Delivery of Care

Who gets to decide the future priorities, strategies for health care?

The latest meeting of the SIM Steering Committee offered a glimpse into how investments are going to be targeted for the future health care delivery system

Photo by Richard Asinof

Many of the leaders of the health care delivery service were at the table for the SIM Steering Committee meeting on Sept. 14.

By Richard Asinof
Posted 9/18/17
The deliberations by the SIM Steering Committee on future investment priorities occurred in what could be described as “Wonkville,” with no media coverage save for Convergence RI.
In deciding future funding priorities, should the SIM project fund ongoing projects and programs that have lost government funding, or should it seek to invest in innovative approaches to health care? Why are health equity zones, which received strong support from the SIM Steering Committee as a priority investment, not on the agenda at either the PBN or the RIBGH summit? How can the development of Neighborhood Health Stations in Central Falls and Scituate become part of the ongoing conversations about the future of health care? How will wearable devices change the dynamics of health care, as patients exercise more control over their own health data?
When it comes to patient engagement around wellness, prevention and nutrition, particularly around how best to reach the many diverse communities here in Rhode Island, there appears to be a disconnect between strategies and implementation. For instance, the African Alliance of Rhode Island held its 12th annual Health Summit this past weekend at Roger Williams University in Providence. I wonder what the participants at the health summit could teach the SIM Steering Committee about patient engagement.

WARWICK – Welcome to Wonkville. Many of the machers, the people who get things done within the health care delivery ecosystem in Rhode Island, had gathered around the table at the State Innovation Model Steering Committee meeting on Thursday evening, Sept. 14, at the Hewlett Packard offices at 301 Metro Center Boulevard.

Call it a gathering of a veritable who’s who in health care in Rhode Island, from government officials – Marie Ganim, R.I. Health Insurance Commissioner, Dr. Nicole Alexander Scott, director of the R.I. Department of Health, Becky Boss, director of the R.I. Department of Behavioral Healthcare and Hospitals, Eric Beane, secretary of the R.I. Executive Office of Health and Human Services and Trista Piccola, director of the R.I. Department of Children, Youth and Families, who all sat together in a row – to executives from the insurance companies – including Blue Cross and Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island, Tufts Health Plan – and representatives of all the major health systems.

On the agenda was discussion of budget priorities and decision-making for how best to allocate some $1.1 million in remaining funds on nine potential projects, ranging from “integrated behavioral health coding and billing” to a “unified social services directory,” from expansion of a “child psychiatry access program” to a “community preceptor program” to train health professional students in home and community settings.

In a process that Chair Andrea Galgay, director of ACO development at the R.I. Primary Care Physicians Corporation, likened to “speed dating,” the steering committee members were able to ask brief clarifying questions about all nine proposals, followed by public comment. At the end of the session, steering committee members were then asked to rank the nine different proposals for priority in funding.

BHDDH’s Becky Boss, for instance, made a strong pitch for funding what was called “SBIRT Practice Facilitation and Project Support” in Rhode Island. The SBIRT program, or “screening, brief intervention and referral to treatment” to reduce and prevent problematic use, abuse and dependence on alcohol and illicit drugs, had been cut 34 percent in funding by the federal SAMHSA program.

Dr. Gus Manocchia, executive vice president at Blue Cross, in turn, argued in favor of expanding the child psychiatry access program, including the behavioral health crisis phone line services on behalf of at-risk youth.
Strong support in favor of greater linkage to Health Equity Zones in Rhode Island, that now exist in 10 different communities, was voiced by Dr. Nicole Alexander Scott and by Eric Beane, among others.

A number of questions were raised about the Community Preceptor Program, focused on whether it should be targeted at the student level or at the existing professional level. In addition, Beau Stubblefield-Tave, the principal at The Center for Culturally Fluent Leadership, asked how the initiative would address training in cultural competency for nurses and workers going into people’s homes.

Marti Rosenberg, the director of the SIM project, made the point when asked questions about the decision-making process, which to some attending as members of the public, seemed opaque: “It’s not SIM; it’s you all.” Further, she added, in regard to the projects, “I love all of them.”

Patient engagement
Also on the agenda were brief descriptions of patient engagement projects submitted to the SIM as part of a request for proposals. They included:

Advance Care Planning Training Program for Consumers and Providers, submitted by Healthcentric Advisors, to facilitate patient-directed end of life conversations, including consumer outreach and engagement with the Latino community, and a pilot project for Medicare beneficiaries within primary care practices in Rhode Island.

Complex Care Conversations Training, submitted by Hope Hospice and Palliative Care, to increase engagement among providers, patients and families in advance care planning and to improve the health literacy of patients.

Consumer Engagement Platform, submitted by the Rhode Island Quality Institute, to enable patients to contribute self-reported health information data to CurrentCare, encouraging patients to upload their advance directives.

Conscious Discipline Program, submitted by The Autism Project, seeks to implement a conscious discipline program in classrooms in three demonstration schools. It features a comprehensive curriculum integrating emotional intelligence and learning, teaching students and teachers how to respond to everyday events, including conflict, as learning opportunities.

A total of $1.468 million has been allocated for the programs selected.

Observations
The only reporter attending the SIM Steering Committee meeting was ConvergenceRI, even though the meeting was posted publicly and was even highlighted in the most recent OHIC newsletter. No doubt many reporters chose to attend the lengthy Senate hearings on the latest Pawsox proposal for a new stadium in Pawtucket.

The conversation around future investments that SIM is targeting to transform the health care delivery system also seemed far removed from the agenda for the two upcoming business summits on health, with a gap that numerous trucks could drive through.

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