Delivery of Care

The high cost of turning public health over to consulting firms

As RI plans to invest $1 billion in a few big ideas, can we first get a public accounting of how much private consulting firms made during the COVID pandemic?

Photo by Richard Asinof

Gov. Dan McKee answering questions at the Aug. 24 news conference, as Lt. Gov. Sabina Matos listens.

By Richard Asinof
Posted 8/30/21
One of the biggest stories in Rhode Island right now is about health care and how best to combat the contagious Delta variant of COVID-19. To do so, it will be important to learn what went wrong with the vaccination rollout facilitated by high-priced consulting firms, which left a high percentage of Rhode Island adults and children 12 and older yet to be vaccinated.
Will the creation of a new public health laboratory in Rhode Island once again fall by the wayside, and not be included as a good investment for the state to make with its $1 billion in ARPA federal funds? What kinds of workforce initiatives does the state need to undertake to rectify the growing shortage of health care workers in Rhode Island? When will other news media begin to ask questions about the high cost of hiring consulting firms to work on public health? What is the role of pharmacy benefit managers in driving up the price of prescription drugs, which has been identified as the major factor in increasing health care costs in Rhode Island?
This week, federal Judge Robert Drain is expected to make his ruling about Purdue Pharma’s bankruptcy plans, and whether the Sackler family will be able to shield its wealth from potential future lawsuits. Here in Rhode Island, unfortunately, there has been a dearth of coverage about the case – and about the role that McKinsey & Co. played as consultants to help the Sacklers “turbocharge” the sales of OxyContin.
On Tuesday, Aug. 31, there will be a local celebration of International Overdose Awareness Day, from 12-4 p.m. at Lippitt Memorial Park, to grieve those lost and celebrate survivors. The sponsors include RICARES, the Central Providence Health Equity Zone, Weber-Renew, the Community Care Alliance, and the R.I. Attorney General’s Office, among others.
What caught ConvergenceRI’s eye on Twitter, however, was a post last week by Roxanne Newman, a Ph.D. student, about her work on an assignment that asked the question: When did recovery science “officially begin?” Great question.
In Rhode Island, much of the initial work on recovery was an improvisation, such as creating peer recovery coaches at emergency rooms, an initiative developed in large part by Jim Gillen. The first efforts to develop metrics for peer-recovery coaching had been done by Gillen and Holly Cekala, a story that ConvergenceRI covered in 2015.
Back in 2011, ConvergenceRI was the first Rhode Island reporter to cover the research being conducted by epidemiologist Traci Green, now the director of the Opioid Policy and Research Collaborative at Brandeis University, who was documenting the deaths from opioids in Rhode Island and Connecticut, when ConvergenceRI worked for the Providence Business News. Back then, there were no consistent records kept on overdoses by hospital emergency rooms, or even agreement on how to code such events. ConvergenceRI shared the story with Dr. Michael Fine, who was then the director of the R.I. Department of Health, and following a conversation with Green, made the decision to change the public health priorities for the state in 2012, creating an ad hoc task force.
Before then, the problem of opioid addiction and overdoses had been ill defined, and problems with drugs were thought to be limited to those “knucklehead” students at Brown, as ConvergenceRI’s editor had claimed.
Now, it seems, there is an opportunity to talk about recovery as a science that focuses on the long-term aspects of treating a chronic disease, one that does not blame the victim, a favorite tactic of the Sacklers, but looks at the strategies that work – and recognizes that there are differences in how to approach recovery in men and women.
When it comes to recovery, there are plenty of experts here in Rhode Island, and it does not require hiring expensive consulting firms to define the problem or the solution.

PROVIDENCE – Last week, mired in the dog days of August, in the midst of a brutal heat spell following a tropical storm, with verbal volleys being fired in a rhetorical, irrational war of words about vaccine mandates and mask mandates, ConvergenceRI decided to attend the Tuesday news conference held on Aug. 24 by Gov. Dan McKee and Lt. Gov. Sabina Matos.

Why attend? Good question.

In advance, ConvergenceRI knew that he would have but one chance to ask a  question, toward the end of the 40 minutes allotted [with thanks to Alana O’Hare for making it happen]. Yes, Rhode Island is blessed with a diligent news corps, always willing to dig into the murky waters of government [even if some members are not above throwing chum into the water to stir up a feeding frenzy].

Choosing the right question to ask is an art form, much like being a jazz musician, with the opportunity for one call-and response to play to competing riffs.

The state is equally blessed with a current Governor and a Lt. Governor willing to answer questions [which was not the case with former Gov. Gina Raimondo, in ConvergenceRI’s experience, during her six-year reign of selective hearing – and her communications’ staff repeated rude failures to return phone calls].

