PROVIDENCE – Reading the news and it sure looks bad. That was the sad yet hopeful Joni Mitchell lyric I found myself singing out loud this morning as I sat down to write this story.

The health care delivery system in Rhode Island is rapidly unraveling, literally coming apart at the seams, a crisis that should surprise no one – legislators, doctors, nurses, patients or news reporters. The current business model is unsustainable, despite serving as the state’s largest source of private sector jobs. And yet, there are hopeful signs of renewal.

What is the primary cause of this ‘dis-ease?’ Threatened federal budget cuts, low reimbursement rates, and illegal actions by the Trump administration in withholding already appropriated Congressional funds. And, if Republicans in Congress have their way, the Medicaid budget will be further slashed.

What actions need to be taken to avert further disintegration? Raise the Medicaid reimbursement rates.

Many of the answers can be found in “Medicaid Matters in Rhode Island 2025,” published on Friday, May 16. The 29-page report offers a comprehensive analysis – both in data and in human portraits – of the current crisis.

Medicaid provides “comprehensive health coverage for approximately one in three Rhode Islanders” [366,082 residents in state Funding Year 2023], the report quantified. Those covered included: 183,193 children, families and pregnant women; 112,745 non-disabled adults, ages 19-64; 12,344 children with special health care needs; 27,535 seniors [age 65+]; and 30,265 adults with significant disabilities.

Further, federal Medicaid funds infused $2.6 billion into Rhode Island’s economy in FY2023, according to the report. [See link below to read the full report.]

Translated, the future health and prosperity of Rhode Island is now dependent upon future investments in Medicaid funding.

AG Neronha to the rescue.  
Tenacious legal challenges by Rhode Island Attorney General Peter Neronha and a coalition of more than 20 state attorneys general have proven successful in holding the Trump administration accountable in the courtroom. Since Trump’s inauguration in January, AG Neronha and his legal team, as part of the national coalition, have filed some 19 lawsuits.

Last week, for instance, the coalition secured a preliminary injunction from federal District Court Judge John J. McConnell, Jr., in Providence, to protect libraries, workers and small businesses. “This order tells the Trump administration, in no uncertain terms, that it must immediately end the dismantling of these agencies and resume the disbursement of allocated funding, and fast,” Attorney General Neronha said in a news release issued on Wednesday, May 14. “With this order and many others, we are stopping the President in his tracks, and we will continued to fight every single step of the way.”

“While we don’t have all the answers, I often point to days like today as examples of attorneys general across the country taking swift, aggressive action in the face of unlawful federal behavior, and our courts ultimately upholding the rule of law. We’ve won many times before; we won today; and we will win in the future.”

The next big win occurred just two days later, on Friday, May 16, when AG Neronha and his legal team, in partnership with the national coalition of attorneys general, secured another victory in federal District Court in Providence. Judge Mary S. McElroy granted a preliminary injunction to halt the abrupt and “illegal” termination of nearly $11 billion in critical public health grants, including more than $20 million headed to Rhode Island. “We will continue to fight, and win, in court to minimize the harm the Trump administration is causing the people of this country,” AG Neronha said in a news release heralding the court victory.

On the front lines of health care    
Meanwhile, the casualties keeping mounting.

•    Frontline workers at Butler Hospital went on strike on Thursday morning, May 15, the result of a breakdown in negotiations between Care New England and SEIU 1199 New England, the union which represents more than 800 registered nurses, mental health workers, clerical, environmental services and dietary staff.

“We need our people to come out of poverty,” striking worker Ashley Ouellette told reporter Steve Ahlquist, while she walked the picket line on a rainy Thursday morning outside the entrance to Butler Hospital on Blackstone Boulevard. “We have people that are living in their cars. Sixty percent of the folks that work here have said that they’ve had to choose between food and housing costs.”

One of the key issues for striking workers is workplace safety, according to Ouellette. “Violence happens in every hospital. We’re constantly short-staffed, and something’s got to be done about it.”

Ouellette framed the strike at Butler Hospital in terms of neighborhood and community. “I want the public to known that the patients are our neighbors,” she said. “They are your teachers, lawyers, doctors, nurses, and police officers. All have gotten treatment here. They are people in the community, and to take care of them, we need experienced staff with the wisdom to care for the psychiatric population. You have to learn from experienced staff.”

More distress signals    
Integrated Network Partners, an “accountable entity” created through an amalgamation of community health centers to take advantage of the financial rewards promised by value-based contracting offered through the R.I. Executive Office of Health and Human Services  [EOHHS], appears to be in disarray, according to a story published in GoLocalPROV, on Wednesday, May 14.

