PROVIDENCE – Three days after Gov. Gina Raimondo released her proposed FY 2021 state budget on Jan. 16, the Rhode Island Foundation released its long-term, 10-year plan for improving health in Rhode Island.

The differences in the two visions for Rhode Island’s future seemed to capture the way in which the Rhode Island Foundation, rather than the R.I. General Assembly or Gov. Raimondo, has become the prime catalyst in making investments in the future of Rhode Island when it comes to education, health care and community.

For example, for the second year in a row, Gov. Raimondo’s budget failed to include requested investments of $1 million in a dedicated funding stream for Rhode Island’s Health Equity Zones, an innovative approach to create community-based solutions that has received national acclaim – and whose community data assessment methodology has been adopted by both the Hospital Association of Rhode Island in its federally mandated community needs assessment and by Blue Cross and Blue Shield of Rhode Island in developing its inaugural Rhode Island Life Index.

[Editor’s Note: There is $180,000 in the proposed Governor’s budget in state minority health money to support HEZs. Whether that money makes it into the legislative budget is anyone’s guess. And while the Governor did call for a dedicated funding stream to support new affordable housing development in her budget, a critically needed investment championed by Homes RI, her budget also called for cutting some $6 million from the aid program for distressed cities.]

Contrast that with the guiding principle of the Rhode Island Foundation plan, entitled “Health in Rhode Island: A Long Term Vision,” as articulated by Jane Hayward, president and CEO of the Rhode Island Health Center Association and co-chair of the stakeholder group: “Across health outcomes we see significant disparities by race, ethnicity, gender and income,” Hayward said. “The committee quickly agreed that it is improving the health of Rhode Islanders overall, not only fixing the health care system, that we must focus on to make lasting change.”

In its published version of the plan, reinforcing that focus on health equity, the first two major points presented in the introduction were: “We are laser focused on health equity’; and “Our efforts cannot be about health care alone, they must be focused on health.” [Is it time to drop the use of the modifier, laser-focused?]

Translated, health equity is a major focus of the 10-year plan. That emphasis was driven home in two of the five priorities articulated under the plan:

• Focusing upstream on root causes and investing in affordable housing, food security and transportation to address underlying inequities and influencers of health disparities.

• Reducing wasteful spending in order to redirect resources to social determinants and improve affordability.

The new health plan developed by stakeholders led by Neil Steinberg, president and CEO of the Rhode Island Foundation, comes with it a commitment by the Rhode Island Foundation to make $1 million in new funds available to support the plan, beyond the ongoing yearly grant-making in health.

Translated, for better or for worse, the Rhode Island Foundation, under the leadership of Steinberg, has emerged as the dominant force in driving investments to secure a better future vision for health in Rhode Island, filling the vacuum created by the R.I. General Assembly and the Governor.

What gets measured gets done
Another key feature of the plan that sets it apart from much of government work and its programs is the way in which it has established and identified an evaluation framework with a set of nearly 40 indicators, in partnership with Healthcentric Advisors, that will be used to track and measure progress of investments, based upon the Commonwealth Fund Scorecard.

The indicators themselves provide some illumination beyond the lofty rhetoric of the plan. For instance, the first category listed under “Health Behaviors” is excessive drinking: the percentage of adults who reported either binge drinking in the past 30 day or chronic drinking problems. The current ranking for Rhode Island in 2018 was 31st in the nation.

[Even if alcohol intoxication is not a central part of the Governor’s Task Force on Overdose Intervention and Prevention’s focus, it will be part of the focus of the 10-year plan.]

• Under “Health Outcomes,” the indicators include: drug deaths; mental distress; alcohol-related deaths, suicide deaths; physical distress; diabetes, infant mortality; and maternal mortality.

• Under “Health Equity,” the indicators include: Housing cost burdened; education, food insecurity; and transportation.

• Under “Health Care Quality,” the indicators include: hospital complications for catheter-associated urinary tract infections, C-difficile infections, and central line associated bloodstream infections [in which Rhode Island ranked 50th, 51st and 44th respectively].

