Delivery of Care

The challenges of speaking up when it comes to challenging policy

Leading Age RI hosts its 13th annual policy summit, but the audience seemed timid to talk in public about policy challenges with state officials in the room

Photo by Richard Asinof

James Nyberg, left, director of Leading Age RI, and Ted Nesi, WPRI-TV, who was the keynote speaker at the 13th annual policy summer hosted by Leading Age RI.

By Richard Asinof
Posted 10/2/17
The 13th annual policy summit hosted by Leading Age RI focused on long-term care offered a series of engaging speakers and panel discussions, from Chis Koller to Ted Nesi, but the audience attending seemed reluctant to engage publicly in conversation around policy questions.
Is there a need for the long-term skilled nursing facility industry and the long-term care industry to develop a stronger, more unified advocacy voice? Why was there no discussion of the damage done by UHIP to the long-term care infrastructure in Rhode Island, given the fact that the state’s top health officials were there? What lessons can be learned from the effective advocacy efforts by citizens to fight back against Republican efforts to repeal and replace Obamacare? Is there a need to hold those responsible for the bad decisions around the UHIP launch accountable, to be able to understand what went wrong and why? Should the state consider suing Deloitte for breach of contract? What is the current actual cost of the roll out of UHIP?
Rhode Island is getting older, and the demands upon the state’s health care infrastructure will only increase, including the costs of care. There is still no public accounting for the outcomes from the first phase of the Integrated Care Initiative, coordinated by Neighborhood Health Plan of Rhode Island. Efforts to trim some $9 million from the Neighborhood budget because of a lack of results somehow were derailed during the House budget negotiations, with no public explanation.
Rhode Islanders who were insured under Neighborhood Health Plan commercial health insurance plans were pleasantly surprised this week to receive a rebate for their premium fees paid, because Neighborhood did not spend the required 80 percent from the premiums it received on health care services, as mandated by the Affordable Care Act.
In 2016, Neighborhood spent only 75.8 percent of the total $56.9 million it received in premiums on health care and activities to improve health quality. As a result, the insurer was required to rebate 4.2 percent of the customer’s health insurance premiums by Sept. 30, 2017.

WARWICK – In a word, the audience response attending the annual 2017 policy summit hosted by Leading Age RI and the R.I. Assisted Living Association was quiescent.

The program included a number of challenging presenters: Barbara Gay, the vice president for Public Policy and Communications for the national office of Leading Age in Washington, D.C., gave an in-depth analysis of the legislative prospects in Congress for health care, steeped with a kind of insider knowledge that most news reporting lacks. The response to Gay’s talk was tepid applause.

Next, Chris Koller, the president of the Milbank Memorial Fund and the former R.I. Health Insurance Commissioner, using the phrase that former New York City Mayor Ed Koch always asked reporters, “How am I doing?” asked the audience to consider why the rankings in the Long-Term Services and Supports State Scorecard was so low – Rhode Island ranked 32nd compared to Vermont at third, Connecticut at 10, Massachusetts at 11, New Hampshire at 16, and Maine at 18.

The measures in the scorecard included: support for family caregivers, effective transitions, affordability and access, choice and setting and provider, and quality of life and quality of care.

Koller debunked any number of excuses for the poor performance, using the five stages of grief analysis. He then challenged the audience to consider what long-term care service providers could do to improve their performance, based upon other examples of successful innovative health initiatives in Rhode Island.

Among the suggestions Koller offered:

Recognizing that the strategy of rebalancing was necessary but not sufficient to change the outcomes.

Realizing that the challenge was one of leadership and culture, not technical policy changes

the reasons why other states, such as Georgia and Delaware, have achieved improved results

Looking at how Rhode Island was able to achieve stellar results in children’s health, recognizing that the high performance was not an accident.

Koller said that advocacy groups such as Rhode Island Kids Count played a critical role, refusing to let the discussion around children’s health be one that only involved the government and providers, demanding a seat at the table. Koller urged the attendees to go to the annual Rhode Island Kids Count breakfast to see how advocacy efforts for kids can be leveraged into political capital.

The last slide in his presentation asked: are we prepared to do as well for our seniors and people with disabilities? Good question.

Louder applause followed, but there were still not many provocative questions.

RI Bridges
Next up was a brief presentation by Eric Beane, the secretary of the R.I. Office of Health and Human Services. That was followed by a panel discussion that included: Lt. Gov. Dan McKee; Patrick Tigue, the director of R.I. Medicaid; Courtney Hawkins, director of the R.I. Department of Human Services; Gary Liguori, dean of the College of Health and Sciences at URI; and Benedict Lessing, president and CEO of Community Care Alliance.

As part of the conversation, the Unified Health Infrastructure Project, or UHIP, was referred to as RI Bridges.

The audience, once again, did not seem to want to engage with the panelists on issues related to reconciliation of interim payments made to skilled nursing facilities or whether or not there would ever be an online portal for Medicaid eligibility for long-term care services.

Hawkins did talk about the enormous number of changes being undertaken to correct problems with the Deloitte software glitches.

The only fireworks from the audience came from a person of color who identified the lack of diversity in home health care providers as a big problem. People of color want to be cared for by people who look like them, she said. Further, in the future, she continued, panel discussions need to look at ways to include people of color as panel members.

That sparked a discussion about how to make the educational opportunities more accessible to diverse students. But no one seemed to know about the Rhode Island Nurses Institute Middle College, a program that is targeted at urban high school students to begin an intensive nursing educational program beginning with 10th grade students, or the efforts at Rhode Island College to work with parents.

Nesi’s notes
The keynote address at the summit was given by Ted Nesi, reporter and columnist at WPRI TV, who offered a series of analyses of the politics of health care, state budget problems, continuing concerns about UHIP, and some early commentary on the upcoming governor’s race in 2018.

In discussing the problems with UHIP and its botched rollout, Nesi shared with the audience his own questions about what could he have done differently in his reporting to challenge what state officials were saying.

[Left unsaid, perhaps, was what those in the audience could have done to speak out more forcefully about what happened with UHIP in advance of the botched rollout, which occurred just a year ago, on Sept. 13, 2016.]

Nesi also called attention to the fact that the contract for Deloitte expired on Sept. 30, with little conversation or doubt that it would be renewed by the state.

Nesi also said that covering the health care debate in Congress was often like being stuck in a rerun of Groundhog Day.

One of the political lessons learned from the debate was the realization that Medicaid was a much more resilient program with broad popular support, making it difficult to eliminate and drastically cut back, according to Nesi.

In terms of the state budget, Nesi expressed worries about how the $25 million in cuts to state funding would be achieved on the to-be-determined basis.

It will not be easy to find places to cut, Nesi warned. He mentioned that the operating budget of the R.I. Department of Health had been cut some 23 percent in recent years, and that the projected deficit for the next budget cycle was some $237 million.

Finally, in terms of the upcoming governor’s race, Nesi wondered what the potential impact of a Lincoln Chafee entrance into the Democratic primary, running against Raimondo, would be. In addition, he wondered whether the botched UHIP rollout would dog Raimondo in her re-election campaign.

On the Republican side, he described the current potential candidates as Cranston Mayor Fung, Rep. Patricia Morgan, and former state Rep. Joe Trillo, one of the earliest supporters of Donald Trump.

Nesi shied away from making any conclusive statements about the upcoming campaign, other than to say that there were lots of frustrated voters in Rhode Island.

The audience gave him a rousing round of applause.


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