• News conferences are a practiced routine of choreographed moves, based upon five decades of experience in the news biz. Most of the dance steps are routines, practiced in advance, the way that marble steps in older buildings are worn down in the center from all the foot traffic. Arriving early, ConvergenceRI took his place in the front row, part of the chorus line of reporters in the media scrum.

Unlike the most recent news conference ConvergenceRI had attended, all of the reporters and camera technicians, thankfully, were now masked. [See link below to ConvergenceRI story, “What you see is not what you get.”]

Dressed up for each other
Maybe it was the rapid change from the extreme heat to an air-conditioned room, but there was a song lyric that ConvergenceRI kept hearing in his head but could not quite place: the girls were dressed up for each other, to describe the scene. Was it from Bruce Springsteen’s “The E Street Shuffle,” about everybody forming a line? No, it was from Van Morrison and “Wild Nights.”

The line of seated reporters/dancers in the second-floor conference room in the Department of Administration building were all ready to perform for the assembled cameras and microphones. And yes, the women reporters were much better dressed than their male counterparts. But the question was: Who was the audience? Who was listening?

Cue the synthesized drumbeat
Many of the usual suspects/reporters/chorus line members were in attendance: Kathy Gregg and Patrick Anderson from The Providence Journal, Tim White and Anita Baffoni from WPRI, about to go on maternity leave; Ian Donnis from The Public’s Radio, Steve Klamkin from WPRO, Bill Bartholomew from BTown Podcasts, Ed Fitzpatrick from The Boston Globe, among others. [John DePetro and Pat Ford were there, too, masters of bogarting the microphone.]

Much of the give-and-take was taken up with two subjects: questions about Gov. McKee’s chief of staff, Tony Silva, and whether or not he had attempted to use his influence to get a permit to build on a lot in Cumberland; and issues pertaining to conflicts around mask and vaccine mandates.

Gov. McKee defended Silva, but the next day decided to ask the R.I. Attorney General to investigate; Silva also resigned from a $7,500 municipal job he had been holding in Cumberland.

Also covered: proposed plans for a residential makeover of the Superman building, and plans to re-open the field hospital in Cranston.

The mask mandate and the vaccine mandate continued to be a thorn in the side of the McKee administration, with the Governor continuing to attempt to thread the needle, pushing vaccinations.

Thirty-seven minutes into the presser, ConvergenceRI finally got his chance to ask his question, which focused on whether the Governor had compiled the details around the number and the cost of consulting contracts with large consulting firms, such as the Boston Consulting Group, McKinsey & Co., and others, as he had promised back in April.

Memory jog
At an April 20 news conference, ConvergenceRI had first asked Gov. McKee about the consulting contracts. [See link below to ConvergenceRI story, “Charting the rapid learning curve of Gov. Dan McKee.”]

…In a response to a question from ConvergenceRI at the April 20 news conference, asking what plans the state had to look into the millions of dollars being spent on private consultants to design and implement public policy, [Gov. McKee had responded], “We’re going to dig into that.”


The investigation, McKee promised, will be “across the board. It’s not just on COVID, either,” apparently referring to the millions spent on private consulting firms, including the Boston Consulting Group, to develop a better coordinated response to the coronavirus pandemic in the spring of 2020.

“I think consulting is important, and I think there are certain benefits there, but you’ve got to evaluate it,” McKee said. “It has been somewhat difficult to get the information, and I have asked several [agencies] for information about every consulting agreement that is currently in place. [I want to] take a look at each agreement to see what was actually invested. That’s ongoing; we’re going to get that [information]; I’m pretty persistent on that. We’re going to get that information and then we’ll make it public, about what’s going on, about who we are paying, and what they’re getting.”

McKee, in a somewhat rambling manner that is his speaking style, had announced a tectonic shift in public policy in Rhode Island, promising to investigate, make public, and hold accountable the private consulting firms that have been feasting at the state government trough during the Raimondo administration.



The question is: Why was this investigation not reported by other news media covering the news conference?


The bigger question is: How much state investment has been diverted from paying for the direct care of patients into the pockets of private consulting firms?



The biggest question is: Will Gov. McKee – and the R.I. General Assembly – be willing to hold the culprits accountable, once the information is made public?

Return to the scene of the crime?
What had prompted ConvergenceRI to return the question of high-priced consultants had been a story published in The Washington Post on Aug. 22 by Isaac Stanley-Becker, with the headline: “How the U.S. vaccination drive came to rely on an army of consultants,” with the subhead, “Private contractors cost taxpayers millions while demonstrating few clear results and papering over weaknesses in the country’s public health system.”

The detailed, in-depth, exclusive story by The Washington Post attracted the attention of Julian Drix, who tweeted as his personal view: “This is the article I’ve been waiting forever for someone to write. [Hundred percent] reflects my experience working in state-level COVID response for the past year and a half. Then Gov. Raimondo (now Sec. of Commerce) installed BCG [Boston Consulting Group] as the Executive Director of the entire state COVID response.”

