Innovation Ecosystem

What happens to a question deferred?

It has been difficult to get an answer from Gov. Raimondo and her team about what the plans are for future budget investments planned for Health Equity Zones

Image courtesy of Gov. Raimondo's communication team

Dr. Nicole Alexander-Scott, left, the director of the R.I. Department of Health, and Gov. Gina Raimondo, have championed Health Equity Zones. But no answer has been forthcoming yet about how much will be invested in Health Equity Zones in the proposed post-pandemic budget for FY 2021.

By Richard Asinof
Posted 6/29/20
The future of health outcomes in Rhode Island will be determined, in large part, in whether Gov. Gina Raimondo and the R.I. General Assembly choose to make investments in Health Equity Zones. The problem right now is getting the Governor to answer the question about what her plans are.
How desperate will President Trump become when the American public rejects his re-election efforts – and refuse to drink the Kool-Aid? What kinds of new data constructs are needed to understand how telehealth has changed the dynamics between patient and provider? What are the current state contracts for consulting groups, such as Deloitte, Boston Consulting Group, and McKinsey, identifying the services and the fees? Will the news media in Rhode Island ever own up to what it has gotten wrong in its coverage of health care in the state?
When I was growing up, the dinner table was a time of conversation and argument, where it was OK to be adamant and ferocious in the give-and-take around disagreements. I thought that every family’s dinner table was like that – where arguments were a welcome part of the meal, like dessert and coffee.
In today’s world, I am consistently reminded that, for some folks, arguments and disagreements are considered to be in poor taste. Instead, there is simply a decision not to engage – not to respond to phone calls, not to respond to texts, and not to respond to emails, as if the failure to acknowledge is part of the approved Miss Manners approach to social decorum.
It is like the sound of the dripping faucet – and the wishful magical thinking that if you ignore the irritating noise, it will simply go away. Like the question about investment plans for Health Equity Zones in Rhode Island.

PROVIDENCE – The basic format of journalism is simple: you ask questions; you listen carefully to the answers; and you observe whether or not what is said bears any resemblance to the relative truth. It is not unlike an in-person therapy session, where trained professionals probe for answers, in the hopes of resolving behavioral barriers in which the patient [or, in this case, an elected official] has become stuck, repeating bad patterns [or policies].

Skilled politicians, like nimble boxers, are adept are deflecting probing questions. They often begin by complimenting the questioner, saying, “That’s a great question,” even addressing the questioner personally by his or her first name, and then pivot to give an answer that is totally unrelated to the question asked.

[In President Trump’s case, when confronted with a probing question, he frequently demeans both the question and the questioner, calling it fake news, or challenging the questioner’s professionalism. What does it mean when the President’s venomous response to questions he does not like or does not want to answer is often directed at women of color?

As a journalist, it can be frustrating not to be able to get your questions answered or, worse, ignored.

Recently, ConvergenceRI has found it difficult to get questions answered around exactly what kind of future investments Gov. Gina Raimondo is planning to make in funding for Health Equity Zones in Rhode Island.

Frequently during the last four months, my guess is at least between 10 and 20 separate times, at the once-daily news briefings, both the Governor and Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, have talked about the importance of investing in Health Equity Zones as a public health strategy to fight against the spread of the coronavirus, from a community-based perspective.

It is a question rooted in budget priorities. Money talks. In the Governor’s proposed budget for the FY 2021 [and also in the proposed budget for FY 2020], a proposed investment of $1 million in dedicated funding for Health Equity Zones was not included, despite apparent promises made.

The lack of a sustainable funding stream for Health Equity Zones in the state budget has frequently been translated into contentious discussions around increased financial requirements attached to health systems by the R.I. Department of Health, according to several sources.

Now that the coronavirus has blown up the state budget process for FY 2021, with the Governor and the R.I. General Assembly awaiting the decision whether or not Congress will enact new legislation providing financial relief to local and state governments, my question is: “Has any decision been made around when and how much money will be invested in Health Equity Zones? What are the Governor's plans?”

The question was sent via email on Monday, June 22, to both Josh Block, the Governor’s new communications director, and to Audrey Lucas, the Governor’s deputy communications director. No response has yet been received.

