CRANSTON – So much has changed since March of 2016, which was the last time that ConvergenceRI had an opportunity to sit down and talk with secretary of the R.I. Executive Office of Health and Human Services, conducting an in-person, face-to-face interview.

At that time, two years ago, Elizabeth Roberts was secretary at EOHHS and Anya Rader Wallack was the director of the R.I. Medicaid office.

Both have since left government service, with Wallack leaving to work at Brown University School of Public Health, and then Roberts resigning in the aftermath of the bungled rollout of the Unified Health Infrastructure Project.

Mike Raia, who also sat in on the March 2016 interview, was then serving as the director of communications for EOHHS; Raia is now the overall director of communications for the Raimondo administration.

In terms of capturing a snapshot of that moment in time, the launch of UHIP was then scheduled to happen on July 1, 2016; the launch was subsequently postponed to Sept. 13, 2016, a harbinger of problems to come.

The headline for the ConvergenceRI story, published on March 14, 2016, was: “Measuring success at EOHHS.” [See link to story below.]

Much of the interview at that time focused on the calculations of savings projected under the Reinvention of Medicaid program enacted by the R.I. General Assembly as one of the signature efforts of Gov. Gina Raimondo during her first year in office, digging into the numbers for how the new accountable entities created as part of the framework would work.

Fast forward to Wednesday, Feb. 21, 2018, when ConvergenceRI sat down to talk with Eric J. Beane, the current secretary at EOHHS, with his communications director, Ashley O’Shea, sitting in on the interview. The interview took place at Panera Bread at the Chapel View development in Cranston.

For sure, ConvergenceRI and Beane had often crossed paths since he became secretary at EOHHS – at news conferences, at oversight hearings, and at Task Force meetings.

The most recent interaction had been at the announcement that Rhode Island had been chosen by the National Governors Association to be one of five pilot programs to focus on work being done on neonatal abstinence syndrome, or NAS, with babies who had been with a dependency on drugs. Featured at the news conference was Dr. Barry Lester, the director of the director at the Brown Center for the Study of Children at Risk.

Following the presentation, ConvergenceRI had asked Lester about whether his work to develop a new diagnostic tool for a more reliable and systemic way to identify NAS, based upon a sophisticated acoustic system and database to track and analyze the cries of infants. The effort seeks to develop an automated, hand-held, iPhone like device.

Lester had blurted out in response: “How do you know about that?” To which ConvergenceRI replied, “I interviewed you last year about it.”

That exchange had peaked Beane’s interest, who had toured the NICU at Women and Infants Hospital with Lester, but was unfamiliar with the research on the new diagnostic tool. The result was an interview with ConvergenceRI the next week.

A willingness to engage
In advance of the interview, ConvergneceRI shared a number of recent stories with Beane and O’Shea. At the beginning of the interview, Beane said that he was very familiar with ConvergenceRI and frequently went to the website to check out if there had been stories that he had not seen.

“I remember when I first moved to Rhode Island in 2015, when you were reporting on Reinventing Medicaid, there was a layer of in-depth reporting that was not found in other publications,” Beane said.

Perhaps one of the most significant developments as part of the process of sitting down and talking with Beane was the opening up of communications channels moving forward. That was reflected in the prompt sharing of data with ConvergenceRI regarding the use of Emergency Medical Services for hospital transports of patients with “impressions” of alcohol intoxication, related to reporting that ConvergenceRI had conducted about the prevalence of such transports in 2017. [See link below to ConvergenceRI story, “Moving beyond dilly dilly.”]

Thanks to Beane and O’Shea, here is that data for 2017:

• There were 2,169 ambulance claims for alcohol intoxication that were paid for by the R.I. Medicaid.

• There was $106,120.59 paid for ambulance claims and $854,622.08 paid for associated hospital claims [for alcohol intoxication], for a total of $960,783.07 in 2017.

• There were some 225 out of 919 people who had more than one transport by EMS ambulance to hospitals, but there was no one who had been transported by EMS to hospitals 10 or more times.

“There are a lot of existing strategies that we know work, but where we are not reaching everybody, that I think require more attention,” Beane said, talking about the ongoing work of the Governor’s Task Force on Overdose Prevention and Intervention. Even with medication-assistance treatment, he continued, “which has a strong evidentiary basis for it, we’re not connecting to all the Rhode Islanders who would screen for the need for treatment right now.”

Beane continued: “There is still some stigma and barriers [to overcome], but there is a lot of opportunity there [to improve our reach]. We need to focus our attention on the areas where we can have the biggest impact.”

In regard to the potential for Rhode Island to consider medically supervised consumption centers as part of a statewide harm reduction strategy, Beane voiced some concerns.

“In terms of injection sites, it is on the table for consideration,” he explained. “But it’s not clear at this point if that is the solution that makes the most sense for Rhode Island.”

If it is something that the community believes would be useful, Beane continued, it will be considered. “We’re doing the things that we know there are a demand for, that we know there is a strong evidentiary basis for,” he said. “We are not covering our ears to any potential solutions, but at this point, I don’t think there is a consensus that this is the right thing to do.”

What stood out for ConvergenceRI following the interview with Beane, the first opportunity to sit down and talk in person, was a sense of earnestness that Beane exudes, and his willingness to listen and to engage in conversation.

