Delivery of Care

Strategies to improve the health of communities

State leaders tout their efforts to cut health care costs at Neighborhood Health Station in Central Falls

Photo by Richard Asinof

Ray Lavoie (left), Executive Director and Dr. Michael Fine (right), Senior Population Health and Community Services Officer of Blackstone Valley Community Health Care in a file photo taken at the beginning of construction of the new Neighborhood Health Station in Central Falls

By Louis Giancola
Posted 9/16/19
A former hospital CEO tours the new Neighborhood Health Station in Central Falls and finds much to commend in efforts by the state to control health costs.
What are the demographic trends related to medical costs for older Rhode Islanders, particularly for chronic diseases? Is there a need to invest in programs such as Pay For Success to incent primary care over emergency room care? How does the dependence on the pain scale in medical care get rolled back? Will Rhode Island adopt a toxic stress screening as part its pediatric best practices?
The growing dependence on the use of artificial intelligence algorithms to predict patient behaviors and outcomes carries with it some dangerous trends. The health care system struggles with cultural competence when it comes to care delivery. Patients who push back or ask questions are usually punished rather than rewarded for their advocacy. Arguing with a doctor is difficult; arguing with a cost algorithm is impossible.

CENTRAL FALLS--When ConvergenceRI asked me to cover a press conference being held by Gov. Gina Raimondo at Blackstone Valley Community Health Care's new facility in Central Falls, I was excited to learn how, under the leadership of Executive Director Ray Lavoie and Senior Population Health and Clinical Services Officer Dr. Michael Fine, Balckstone Valley was working to improve the health of the residents of Central Falls. I arrived early and was ushered into a basement room that had been set up for the press conference. Many healthcare leaders in the state began to arrive, including Zach Sherman, the Director of the RI health exchange HealthSource, Marie Ganim, Health Insurance Commissioner, and Wamzetta Jones, the new Secretary of Health and Human Services. The Mayor of Central Falls, James Diossa, was also in attendance and being congratulated on the birth of a child.

The Governor arrived right on time [which is unusal for politicians]. Lavoie welcomed the guests, including a young couple with a baby, who were the first on the agenda. While holding their new baby, Gabe and Rebecca Atwood talked about being able to move back to Rhode Island and start a new business because they could afford individual coverage from HealthSourceRI. Rebecca drew the analogy between the foundation of a house and health insurance. She said health insurance is foundational and, in their case, the only the way they could afford to have their first child.  That’s when I realized the focus of the press conference was on health insurance.

The Governor then spoke and announced that, for the first time anybody could remember the new individual rates for health insurance through HealthSourceRI would be going down. She said her counterparts in other states were looking at 10 to 20 percent increases in premiums. She credited the work of Ganim and Sherman for coming up with proposals to stem increases in health insurance premiums. She also credited the Legislature for supporting a state mandate and a reinsurance program. The state mandate replaces a federal requirement to obtain health insurance, a part of the Affordable Care Act that was deemed unconstitutional by the Supreme Court. The Legislature appropriated funds for the Reinsurance Program which were matched by the federal government. The purchase of reinsurance protects the state against high claims which resulted in lower premiums for individuals purchasing insurance through HealthSourceRI. This is very similar to what private employers do when they “self-insure” health coverage for their employees. It protects years when a few very large claims would undermine the financial stability of the company. The business contracts with a third-party administrator to process claims and contract with doctors and hospitals. 

The seventh most healthy state

The Governor also proudly announced a report by The Commonwealth Fund that ranks RI as the seventh most healthy state, right behind Connecticut and Vermont. This ranking reflects a significant improvement over previous reports. The report measures 47 different performance indicators in five domains: Access and Affordability, Prevention and Treatment, Potentially Avoidable Hospital Use and Cost, and Healthy Lives and Disparity. Rhode Island improved its ranking relative to other states in four of the five domains, Avoidable Hospital Use and Cost being the exception in which the state rank slipped by three places.  [The report deserves your attention; see link to report below.]  
Progress and problems

Although one can always quibble with the methodology, the data highlights progress and problems that we face with the health of our population. I focused on the measures associated with Healthy Lives because the performance measures in this domain are a reflection of how effective our health and social support systems are functioning to address significant problems. 
Highlights in the Healthy Lives section of the report were  the rankings of fifth and fourth in the nation for the rates of deaths due to breast and colorectal cancer respectively. These rankings reflect more residents of Rhode Island being screened and early treatment when these diseases are detected. 
There were three findings that highlight serious problems. Alcohol-related deaths were at 9.6 per 100,000, with a ranking of 23rd in the nation. Drug poisonings deaths were at 31 per 100,000, resulting in a ranking of 41st. Adults and children who are obese were both at 31 per 100,000 with rankings of 22 and 30. It is important to keep in mind that these data points are at least two years old and may not reflect recent efforts to combat these serious problems. These shortcomings may require additional investments and resources to improve the health of our residents.
Although some of these health problems, such as drug addiction, cross socioeconomic lines, poor, minority communities often experience even worse problems. I have some experience working with low income communities to improve health status and quality of life. This work is extremely difficult. The impact of institutional racism and poverty over many generations has taken its toll on the physical and mental health of residents of these communities. The struggle to make ends meet saps energy and can lead to responses, such as poor eating habits or drug use, that creates or exacerbates health problems. People can be reluctant to speak out for fear that they will lose basic necessities, such as subsidized housing or access to health insurance. I often think about what my life would be like if I was struggling to get by on a day-to-day basis.
A tour into the future

After the press conference, Ray Lavoie guided us through the new facility. He is justifiably proud of the great primary care, behavioral health and dental services Blackstone Valley now offers to Central Falls residents, in one location right in their community. The facility also has a Drop-In Clinic available to people even if they don’t receive ongoing care from Blackstone Valley. Hopefully, it will serve to connect patients to a system of care. During the tour Dr. Fine, who has been promoting the concept of a Health Station, talked about how representatives of emergency medical services (rescue), social services, police and doctors meet to better coordinate services to address the underlying reasons that people are experiencing medical emergencies or seeking care in the wrong settings. The objective for these patients is to marshal resources that can improve their health and their well-being. RI is fortunate in having many community health centers that serve so many low -income communities in our state. But healthcare alone is not sufficient to further improve the health of our population. 
I was glad that I attended this press conference not expecting to learn that the efforts of people I greatly admire like Dr. Marie Ganim and Zach Sherman have stemmed the increases in the cost of health insurance. That is incredibly important. But the real news for me was that, although the health of Rhode Islanders has improved, we have so much work to do. I’m also glad the Governor focused on this report by The Commonwealth Fund which deserves our attention.
Louis Giancola is the former President and CEO of South Country Health


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