The costs are not necessarily part of administrative costs, and the health systems do not “eat” those costs, so when you talk about achieving better health outcomes, what are the metrics regarding investments in health IT? Is that something that the long-term planning group might address?
I don’t know if that is going to be an area of focus. That fits with the cost trend analyses, probably [better]. Right now, we’re looking at where do we want to be, how do we drive toward those buckets, with more emphasis on the health side. The triple aim doesn’t go away, it’s a very valid principle. To achieve those aims is easier said than done. Still, a good driving factor.

But, looking at those health outcomes is really what we’re trying to get at. What does it mean to be one of the healthiest states?

ConvergenceRI: Those are really great aspirational goals. I also sensed, in your announcement this week regarding behavioral health and mental health prevention strategies that you were seeking to work on prevention rather than trying to just rescue people, because catching people who are falling into a field of rye is a very expensive proposition.
You heard my presentation the other day. There is long-term systemic change and there’s what is going on outside your door.

So, yeah, if you could put all your chips on prevention, over time, you would like to think that it negates the need for taking care of people. But, in the meantime, they are shooting up, they are starving, they are doing this, we need to help people, and achieving that balance is a bear. It’s very challenging.

ConvergenceRI: Would it make sense to change the terms to brain health, rather than behavioral health or mental health, as a way of helping to remove stigma?
I defer to Dr. Alexander-Scott, who I asked that question. And she said, behavioral health is mental health plus substance abuse.

ConvergenceRI: It’s been two years since I brought sociologist Shannon Monnat to RIC, to talk about her research into the diseases of despair – that it is not just deaths from drugs, but also suicide and alcohol. As much as suicide has begun to creep into the conversation, alcohol still remains far and away the leading co-morbidity.

I recently talked with someone in the recovery community, she said that in 84 percent of all ODs, alcohol was a co-morbidity. Still, we don’t have a comprehensive dataset for the diseases of despair yet. And the Governor’s Task Force is equally clear that that is not their job to create that.

Is there an opportunity for the Rhode Island Foundation to broaden out that question, to create a quality of life index for Rhode Island, as a longitudinal dataset that creates benchmarks? I know that we’ve discussed before. Without that kind of dataset, I worry that folks will continue to follow the existing data map, even if the GPS is wrong.
I think we’re still using Trip-Tiks from Triple A [laughter]. Yes, I get it. But the challenge is that there are all of these pockets. For the time being, we’re looking at pre-K through 12, to get all of our kids the best education we can, to look at some of these areas on health.

Again, something I keep referencing because it is still on my mind: Life expectancy in the United States of America where we grew up, thinking it was the best of everything, ain’t the best. Neither is our educational system. It’s just not what it used to be.

When you look at the decline in life expectancy, you still shock people by saying: it’s substance abuse, it’s suicide, which are [the factors] driving that.

ConvergenceRI: There is an economic factor to the diseases of despair.

ConvergenceRI: Another big question, which fits both into long-term health and education policies? Do we need a better way of educating students and residents not just about the threats from climate change, but bringing them into being participants in the conversation? Is that an initiative that the Rhode Island Foundation could become involved with? Supporting messaging to go with weather reports?
You are very complimentary and very challenging at the same time.

I made the comment [at the annual meeting]. Together, with the help of a lot of people, we can do anything, but we can’t do everything.

We never say, that’s not important, or that’s not an idea. We just can’t do it all. If somebody develops it and gets it down the road, and they want to pitch it to us, we’d listen to it, it’s not something today really we can lead the charge on.

Not because it’s something I don’t think is important, but because we don’t have the bandwidth to do all these things.

It’s a compliment, but it is almost by default, the way you describe. If not us, then who?

ConvergenceRI: If not now, when?
Yes. And we use that, once in a while, in our thinking, as we take on these gadzillion things. But we can’t always be doing a gadzillion and one things.

ConvergenceRI: I’m planting a seed.
And, I appreciate it; I am not telling you I don’t think it is important. But we need more partners to do this stuff.

That’s really one of the messages. We need more, whether it is corporate entities stepping up, whether it is other philanthropic organizations stepping up, we need more partners doing this.

As you have challenged me about [the need for] data, let me ask you about what the commercials are going to do, given the demographics of who is actually watching TV.

Nobody under 35 or 40 watches the weather on TV. They get it on here [holding up his phone.]

