Innovation Ecosystem

On the road to find out

The analyses provided by Briljent provide an example of how private consultants can blur history, in order to promote a corporate agenda

Image courtesy of RI EOHHS

The cover of the second part of the Briljent RI HIT Roadmap Strategy.

By Richard Asinof
Posted 10/12/20
The consultant’s rewriting of history about past failures of health IT efforts in Rhode Island does not augur well for future efforts to develop a HIT road map strategy moving forward.
What is the liability for corporate consultants who rewrite and skew history while they are under contract with Rhode Island state government? How can Rhode Island state government invest more resources in developing its own talent and expertise to manage public policy? Why were so many stakeholders, when approached by ConvergenceRI, unfamiliar with the plans for the state’s HIT road map strategy? What have been the lessons learned around patient needs in developing responses to the coronavirus pandemic in Rhode Island?
Much like in the increasing threats of climate change, the damage done to Rhode Island’s local nursing home infrastructure as a result of the UHIP debacle may have worsened the ability of nursing homes to respond to the threats from the coronavirus pandemic.
Just as forests weakened by drought became susceptible to insect infestation and then became tinder for forest fires, the weakening of the financial infrastructure caused by the delay in Medicaid eligibility certification left many skilled nursing facilities vulnerable to the financial stresses from the coronavirus.
The inability to raise wages for employees, in large part due to the failure of the R.I. General Assembly to approve cost-of-living increases due for years, exacerbated the situation. Further, the just-in-time “supply” relationship with hospitals, anxious to decrease the costs of in-patient care by moving patients as quickly as possible out of hospitals and into skilled nursing settings for rehabilitation stints following procedures, created undue pressures on nursing homes to accept patients who may have been infected with the virus. Only a month into the pandemic did Rhode Island change its policies, it appears.
Making nursing homes the scapegoat of failed legislative policies and failed patient transition policies may be convenient, but until the Governor and the R.I. General Assembly are willing to make investments in better patient care, the congregant settings of nursing homes will continue to make many of Rhode Island’s most vulnerable residents even more vulnerable to the current and any future pandemics.

PART Two

PROVIDENCE – One constant truth that has resonated with ConvergenceRI during the last decade of reporting on the convergence of health, science, innovation, technology, education, and research: there is an ever-increasing dependency on highly-paid private contractors as “expert” consultants to design and implement health policies, often tied to health information technology.

Corporate consultants such as McKinsey, Boston Consulting Group, Deloitte, Hewlett Packard and even Amazon have seemingly become well-paid appendages of state government in Rhode Island, particularly when confronting how to manage the seemingly unmanageable – delivering health and human services to customers and patients alike, calculating the costs, risks and dividends of population health through a lens of “innovative” regulation of federal health insurance programs such as Medicaid and Medicare. As if these federal insurance programs would easily conform to the performance metrics of equity investments in the stock market – if we only followed a path of economic innovation. Yes, we have an algorithm for that.

Briljent is the latest in a series of corporate consultants who are thriving on doing business with the state government in Rhode Island.

On its website, the Fort Wayne, Ind., private consulting firm, in a recent blog post, seemed to be an expert in talk in the consultant’s jargon, revealing a fluency in its approach toward innovation:

“In yoga, we have a concept called Beginner’s Mind,” the blog post began. “It is the practice of coming to a pose as though you’ve never done it before, even if you’ve done it 1,000 times. The idea is to let each experience of a pose teach you something new; something you didn’t notice before, a more effective alignment, a calmer space, a balance between effort and ease, or how you ‘talk’ to yourself.”

The post continued: “It requires approaching the pose with an open mind and an open heart and being willing to begin again, each and every time. It requires dropping our preconceived notions of whether we like it or hate it, whether we’re any good at it, and even what ‘good’ looks like.”

Further, the post argued: “The reason for this practice is that it keeps us in learning mode, present in the moment and open to the experience. It puts us in a mental space where learning can occur. Often, when we go through the mechanics of our day, we switch into mental autopilot. It’s a protective mechanism of our brain to preserve mental energy. While this serves a purpose, it can lead to moving through your life without much thought and without noticing what is happening around you. Have you ever had the experience of driving somewhere in your car and having no recollection of the ride? That’s mental autopilot in action.”

Translated, the competitive advantage of a firm like Briljent appears to be in its capability to help governments re-imagine how to see the world.

The purposeful rewriting of history
More instructive, perhaps, is the actual language chosen by Briljent to rewrite the history of Rhode Island’s interface with corporate-led health IT design, such as the launch of the Unified Health Infrastructure Project [UHIP], which was launched in September of 2016, four years ago, with disastrous consequences and enormous cost overruns.