National reputation
For sure, ConvergenceRI is not CNN or MSNBC or CNBC or CBS, when it comes to the frequent availability of Gov. Raimondo appearances for interviews to tout the state’s response to the coronavirus pandemic.

Of course, at the same time, none of the national news programs will ever get the level of specific granularity that ConvergenceRI does in asking questions about health equity, health care delivery, and health care innovation.

For the record, for much of the last seven years, ConvergenceRI has been a clear, consistent source of news, analysis and reporting on the work of Health Equity Zones in Rhode Island.

The sea change in how the Rhode Island Foundation changed its investment strategies to look at health and health equity, not just clinical programs, was driven, in part, according a number of observers, by ConvergenceRI’s coverage.

[No one else in the Rhode Island news marketplace – including The Providence Journal, The Providence Business News, WPRI-TV, WJAR-TV, The Boston Globe, The Public’s Radio, or even Uprise RI – has provided such detailed coverage. Why is that?]

A funny thing happened when CommerceRI conducted a targeted marketing effort earlier this year, using LinkedIn accounts, promoting a story about Health Equity Zones written by U.S. News and World Report. It received a strong positive response from C-Suite executives. [See link below to ConvergenceRI story, “The pandemic’s silver linings playbook.”]

What C-suite executives around the country were most interested in about Rhode Island, it turned out, was its innovative approach to changing its approach to how health care is delivered.

White noise
There are a number of competing narratives around health care delivery in the midst of the coronavirus pandemic, which has not gone away and is not “quiescent,” regardless of what some journalists, busy watching the scoreboard, would have you believe.

For those health care workers on the front lines, in hospitals and in nursing homes and at community health centers, the stress and trauma of the day-to-day struggle with life-and-death situations is taking a heavy toll. Wall Street Journal reporter Jennifer Levitz wrote about how, at a Boston hospital filled with the dying, a surgeon, Tracey Dechert, pinned her hopes on the survival of a young, pregnant woman. [A great read, if you can find your way around the paywall.]

There is another narrative, one of worry, about how the coronavirus has disrupted the normal care provided to children and families, particularly around the delivery of regular vaccinations and checkups. In her recent daily email message, Gov. Gina Raimondo wrote: “We are behind in immunizations, and we need to catch up. We’ve seen concerning drops in childhood immunizations, lead screenings and child wellness visits over the last several months.” The Governor’s message was to talk about how to ensure that children in Rhode Island can remain safe and healthy even during this pandemic.

Yet another narrative, a countervailing opinion, seeks to put out the message that the vast majority of patients who have not gone to their physicians because of pandemic disruption may be doing just fine, theorizing that a lot of people with health insurance have been over-treated in the world’s most expensive and wasteful health care system. It is, in ConvergenceRI’s opinion, an affluent elite’s perspective. Anyone who has studied the results of health outcomes, comparing states that have expanded Medicaid and those that have chosen not to, can determine that such arguments do not pass the smell test when it comes to the ability to access health care and the consequences of delayed care. Quite simply, “Black moms matter.”

Finally, there is the reasoned narrative written by Sanne Magnan in the National Academy of Medicine journal, on the social determinants of health and the limits of medicine in being able to fix disparities in health outcomes.

The bigger problem, perhaps, is this: does anyone still read anymore?

Context and nuance
The question posed by ConvergenceRI about future state investments in Health Equity Zones cuts to the chase: How much is Rhode Island willing to invest in health – and not just health care delivery?

No one else in Rhode Island in the news media – whether it be the traditional enterprises or the upstart new media outlets – will ask the question, in large part, because they may not understand or comprehend how important it is in determining the state’s competitive economic advantage moving forward in a post-pandemic world.

The choice, of course, is to attend the media scrum known as the press briefing now being held in person at the Veterans Memorial Auditorium, and compete for airtime with other journalists, with the next session scheduled for Monday, June 29 at 1 p.m.

It may yet come to that – in which I would be choosing not to listen to the advice of my primary care physician and my neurologist – and attend.

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