Innovation Ecosystem

Through a lens of racial equity

A one-on-one interview with RI EOHHS Secretary Womazetta Jones -- and her plans to bring Health Equity Zones under the EOHHS umbrella

Photo by Richard Asinof

R.I. EOHHS Secretary Womazetta Jones.

By Richard Asinof
Posted 2/14/22
R.I. EOHHS Secretary Womazetta Jones shares her vision for the future directions of her agency, including bringing the Health Equity Zone initiative under the EOHHS umbrella.
What will be the future role of Optum, a wholly owned subsidiary of UnitedHealthcare, which has been deployed by both Neighborhood Health Plan of RI and UnitedHealthcare as part of their managed care organizations for Medicaid members, seemingly a conflict of interest? Why does there seem to be a revolving door enabling the former director of the Rhode Island Medicaid office, Ben Shaffer, secure a job as a principal with the Boston Consulting Group, a private consulting contractor with the state? What kind of legislative intervention is needed to secure increases in Medicaid reimbursement rates, even there is nothing in the Governor’s proposed budget for FY 2023? What kind of financial conditions, if any, can be created as part of a proposed merger between Care New England, Lifespan, and Brown University to support the expansion of Health Equity Zones, given that 90 percent of health outcomes are determined by determinants outside a doctor’s or nurse’s office?
The wisdom of R.I. Attorney General Peter Neronha in his insistence that financial conditions be placed upon the sale of CharterCARE by its private equity owners has been proven by the latest developments: California-based Prospect Medical Holdings is reported to be selling its health systems in Connecticut to Yale New Haven Hospital, and apparently, it is also seeking to sell its ownership of CharterCARE – including Roger Williams Medical Center and Fatima Hospital – an event that Neronha had predicted to be a likelihood once the outstanding loans came due.
What has yet to be addressed in any substantial way are larger questions about the sustainability of the business model for health systems in a world where private equity has become the owners of many hospitals – where the desire for profits outstrips the need for better patient care.
The increasingly important role that community health centers play – and the success of non-hospital-centric models of care such as Ortho RI – point to a different direction that health care can choose to move.

PROVIDENCE – When Womazetta Jones arrived in Rhode Island in 2019 to take on the position of Secretary of the Executive Office of Health and Human Services, she announced her intention to lead the state in a series of uncomfortable conversations around racial equity.

“We have to get comfortable with having uncomfortable conversations about racial equity,” Jones declared, at a reception held in her honor at the Rhode Island Foundation on Aug. 22, 2019, as tweeted out by Angela Ankoma, who was then executive vice president at United Way of Rhode Island and now serves as an executive vice president at the Rhode Island Foundation. [See link below to ConvergenceRI story, “It is time to have some uncomfortable conversations.”]

In an in-depth interview later that month with ConvergenceRI, Secretary Jones laid out what she called the pillars of her job: “Community engagement, racial equity, and working with the whole person.” We have to ensure, she continued, “that we are giving up power. We need the community to know that their voices… are the ones that need to lead how we do this work, to help us shape this work.” [See link to ConvergenceRI story below, “A change is going to come.”]

In July of 2021, the next time Secretary Jones sat down for a one-on-one interview with ConvergenceRI, she talked about her progress in leading those “uncomfortable conversations” about racial equity. “Well, I will tell you, I didn’t back down. I want to say to you, it is going well, but nowhere near as well as it needs to be.” She pointed to the example that there needed to be an Equity Council established, as the state was making its way through COVID. [See link to ConvergenceRI story, “Listening to our authentic voices.”]

Two and a half years later, with Rhode Island still in the midst of a pandemic, when the lens of racial equity has revealed deep fissures in the way that services have been delivered to underserved and vulnerable Rhode Islanders, Secretary Jones found herself unexpectedly at the center of what appeared to be one of those “uncomfortable” moments, when she attended a news conference on Tuesday, Jan. 25, 2022, held by R.I. Attorney General Peter Neronha, to announce a $112 million settlement with drug manufacturers and distributors. [See link below to ConvergenceRI story, “Holding bad corporate actors accountable for their misdeeds.”]

Secretary Jones, a woman of color, was the only woman among eight other public officials, all men, including Gov. Dan McKee, House Speaker Joseph Shekarchi, Providence Mayor Jorge Elorza, and Senate President Dominick Ruggerio. Yet she was not invited to speak from the podium – even though Secretary Jones would be placed in charge in directing how some $90 million in funds would be spent toward the purpose of “opioids abatement.”

During the speeches, as reported by ConvergenceRI, there was: “a sly fist bump that House Speaker Joseph Shekarchi gave to Senate President Dominick Ruggerio, after each had spoken from the podium. The fist bump was performed literally in front of Secretary Jones, who was sitting in between them… The two legislative leaders simply ignored her presence as they fist-bumped.”

For whatever reason, none of the other media attending the news conference reported on the fist bump – but Secretary Jones told ConvergenceRI during an interview conducted on Feb. 7 that she was well aware of what happened.