Rebecca Plonsky Babigian, CEO of Integrated Network Partners, has left the organization. “Last Friday was my last day,” she told GoLocalPROV,

Earlier this month, the Providence Community Health Centers announced the lay off of some 70 workers, blaming it on shortfalls in health insurance reimbursements. In July of 2024, nine months earlier, PCHC had terminated some three-dozen community health workers and closed down one of its satellite facilities in Olneyville, because of financial shortfalls.

Thundermist Health, a community health center with headquarters in Woonsocket, had melted down financially during the fall of 2024, requiring interventions by the state and by health insurers to keep the community health center afloat. Chuck Jones, a previous CEO, has been recruited to lead Thundermist again.

Diminished value    
Lynn Arditi, award-winning health reporter at The Public’s Radio, in a story published on Monday, May 12, detailed what appeared to be a sudden move by Brown University Health to drop some 700 patients from its innovative remote monitoring program. The end of the program had resulted in the layoffs of some 20 Brown Health employees, according to Arditi’s story.

The story appeared on the same day that Cory King, the OHIC Health Insurance Commissioner, held a public forum to highlight the release of the latest data analyses from its 2025 annual report, “Health Care Spending and Quality in Rhode Island,” with an introduction that began: “The trap of high and growing health care costs.” [See link below to OHIC report.]

However, Arditi’s story was incomplete if not somewhat inaccurate. Only part of the remote monitoring program, as part of an ongoing contract with Brown University Health has with Healthcentric Advisors, had been “eighty-sixed.” The programs of remote glucose monitoring are continuing, as are a series of remote texting platforms that connect patients with providers.

What had been missing from Arditi’s story was the background and history of the remote monitoring program:

•     The home monitoring program, begun as an innovative pilot in 2019 six years ago under the leadership of Healthcentric Advisors, enabled patients diagnosed with heart failure, high blood pressure, and [COPD] Chronic Obstructive Pulmonary Disease to share data from home. [See link below to ConvergenceRI story, “Engaging with patients around managing high blood pressure.”]

As Arditi had reported in her story last week, “The programs allowed nurses and health coaches to remotely monitor patients by providing them with blood pressure cuffs, oxygen monitoring devices, scales and other medical equipment linked to software programs. The health data from the devices allowed the staff to intervene if the patients’ conditions worsened between doctor’s visits.”

[Editor’s Note: The program also eliminated the need for risky, unnecessary and costly patient visits to medical offices during the height of the COVID pandemic. See link below to ConvergenceRI story from April of 2020, “From a novelty to a necessity: An innovative texting digital platform built and deployed by Healthcentric Advisors is pushing telehealth to the forefront in responding to care needs during the coronavirus pandemic.”]

The programs actually saved more money in avoided health care expenses than they cost to run, Brown Health had admitted to Arditi. For years, Brown Health spokeswoman Jessica A. Wharton told Arditi, the remote home care monitoring programs for high blood pressure had saved the health system “more than twice what they cost” to operate.

But as health care cost have soared in the last few years, driven in part by the high cost of prescription drugs such as popular and pricey new weight loss medications, according to Wharton, Brown Health’s overall health costs exceeded the targets set in the value-based insurance contracts and, as a result, “faced steep financial penalties.”

Arditi had raised the question within her story, wondering if the end of such remote monitoring programs foretold the end of innovative health delivery services adopted under value-based contracting. Arditi had reported that Coastal Medical, one of the state’s largest primary care providers, had been successful in implementing the remote monitoring program and, as a result, had lowered costs and improved patient outcomes in primary care delivery. [Editor’s Note: The Coastal Medical practice was bought in 2021 by Lifespan, now Brown Health.]

Go right to the source    
To get the fuller story, ConvergenceRI reached out to John Keimig, the President and CEO of Healthcentric Advisors. Brown Health, he said, would continue with its remote glucose monitoring program as well as remote texting platforms developed by Healthcentric Advisors to monitor pediatric behaviors as well as to stay in constant contact with vulnerable patients to prevent unnecessary hospitalizations.

The brighter side of the health equation    
In the same manner that the innovative remote monitoring program for patients represented a brighter moment within Rhode Island’s health care delivery system, the grand opening on Monday, May 19, of CODAC’s new integrated community care center, located on Royal Little Drive in Providence, marks an innovative sea change in the narrative around patient care. The celebration will feature guest speakers Sen. Sheldon Whitehouse and Sen. Jack Reed.

The new integrated community care center, explained Linda Hurley, CODAC’s president and CEO in an interview with ConvergenceRI, represents not just a change in the structure of providing care but a change in the culture. The facility represents a new kind of innovative medical home with the onsite capability to provide patients with an array of services – housing needs, transportation needs, mental health needs, substance use needs, and medical needs, among other services offered

Translated, the center’s organization around a series of suites, Hurley said, will be able to respond to an individual being able to define what their own needs are, rather than professionals defining what those needs are. [See link to story in the current edition of ConvergenceRI.]