Listen, WJAR could do it right now, if they wanted to. They don’t need our money.

ConvergenceRI: That’s a Sinclair-owned station; I doubt they would allow it to happen [given their political leanings].
Sorry. I meant to say, any of the commercial entities that wanted to do it, could certainly do it.

ConvergenceRI: Another issue around health care, and I am pushing the envelope a bit here, with everything that is happening around women’s health, would the long-term planning group address the economics of women’s health – of what happens if abortion bans really take place?

Because women deciding about their own health care and when to have children, along with access to birth control, has changed the dynamics around the ability of women to enter the workforce. The other big question is around access to childcare that is affordable.

The other part of that is access to childcare that is affordable. Are these questions that the statewide health care planning group will consider addressing?
It is not an area that we’ve picked up. People have very personal opinions. It has not been looked at, that I’ve seen, on an economic basis. Again, I go back to: we can’t boil the ocean.

We’ve got to focus on what gets us 80 percent of the way there. If you can get at different aspects of what makes people healthier, what keeps them going, can we keep people out of the emergency rooms?

There’s a great story, it’s one of my favorites, Peter Marino from Neighborhood Health Plan of Rhode Island has told this in public.

ConvergenceRI: About providing an air conditioner to the patient who was spending much of his time in the emergency room because it was cool, while his apartment was too hot?
It’s simple. It’s easy for someone like me to understand. For $200 investment you can save thousands of dollars.

Now, what hasn’t been done is that I don’t think they’ve [figured out] how to replicate that. But it makes sense. The hope is that there are some ideas where there is just good business common sense that we can do.

ConvergenceRI: Let me jump to what I consider to be one of the strengths in terms of Rhode Island, the growing research enterprise that is part of the state’s emerging innovation ecosystem…
You better get a name tag, from what I read [laughing, referring to the incident reported in the latest issue of ConvergenceRI about what happened when an official from the Cambridge Innovation Center put his hands on ConvergenceRI and attempted to push him out of line.] See below link to ConvergenceRI story, “Will hope or hype reign in Rhode Island?”

I hate to tell you, but that was the most interesting part of your story last week.

ConvergenceRI. I often bury the lede. But it illustrated the problems with the way that the innovation ecosystem is being marketed in Rhode Island. There is a need, I believe, to redefine the relationship of the research enterprise in Rhode Island with Boston and Cambridge.
We have all watched for a long time the way that innovation has become an overused word. Betaspring was the hot thing several years ago. And, for a variety of reasons, that kind of came and went.

What happens is, because [the ecosystem is] not larger enough here, so that we tend to anoint whatever is the next hot thing. I believe there is as much innovation down at URI and in Newport as there is in Providence; things get a certain amount of attention because of whatever, real estate and location are everything.

ConvergenceRI: I believe that the real gap in the marketplace in Rhode Island is not with startups, it’s the capability of startups to take their research and translate that into viable commercial companies.

I also think that the old pipelines that once existed for commercialization may not work in the same way anymore. With medical devices, the recent revelations about the FDA hiding tens of thousands of reports, as documented by Kaiser Health News, concerning defects and patient injuries, is pretty alarming. Also, it is unclear how much money is available from hospitals to incent the commercialization of new devices. And, venture capital investments in Rhode Island companies have been declining.
There’s a lot in what you are saying. There’s innovation; there’s entrepreneurship; there’s funding.

Drawing on my old, now very old, finance experience, good deals get funded. It’s one of the maxims that have always been true. Good deals get funded. Whether they are here, whether they are in Dubuque, wherever they are, good deals get funded.

You’re talking about funding enough stuff that it makes a difference, not one or two things. Boston obviously has multiples of these collisions. I think our culture and DNA is different. Here it’s not so robust. Right now there are probably two people standing outside a building at MIT starting a company as we’re sitting here. I don’t know if that is going on here. I don’t think we have that kind of volume for a variety of reasons; it’s well beyond my ability to pinpoint why. But I don’t think that culture and ecosystem is here. [The question is]: whether there should be more time and energy and focus on growing the ones that we have and really providing the supports, for wherever capital comes from or management comes from? Or [should we focus] on creating new ones?

But it doesn’t look cohesive to me. I mean, it wants to be cohesive; it talks cohesive, but it just doesn’t look cohesive to me.


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