ConvergenceRI: At the $112 million settlement news conference, there was a moment when House Speaker Shekarchi and Senate President Ruggerio fist bumped, right in front of you, as if you were invisible. Were you aware that had happened?
JONES: I was definitely aware that it happened. I don’t know the narrative behind what led to it. But, of course, I was aware that it happened.

ConvergenceRI: To me, and I could be wrong, but I saw it as an example of what I would call “unconscious racism” – particularly because you were not invited to speak from the podium that day, which I found to be offensive. Is that something you can talk about?
JONES: What I would say to that is this: I would encourage the two of them to think about what was behind the fist bump; and it being [done] in front of me, rather than behind me.

And, I would encourage them to think about that. More so, perhaps for those who were present, and [for those who were] speaking, to look at the reason why [the person leading] the entity responsible for shepherding those dollars was not given an opportunity to say a few words.

I was the only woman up there, too. [I would ask them] to think about that. They could just take a moment to think on it. I really want to think, Richard, whether naively so, but I would like to believe that they meant no disrespect for me, and it wasn’t intentional, whether it be the fist bump, or [my not] speaking from the podium, that it wasn’t intentional to be disrespectful. But, I think they need to be aware of what were the reasons.

ConvergenceRI: Was it OK for me to raise that issue, based on what I observed, in my story?
JONES: Yes, I was very proud of you for raising that, because you can say things that I can’t. There are some things that I do say, whether people like it or not. My statement would be, I think that they need to think about: Was it disrespectful? Am I owed an apology? And, that is for the fist bump [and for] not being allowed to speak.

ConvergenceRI: I appreciate your discretion in what you are saying. In my role, I am often put in this situation where I am the one who has to raise the uncomfortable questions, to pursue the uncomfortable conversations, as part of my reporting.

Here is the ConvergenceRI interview with Secretary Womazetta Jones, the latest in a series of continuing conversations, talking about the future challenges facing R.I. EOHHS, and the efforts to bring the Health Equity Zone initiative in Rhode Island under the umbrella of her agency, in order to braid more resources and funding to make the initiative more sustainable.

ConvergenceRI: How do you see the future challenges for R.I. EOHHS, and where you are going?
JONES: That is a big question and a good question. You know, Richard, the first thing, I think, for me, is it is important to me that people truly understand what EOHHS is and what our statutory authority is, and what we actually, truly can do – and cannot do. Because I believe that there is a narrative out there that is not accurate.

If you read the statute about EOHHS, and you read the department statutes, we have a Secretariat model that is not smooth and easy to operate.

But, I believe that EOHHS has really tried to overcome those challenges, to really, for example, handle budgeting. Budgeting is supposed to be centralized. I can say that at least, under my watch, we have really been pushing to make it clear that budgeting is centralized and that budgeting decisions – that, in the end, go to OMB and the Governor’s office – are done so after the Executive Office has looked at everything, and then moved forward what is not duplicative, what is complementary, and what really moves the mission forward to truly help all Rhode Islanders.

But, there are certain things that EOHHS does not have the authority to do. We [do] not oversee personnel [decisions]. Directors do report to the Governor, unless the Governor delegates it differently. And, the Secretary at EOHHS only knows what he or she is told.

It is important for people to truly understand what the boundaries are – or what the barriers are – to EOHHS truly being a true Secretariat model. To get there, we are going to have to change the statutes. We are going to have to invest more resources. And, we are going to have to actually support EOHHS.

So, when I look at the big picture of what is happening in today’s world, that’s what is important to me. I never make excuses. I am going to own what I haven’t done, and what I should have done. However, it is very difficult being held accountable or responsible when I don’t have the authority.

ConvergenceRI: What changes in the Secretariat model, if you free to talk about it, would you like to see? I know that, for instance, for some of the departments under you, you do not necessarily have access or information to what they are doing, and you can’t control their decision-making. Is that accurate?
JONES: That would definitely be accurate. The word “control,” I think, is the most important word. I can attempt to influence, I can recommend, I can be very strong in my direction. However, statutorily, department directors report to the Governor. And, statutorily, there are many pieces that the directors completely control, not EOHHS or the Secretary.

What I would truly love to see is a system that is rooted, first and foremost, in helping to support and strengthen all of our families in Rhode Island – in whatever many ways they may need those supports – whatever a family may need.

That is what we need to do. And, I really believe that a Secretariat model is the right model. But that model has to be situated in a way that the Secretary at EOHHS can truly have more control. I am not saying ultimate control, because I don’t recommend that anything have all the power. I want to stress that.

I am not advocating for EOHHS to have all the power. But there has to be a mechanism created to allow EOHHS to truly have the oversight and management authority to coordinate the work the right way for all Rhode Islanders.

You see that when you look at budgeting, for example. One of the things that I am told that has happened under my watch, not previously, was that all budgets first come to us at EOHHS. And, we meet with each department and we talk to each department about ways that they are duplicating, or ways that they can better connect, to achieve the ultimate goals.