Translated, it appears that in pursuit of the 10-year plan being championed by the Rhode Island Foundation, the data to support a “Quality of Life Index” will be created. The question is: how will it be deployed as a potential tool of economic development?

The stakeholder group that participated in the discussions in developing the Rhode Island Foundation’s 10-year strategic health plan represented, for the most part, a top-down approach to decision-makers, with many of the usual suspects. They included:

• John Murphy, Executive Vice President for Physician Affairs, Interim President of Rhode Island Hospital and Hasbro Children’s Hospital, Lifespan

• Teresa Paiva-Weed, President, Hospital Association of Rhode Island

• Donna Policastro, Executive Director, Rhode Island State Nurses Association

• Betty Rambur, University of Rhode Island, College of Nursing

• Aaron Robinson, President & CEO, South County Health

• Samuel Salganik, Executive Director, Rhode Island Parent Information Network

• Neil Sarkar, Interim President & CEO, Rhode Island Quality Institute

• John Simmons, Executive Director, Rhode Island Public Expenditure Council [resigned from that position]

• Susan Storti, President & CEO, The Substance Use and Mental Health Leadership Council of Rhode Island

• Jane Hayward, President & CEO, Rhode Island Health Center Association [co-chair]

• Neil D. Steinberg, President & CEO, Rhode Island Foundation [co-chair]

• Dr. Nicole Alexander-Scott, Director, Rhode Island Department of Health

• Al Charbonneau, Executive Director, Rhode Island Business Group on Health

• Antonios Clapsis, Vice President, Enterprise Strategy, CVS

• William Corwin, Member of the Physician Health Committee, Rhode Island Medical Society

• Thomas Croswell, President & CEO, Tufts Health Plan

• Dr. Jack Elias, Senior Vice President for Health Affairs and the Dean of Medicine and Biological Sciences, Warren Alpert Medical School of Brown University

• Dr. James Fanale, President & CEO, Care New England

• Stephen Farrell, CEO, UnitedHealthCare

• Scott Fraser, President & CEO, Rhode Island Health Care Association

• Marie Ganim, Rhode Island Health Insurance Commissioner

• Lou Giancola, former President & CEO, South County Health

• Tom Giordano, Executive Director, Partnership for Rhode Island

• Dolph Johnson, Executive Vice President, Chief Global Human Resources, Hasbro, Inc.

• Womazetta Jones, Secretary, Executive Office of Health & Human Services

• Linda Katz, Policy Director, Economic Progress Institute

• Kim Keck, President & CEO, Blue Cross & Blue Shield of Rhode Island

• John Keimig, President & CEO, Healthcentric Advisors

• G. Alan Kurose, President & CEO, Coastal Medical

• Joan Kwiatkowski, CEO, CareLink and PACE of Rhode Island

• Bess Marcus, Dean, Brown University School of Public Health [resigned from that position]

• Peter Marino, CEO, Neighborhood Health Plan of Rhode Island

Larger questions loom
As much as the 10-year plan developed by prominent stakeholders in partnership with the Rhode Island Foundation lays out a strategic direction for the state, it does not appear to address some of the greatest health threats on the horizon. They include:

• The threats to a woman’s right to make her own personal choices about health care.

• The dismantlement of the Affordable Care Act [Obamacare].

• The further wave of corporate consolidation of health systems, insurance firms and pharmacies.

• The uncharted waters of the introduction of Artificial Intelligence and algorithms into health care policy and decision-making.

• The continuing problems of interoperability and the time-sucking nature of Electronic Health Records., disrupting relationships with patients.

• The problems of disparity in levels of reimbursement rates for mental health, behavioral health, and dentistry in Rhode Island.

• The push—and the corporate pushback – to create a national Medicare for All public option in the U.S.

• The growing demographic trends in Rhode Island, with a falling birthrate, an increasing number of older Rhode Islanders, and the increasing number of immigrants.

• The disconnect between health care and prevention from environmental and toxic hazards as well as threats created by man-made climate change.

The bottom line is that health care now consumes 20 percent of the average family’s income, a figure that threatens to keep growing, making it unsustainable.