The health IT system, built by Deloitte, had been riddled with enormous flaws and glitches, first identified by former HealthSourceRI Director Christine Ferguson in 2014 and presented to incoming Gov. Gina Raimondo in a briefing book, which detailed how defects and glitches in Deloitte’s software had resulted in nearly $9 million in cost overruns because of the need to do manual overrides to correct the problems. [See link below to ConvergenceRI story, “The case of the missing briefing book.”]

[The findings in the briefing book were apparently ignored, and Deloitte was “rewarded” by being selected to help facilitate the work of the Reinvention of Medicaid working group.]

The section in the “RI Current State Assessment” document describing the UHIP fiasco makes no mention of UHIP; rather it adopts the state bureaucratic language of branding the effort as “RI Bridges” as the headline for the “rewritten” history.

It reads: “In 2015, EOHHS transitioned the Medicaid eligibility and enrollment system, formerly called InRhodes, to create the RI Bridges system, a single technical platform that supports Medicaid, HSRI, and other state human services eligibility. RI Bridges is an interagency initiative between EOHHS, HealthSource RI, and OHIC.”

The section headlined “RI Bridges” continued: “The first phase of this effort, to implement the [Affordable Care Act] and develop an integrated approach to Modified Adjusted Gross Income [MAGI] Medicaid and health insurance exchange eligibility, went reasonably smoothly [emphasis added].”

Reasonably smoothly? Talk about bureaucratic balderdash and outright distortion. What about the $9 million in cost overruns attributed directly to flaws in Deloitte’s system identified in 2014 by HealthSource RI? That is like saying: the Trump administration in the last seven months has managed the coronavirus pandemic in the U.S. “reasonably smoothly,” with more than 7 million cases and more than 210,000 deaths, and counting.

The section continued: “The integration of the remaining human services programs such as Supplemental Nutrition Assistance Program [SNAP], Temporary Assistance for Needy Families [TANF], childcare support, and long-term care proved to be significantly more difficult [emphasis added], with a premature roll out [emphasis added] resulting in negative consequences [emphasis added].”

Significantly more difficult? Premature roll out? Talk about understatement, rewriting history and willful obfuscation. The “significantly more difficult” operation led to federal lawsuits, the resignation of the Secretary of R.I. EOHHS and the demotion of her top aide, and a series of angry House Oversight Committee hearings. [See link below to ConvergenceRI story, “Waiting for a technological Godot or someone like him.”]

The UHIP roll out had been pushed by Gov. Raimondo’s team, despite a two-month delay, complaints from numerous stakeholders both inside and outside the administration, and warnings issued by the federal government. The other problem, never talked about, was the apparent conflict of interest because Michael DiBiase, then R.I. Director of Administration, and Elizabeth Roberts, then Secretary of the R.I. Executive Office of Health and Human Services, were involved in a romantic relationship, while at the same time they were busy promoting the “inaccurate” premise that the new UHIP program would result in lower labor costs and improved efficiencies through which the initiative was expected to pay for itself in little more than a year.

Negative consequences? If Briljent adhered to its philosophy articulated in its blog – “it requires approaching the pose with an open mind and an open heart and being willing to begin again, each and every time” – the corporate consultant should be willing to provide more honest details about what those negative consequences entailed.

For instance, the promised online portal to apply for Medicaid eligibility for long-term supports and services never worked and had to be abandoned. The resultant delays in processing Medicaid eligibility applications for long-term supports and services, with hundreds of applications piling up beyond the 90-day period allowed by state law, pushed a number of nursing homes to the brink of bankruptcy, requiring more than $180 million in emergency payments to be made by the state to keep them from going out of business. Yes, there were some “negative consequences.”

Three years later, there was still a backlog in processing Medicaid eligibility claims in a timely fashion, there was still no online portal, and the problems with the Deloitte system still require expensive work-arounds. [See link below to ConvergenceRI story, “The issue is still UHIP, says Scott Fraser, president and CEO of RIHCA.”]

Remarkably, the section continued: “This experience resulted in a loss of community trust regarding the state’s management of IT projects. The subsequent turn-around activities, analysis, and evaluation led to sweeping changes in how the state now manages IT projects and to increases in the capacity and influence of [the Division of Information Technology] across state agencies.” Really? to quote WPRO’s Steve Klamkin.

Translated, the state is still totally dependent on Deloitte to manage the UHIP project, with a new contract signed in 2019 that removes the threat of the state from suing Deloitte for damages. [See link below to ConvergenceRI story, “When it comes to UHIP, money talks, the needy walk.”]

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