Here is the ConvergenceRI interview with Eric J. Beane, secretary of the R.I. Executive Office of Health and Human Services.

ConvergenceRI: At the most recent Task Force meeting, you spoke about your desire to break down silos in government and the importance of doing so. Can you talk about why that premise is so important for you, as a matter of policy and practice?
BEANE: If I may, I’ll tell you my personal story. I moved to Rhode Island, as you may know, at the start of the Raimondo administration, Jan. 1, 2015.

Before that, I had worked for Gov. O’Malley in Maryland, and the last job I held for him was deputy chief of staff, overseeing all of the public safety agencies.

The health secretary had come to me and said, “I need your help. The overdose crisis is exploding; I need public safety officials and law enforcement officials to start thinking differently about their work.”

And so, he and I partnered together with others in the O’Malley administration and created an overdose prevention council. We had discussed it with Gov. O’Malley, and persuaded him to issue an executive order creating that group.

The key message there was that you needed to break down these silos, and to start that by data sharing across different agencies.

We had some hypotheses about where there were areas where we could have the biggest impact. We saw that there was potential in getting first responders, such as police and EMTs, greater access to naloxone.

This was many years ago; it seems normal now. But it wasn’t normal five years ago.

We also wondered about people coming in and out of prison and jail, and how much that was a contributing factor in the increasing number of overdose deaths.

We worked through all the legal issues that were required to share data across all of these different state agencies. When we compared the medical examiner’s data with the prison’s data, we found that there was a greater risk of overdose in the first seven days after someone leaves [prison] during any other time period during the first year [on the outside].

Washington State did a similar study in recent years that found that there is an especially high risk of overdose then.

I think you know, in the epidemiology of addiction, that tolerance is a key attribute. When you lose your tolerance [having detoxed in prison], you’re more susceptible to an overdose. I had that in the back of my mind when I came here to Rhode Island.

The Governor told me during my first meeting with her, after the interview, she said this is something that I want you to focus on. I had a sense of how it had been approached in Maryland.

I think that Rhode Island was ahead of most states, that Rhode Island was a little more forward thinking about this, because it was one of the earliest and hardest hit states. There were already a lot of good strategies in play.

My experience in working in state government had shown me that agencies often think about their core mission and their core programs and miss opportunities to help the people that they are trying to serve.

And, a crisis like the addiction and overdose one, it requires everybody to come to table and think about how their works relates to each other.

ConvergenceRI: Can you explain what you mean?
BEANE: So, a paradigm shift has occurred, where you’ve got West Warwick police officers doing pre-arrest diversion and visiting people homes.

You’ve got the state police tapping into Google [settlement] funds to distribute naloxone; you’ve got the Department of Corrections screening people for addiction and helping to get them on a course of treatment, or maintaining an existing course of treatment.

ConvergenceRI: The initial results achieved as a result of the introduction of the medication assisted treatment in the prisons was impressive.
BEANE: The result in comparing those two six-month periods, [before the program was introduced and after the program began], while I expected it was going to be successful, and I thought it was the smart thing to do, and I thought it was the best thing for the individuals, I didn’t expect a 61 percent reduction [in overdose deaths] comparing those two six-months periods [before and after medication assisted treatment was made available to prisoners]

That is a meaningful glimmer of light in a really tough crisis, a sobering crisis.

ConvergenceRI: How do efforts to develop a comprehensive statewide harm reduction strategy fit into the work plan of the Task Force? It was one of the tasks listed in the July 12, 2017, executive order by the governor.
BEANE: The governor’s approach form the beginning has been to create an open process, with a broad representation of stakeholders. Her view is we need to consider all strategies that may work.

She wouldn’t have issued another executive order if she didn’t think that there were more areas that required additional attention. The fact that she included [harm reduction strategies] in there shows that she recognizes we need to be thinking about harm reduction as well as more efforts about prevention, which was also highlighted in the second executive order.

I think there are a number of harm reduction strategies already in place that we need to stay focused on. [Making] Naloxone [more available] is acknowledging that there are drug users who overdose. We should care about that; we should arm people with tools to save lives.

Another [strategy in place] is the needle exchange program, which obviously dates back to an earlier crisis. There is a lot of evidence about the positive benefits from investing in those strategies, not only limit the spread of HIV but also of other infectious diseases.

ConvergenceRI: Is there a need to address, as part of the overall strategy, what some have called the diseases of despair, looking at economic and social disparities, as part of the road to recovery? Also, the connections to sexual violence and domestic abuse?
BEANE: What you’re getting at here is important. Overdose deaths are the most acute aspect of a broader challenge that society is facing with the prevalence of behavioral health problems, such as mental illness.

Overdose is now the leading cause of death in America for people who are under the age of 55. That’s a startling statistic. The governor is focused on broader strategies to get at the need for better access to behavioral health services; in fact she mentioned it in her state of the state address.

It is a signal that it will be a priority for her this year. She has asked the Health Cabinet to look at the issue in a number of different ways. Historically, we have heard from the community that there are parity issues. We need to break those down, to make sure that treatment is on a par with physical health.

I think through some of our work with Medicaid, people have begun to think differently about the need to integrate services, to look at the whole person, and think more about how community service sand support services are necessary to meet people’s needs.