Delivery of Care

In the bumper car of life, who determines the value of health?

Coming attractions this week: the pediatrician whose research on lead poisoning in children helped halt the travesty in Flint; a community conversation about safe injection sites, the first of its kind in Rhode Island; a legislative breakfast by the health insurance advocacy group that includes a health disruptor at the podium; and a talk by the CEO of a digital health incubator that specializes in disruption

Image courtesy of CommerceRI website showcasing coming attractions

Bumper cars on ice are one of the latest attractions at the Alex and Ani skating center in Providence. This week, there are four coming attractions in ongoing conversations about health equity, health care, health innovation and community voices in health.

By Richard Asinof
Posted 2/26/18
With the current health care landscape in Rhode Island in upheaval, four different events scheduled for this week offer a glimpse at how difficult it can be to achieve convergence in important ongoing conversations in public health, in health equity, in the deal flow of the innovation ecosystem, and in the health insurance industry’s view of value in health care.
How do health equity zones fit into the conversation around the community finding its voice in determining what it values about health, not just health care delivery? How will better coordination of data around mobile health care change the delivery model? As MedMates approaches its second annual expo about the life sciences industry in Rhode Island, will it include a discussion about the ongoing arguments about the future of the academic medical research enterprise in the state? Why has the state House of Representatives never moved forward with the legislative commission, first enacted in 2016 and again approved in 2017, to study lead in drinking water in Rhode Island? As hospital systems buy up insurance companies and insurance companies buy up hospital systems in a dizzying wave of consolidation, is there a way to remove the opaqueness of medical costs – and be transparent about what those medical costs actually pay for? When will nurses become full participants in the discussion around defining the value of health care in Rhode Island? When will the Governor’s Task Force on Overdose Prevention and Intervention release its statewide harm reduction strategy document?
As any consumer or patient will tell you, if you’re willing to listen, it takes enormous energy, gumption and persistence to try and make the health care delivery system responsive to your needs, to be heard. What are you supposed to do if you go in for a regularly scheduled check up with your primary care provider, only to find out the practitioner has the flu, is wearing a mask, and care barely talk above a whisper? Do you walk out? Do you complain? What is the recourse when you fall ill with the flu the next week? Do you get a refund on your co-pay?
The high school students in Florida have provided a wake-up call to many politicians and, for that matter, news commentators, with their willingness and refreshing honesty to call bullshit on the status quo. [Having the CEO of the NRA attempt to mimic their voice in calling bullshit was the height of hypocrisy.]
It remains unclear whether their passion will be sustained and carry over to the ballot box this fall. But they have certainly changed the conversation, not settling for listening sessions that in the past often served as a kind of cathartic management strategy by politicians to appear as if they were listening but not changing their policies.
Stay tuned. And, watch out. To paraphrase the Ramones, they do not want to be sedated.

PROVIDENCE – Next week promises to be a busy week when it comes to conversations around public health, health care and health innovation in Rhode Island. It remains unclear, however, what if any common ground exists where the conversations can converge and silos be broken down.

On Monday, Feb. 26, from 5:30 to 7:30 p.m., MedMates will host one of its gatherings featuring Dan Schwarzman, the CEO of MindUP, at the Brown Community Collaborative at 339 Eddy St.

MindUP, described as a digital health incubator that seeks to translate disruptive technologies into new product concepts in digital health ventures, is a joint venture involving Medtronic, IBM, Pitango Venture Capital, Impact First Investments and Rambam Medical Center in collaboration with the Israel Innovation Authority.

The overarching question about such new product concepts is: for whose benefit? The consumer? The investor? The large corporation with the capabilities to mine the data? And, how does the product improve public health outcomes?

One sign that 2018 is an election year is that Lt. Gov. Dan McKee, who is being challenged by Rep. Aaron Regunberg in the Democratic primary for Lt. Governor, has been announced as a last-minute special guest for the event.

On Thursday, March 1, Dr. Mona Hanna-Attisha, a pediatrician and public health advocate whose research helped to expose the crisis of lead poisoning in the water in Flint, Mich., will be giving a lecture at Brown University. Her talk is sponsored by Brown’s School of Public Health and the Center for the Study of Race and Ethnicity in America, as part of the “Building Health Equity in an Unequal World” lecture series. The talk will be held from 6 p.m. to 7:30 p.m. at the Institute at Brown for Environment and Society at 85 Waterman St. The event is free and open to the public. [See interview with Dr. Hanna-Attisha in this week’s ConvergenceRI, “There are Flints everywhere.”]

Also on Thursday, March 1, from 5:30 to 7 p.m., RICARES and Protect Families First will be hosting a community conversation on “Medically Supervised Consumption Sites” in Room 170 at the Brown University Medical School at 222 Richmond St. The panel will discuss what exactly are medically supervised consumption centers, also known as “safe injection facilities,” the evidence behind them, and how they fit into a harm reduction model to prevent overdose deaths. The event is free and open to the public.

The next morning, on Friday, March 2, the Rhode Island Business Group on Health, the advocacy organization for the health insurance industry, will be holding its 2018 annual legislative breakfast, from 7:30 a.m. to 11 a.m., at the Providence Marriott at 1 Orms St. The convening topic is “low-value” care, with keynote speaker Dr. Mark Fendrick form the University of Michigan School of Medicine and School of Public Health presenting on “value-based insurance design.” There is a $40 dollar registration fee.

Also speaking will be Shannon Brownlee, senior vice president of the Lown Institute, author of the book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

Among the members of a panel of respondents to the presentations are: Marie Ganim, R.I. Health Insurance Commissioner; Robert Hackey from Providence College, Bob Selle from Ocean State Job Lot, Matthew Collins from Blue Cross & Blue Shield of Rhode Island, and Dr. Michael Fine, the former director of the R.I. Department of Health who is serving as health policy advisor for the city of Central Falls.

Including a disruptive view
The invitation to Fine to be a member of the response panel represents the first time in recent memory that RIBGH will be opening up its podium at its annual legislative breakfast meeting to include a disruptive view of the current health care delivery system. Fine is an advocate of Neighborhood Health Stations in Rhode Island, and he is also writing a book about what he terms the coming health care revolt. [See links below to ConvergenceRI stories.]

In advance of the event, ConvergenceRI asked Fine to share what he thought were the questions that needed to be asked about determining value in health care in Rhode Island. Here are his responses:

“First, value to whom and for what?” Fine asked. “Individuals value different aspects of health differently themselves. Health care services have a different kind of value from the perspective of employers, communities and measured public health outcomes.”

Fine continued, “Who decides [what the value is]? Using what calculus?”

Further, “How does the population under analysis impact this calculus?” Fine asked. “Isn’t the question [about value] also how to make sure the whole population that might benefit receive the high-value service gets that service? And, in turn, how we protect the whole population from low-value care, particularly low-value care that is expensive and is paid for publicly.”

Fine included some additional questions about the value of primary care: “Is primary care always high-value? If not, what aspects are not? And which aspects are high-value? And why?”

The challenge moving forward, Fine said, was achieving a consensus about value. “Finally, how do we reach consensus about value in health care? And, how do we change what we now do, given the many interests vested in keeping things as they are?”

It promises to be a lively experiment in talking about the value of health care.


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