Here are some excerpts from the story reported by Isaac Stanley-Becker:

At least 25 states, along with federal agencies and many cities and counties, hired consulting firms, according to a Washington Post tally.

• The American vaccination drive came to rely on global behemoths such as McKinsey and Boston Consulting Group, with downsized state and local health departments and even federal health agencies relying on the private sector to make vaccines available to their citizens, according to hundreds of pages of contract documents emails and text messages through public records requests.

• By farming our vital health services, from disease surveillance to contact tracing to vaccine distribution, state and local governments have eroded their own capacity, experts argue, making Americans more reliant on private companies to safeguard their health.

The weaknesses are all the more glaring with the Delta variant’s devastating march through the United States, enabled partly by insufficient penetration of vaccines.

• It was not federal authorities but BCG consultants, who convened officials from seven Northeastern state on Zoom last winter to discuss policies ranging from immunizing people from out of state to accelerating inoculations at nursing homes, according to emails.

BCG’s vaccine footprint extended across more than a fifth of the states, not just those seven states, New York, New Jersey, Connecticut, Massachusetts, Pennsylvania, Delaware and Rhode Island, but also in Idaho, Illinois, Kansas, and Washington state.

• The vaccine working group served two aims, Selin Zalina, a BCG consultant with no public health expertise noted on her LinkedIn profile, said in an email to the Massachusetts assistant public health commissioner – “part to learn from each other, part therapy.”

• Vermont, the first state to deliver a dose to 80 percent of the eligible residents did not join the Zoom confabs or hire consultants. Vermont Gov. Phil Scott, a Republican and former construction executive, built trust in the rollout by relying on public officials to manage it, his top aide said.

• “Our system has at last one major advantage over a contracted system: Executive branch leaders, at the highest elected and appointed level, accepted the responsibility and the accountability of managing the responses, said Jason Gibb, Scott’s chief of staff. Gibbs added, “Our approach is scalable to any size state., I simply do not buy ‘The Vermont was successful because it is small hogwash.’”

Editor’s Note: The role of the Boston Consulting Group in its consulting task in Rhode Island was recently likened to an untrained person overseeing the work of an eye surgeon in the operating room, watching over the surgeon’s shoulder, by one state public health expert.

The question is: How much of the problems with Rhode Island’s vaccine rollout, where some 170,000 Rhode Island residents ages 12 and above still remain unvaccinated as of Thursday, Aug. 26, can be attributed to the contractual work done by large consulting firms? And, what was the final tab for the work?

Asked and answered
At the news conference held on Aug. 24, ConvergenceRI asked:

ConvergenceRI: At one of your first press conferences, you [committed] to making transparent the contracts with big consulting groups in Rhode Island, and you wanted to make that [information] available to everyone to see.
I was wondering whether you have done that, and whether you have issued a report about what the status is [of those contracts], so we can learn what some of the big consulting groups and their contracts are in Rhode Island, such as Boston Consulting Group, McKinsey, and others?
McKEE: I have certainly been asking that question and I believe that we have some of that information, but I don’t think we have all of the information, which is a little bit of a disappointment. We’ll give you what we [have].

ConvergenceRI: When will that happen?
McKEE: We will give you what you we got, shortly after the news conference.

Editor’s note: A Governor’s aide attending the news conference did provide ConvergenceRI with the link to a website, www.transparency.ri.gov/covid, but after more than 30 minutes spent trying to locate the information on the consulting group contracts, gave up because the consulting firms did not appear to be listed.

The impertinent question
In the near future, the Rhode Island Foundation will announce its latest Make It Happen results, choosing three to five transformative, big ideas for spending roughly $1.1 billion in American Rescue Plan Act funds, following 400 idea submissions from Rhode Islanders, and from some 150 ideas submitted at meetings, focus groups, and interviews and meetings.

The Rhode Island Foundation created a 15-member stakeholder panel, working in concert with the Economic Progress Institute and the Rhode Island Public Exchange Council. “These need to be investments that deliver enduring change,” Neil Steinberg, president and CEO of the Rhode Island Foundation, told WPRI’s Ted Nesi. “The real test is, can we do what we say we’re going to do? ” Steinberg continued. “None of us wants to be here in five years, saying, ‘What happened to that billion dollars?’”

But, without a public accounting of how previous federal money was spent on high-priced consulting groups such as Boston Consulting Group, to manage the public health response in Rhode Island to the COVID-19 pandemic, the question is: Will the big three or four ideas be implemented without any consulting fees to high-priced consulting firms?

How much, in total, was spent on the consulting firms such as Boston Consulting Group and others in the last year? Is there a consulting firm that has been hired to present the big three or four ideas to the public and roll out the public relations campaign to promote it?

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