Those are the budgets that are submitted to OMB, and then, in turn, shared with the Governor’s office. [Editor’s Note: The Governor, however, as happened with a number of budget requests made by EOHHS, does not have to honor those requests.]

We are getting there. But, even with that, because we do not have certain authority, we may not know about certain elements that are happening within departments, if they don’t tell us. We don’t know. And so, it is very problematic.

I think that Northeasterners like to compare [each state] to one another. We need to look at how Massachusetts has [created] its Secretariat model – and how it differs so greatly from how we have done ours. They have had some successes that are rooted in the structure that they have put into place. And, we could have some of those same successes, if EOHHS was given that opportunity.

ConvergenceRI: Let me follow up with a question about the future of Health Equity Zones. Could you talk about what you would like to see as the future direction of HEZs in Rhode Island?
JONES: Most definitely, because I am excited right now. One of the decisions that I have made is that the Health Equity Zones need to fall under EOHHS. The reason: HEZs are cross-agency. They are not just about the R.I. Department of Health. I can easily give examples of HEZs and the inter-connectiveness with DCYF, with DHS, with BHDDH, easily, without a doubt. As such, cross-agency initiatives such as what a HEZ is, it’s best for the HEZs to actually fall under EOHHS, for us to bring all of the departments on board, with helping these be successful.

Because we know that the true mission of the HEZ is to build a healthy and resilient Rhode Island by investing in our communities and in their capacity to affect change. But also, we are talking about, in particular, our communities of color and communities that are poor in terms of socio-economics.

So, I have been looking at how we can really make HEZs bigger and better and greater. And, to me, it made sense to start to move this piece over to EOHHS, so that we can grow the HEZs appropriately,

There have been some things, like the Mayor of Central Falls, who has spoken with me in the past about the fact that with COVID, it was like dollars were passed through the HEZs to the community. And, I have had to say, I don’t know if that was right or wrong, but I think that we could have done it in a way where nobody thought it was a problem.

We have some areas of the state where they don’t even know what HEZs are. I don’t understand why that is, because HEZs should be in every community. They really should be. I think it is great when you look at how we braid those interagency funding pieces, and in looking at being authentic about equity work, my thought is, in the upcoming fiscal year, to begin to bring the HEZs under EOHHS.

Of course, it is a perfect time to do so, with us having an Assistant Secretary Ana Novais, because it was actually her brainchild. And, we can do so much for it, if it is at EOHHS. [Editor’s Note: Novais is currently on loan to the R.I. Department of Health, serving on the transition team for a new director.]

ConvergenceRI: I am aware that Ana Novais rarely gets the credit that she deserves for shepherding the HEZ initiative forward.
JONES: She has a portfolio about the evolution of HEZs – of how to braid more funding together and how to better connect with communities. That is why I really believe that the right space for HEZs is under EOHHS – and it is perfect timing having the person who truly dreamed about this, and moved it, who is now Assistant Secretary, to help fund and plan within EOHHS. And, more importantly, [helping to create] that centralization of funding and budgeting will help the HEZs become more a lot quicker.

ConvergenceRI: One of the things I was really impressed with, in the settlement of the $112 million that Attorney General Neronha announced, was that there was going to be this new advisory council created overseeing how the state plans to disperse some $90 million toward the purpose of opioids abatement, and you are in charge of it. Can you talk about what that role means to you?
JONES: Personally, it means so much to me. It really does. Richard, as you know, my entire career has been in health and human services, from working as a direct line staff to supervisor to whatever the top roles were in the three states that I’ve worked. This opioid work has been something that has been at the front of my mind and part of my spirit. It means a lot to me that it is going to be shepherded by EOHHS.

And, as it relates to the Advisory Council, when I look at the fact who is part of that advisory council, most importantly, I believe is the fact that it is going to have three community members, and three experts, and we are going to have six people, I believe, representing the cities and towns.

We will have some major stakeholders who should be also held accountable looking at this, such as having the Attorney General’s office having a seat, the House Speaker, the Senate President at the table. And, they can work together to make recommendations.

I also want to make it very clear that the work needs to be outcome driven, and the outcomes need to be about all of our communities. I look forward to being able to really saturate this with a racial equity lens and a socio-economic lens – and ensuring that all communities truly benefit from us attacking this crisis.

ConvergenceRI: One of the things you talked about, from the time we first did an interview back in 2019, was your strong feelings about how communities have to have a seat at the table – and that their voices have to be heard. There has been some concern within from the recovery community that their voices haven’t been heard, in the past, particularly around budgetary issues. Do you think, while you are ready to listen, that other folks are ready to listen to what members of the recovery community have to offer, in defining what recovery means?
JONES: You know, I want to believe that they are ready to actually listen. And, not just listen, but let their actions show that they are really listening. What I can say to you is this: They will not be able to say that they didn’t hear it, because this will be a public meeting. What is shared, everyone will know. And, no one will be able to say, “Well, I wasn’t aware.”

I am going to push very hard to make sure that the three experts are truly community members and not providers, per se. But providers with real, lived experiences, and really entrenched in the work. There will be no way that they can say: they didn’t hear it.

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