Why our health care stories need more, better illumination
The rise and fall of primary care as a function of neighborhoods
When people complain about how cold it is outside, the memories of the hard exertions of what it took to have hot water for a shower is a reminder that we often take for granted what it means to survive in a wood-heated lifestyle.
PROVIDENCE – The “news” was buried in a story published on Friday, Jan. 24, by GoLocalProv, reporting on a series of real estate transactions related to the repurposing of a former Hasbro office space in downtown LaSalle Square, detailing how Brown University Health planned to reconsolidate its numerous properties.
“Brown Health is proud to invest in the city of Providence and contribute to the success of an economically vibrant downtown,” said Dr. John Fernandez, president and CEO of the health care delivery system formerly known as Lifespan. “By consolidating our existing scattered administrative functions into one central space, Brown Health will achieve savings while instilling a more integrated workforce for our health system.”
Providence Mayor Brett Smiley seconded that emotion, saying: “I’m excited to see this prominent Downtown location put to great use by Brown University Health. This move will bring new vibrancy to LaSalle Square and preserve over 600 jobs in the city, further underscoring Providence as a dynamic economic hub.”
Translated, the former Hasbro office space in downtown Providence will survive as a health care administrative space for the state’s largest health delivery system, regardless of whether or not Hasbro decides to relocate its corporate headquarters to Boston from Pawtucket.
You may ask: What was the buried ‘news?’ The answer given, in the following explanatory graph in the GoLocalProv story [apparently mostly rewritten from a news release from Brown University Health], was this: “Administrative and corporate service functions will be consolidated from the Coro Bulding and current underused South Providence leased locations, including 10 Davol Square… [emphasis added].
Not asked, however, was the question: What had been located at 10 Davol Square? [emphasis added]. The answer: The former corporate headquarters of Coastal Medical, which had been acquired by Lifespan in April of 2021, some four years ago.
In other words, the GoLocalProv story contained the apparent “obit” for the corporate office space that once housed Coastal Medical, now deemed to be an ”underused lease location.” [Editor’s Note:The 10 Davol Square building also serves as the corporate headquarters of ecoRI News and the Social Enterprise Greenhouse.]
Unwritten histories.
What happened to Coastal Medical after it was acquired by Lifespan in 2021, now Brown University Health – as well as the quiet “disappearance” of Dr. G. Alan Kurose, the former president and CEO of Coastal Medical – is a news story that so far has escaped attention by much of the state’s news media.
Why does it matter? Because, in ConvergenceRI’s opinion, that story is connected to the ongoing crisis in primary care delivery in Rhode Island.
Under the leadership of Dr. Kurose, Coastal Medical had been a pioneer in developing what was known as an Accountable Care Organization [ACO] in Rhode Island, a collaboration with the federal Centers for Medicare and Medicaid Services [CMS] to better manage Medicare costs, moving away from a fee-for-service payment model to a bundled payments model based on a continuum of care, promoting population health.
Dr. Kurose, in turn, had received an MBA from Yale University in 2014, with his thesis focused on developing a primary care-driven accountable care business model.
The state of Rhode Island, under the Reinvention of Medicaid law enacted by the General Assembly in 2015, developed a similar approach, known as “accountable entities,” for the delivery of Medicaid services, underwritten with a federal award of $129.7 million over five years. [See link below to the 2016 ConvergenceRI story, “A peek behind the curtain at reinventing Medicaid 2.0”]
Translated, private health insurers [initially including Neighborhood Health Plan of RI, UnitedHealthcare of New England, and Tufts Health Plan] were awarded contracts to deliver Medicaid services to roughly 300,000 Rhode Island residents, lucrative contracts amounting to more than one-third of the state’s annual budget.
Accountable entities in Rhode Island also included a number of federally qualified community health centers [such as Blackstone Valley Community Health Center and Providence Community Health Centers], Integra [a Care New England accountable entity], and a CharterCare/Prospect Health accountable entity.
[Editor’s Note: Dennis Keefe, the former president and CEO at Care New England, once quipped to ConvergenceRI: “If you’ve seen one ACO, you’ve seen one ACO,” because of the great variety. A former chief medical officer at a community health center wryly told ConvergenceRI: “Accountable entities give clusterf**k a bad name.”
Dr. James Fanale, the successor to Keefe at Care New England, was first hired to serve as director of Integra’s accountable entity.]
Fast forward to 2021, when Lifespan acquired Coastal Medical, and Dr. Kurose became a senior vice president for primary care and population health at Lifespan. In anticipation of the planned merger between Lifespan and Care New England, Dr. Kurose then partnered with Neil Steinberg, then president and CEO of the Rhode Island Foundation, to capture the community’s response to the merger.
Nearly a year later, in February of 2022, the proposed merger was rejected by both the Federal Trade Commission and by R.I. Attorney General Peter Neronha. [See link below to ConvergenceRI story, “Getting to no.”]
Then, at the end of July of 2023, Dr. Kurose quietly departed his position at Lifespan – eventually leading to the decision announced last week by Brown University Health to move what remained of the corporate offices of Coastal Medical located at 10 Davol Square to the former Hasbro building in LaSalle Square. So it goes.
Rites of passage
Sometime during the last few weeks, another transition occurred – call it a rite of passage – but one that was not accompanied by any news release. A number of health care professionals who had been practicing at an enterprise known as Women’s Medicine Collaborative changed their affiliation, moving from Brown University Health and returning to Care New England and Women & Infants Hospital, according to four different sources.
“I can confirm that some providers who went to work for Lifespan in 2012 are now returning to Care New England,” Doreen Scanlon Gavigan, public relations manager at Care New England, told ConvergenceRI.
To provide the context, in 2012, more than a decade ago, when the Women’s Medicine Collaborative was first created, the decision by health care practitioners to leave the umbrella of affiliation with Women & Infants Hospital and to join up with what was then Lifespan, a move created shock waves within the health care community.
It presaged a number of corporate confrontations between Care New England and Lifespan around women’s health care – including a concerted effort by Lifespan to create its own birthing center in direct competition with Women & Infants Hospital to be located at a site just a few hundred yards away from the current hospital, where roughly three-quarters of all women in Rhode Island delivered their babies.
This was a decade that featured numerous hospital mergers, acquisitions and takeovers – driven by what NBC investigative reporter Gretchen Morgenson has called “private equity plunderers.” One of the most infamous of these was the Steward Health Care takeover of 10 Massachusetts hospitals, which resulted in the 2024 bankruptcy of Steward.
During this time period, what ConvergenceRI had once described as “a game of corporate musical chairs,” Care New England pursued a number of potential merger opportunities with several different hospital delivery systems, including: Southcoast Health in Fall River, Massachusetts; South County Health in Wakefield, Rhode Island; the purchase and then the abrupt closure of Memorial Hospital in Pawtucket, Rhode Island; and the planned merger with what then was known as Partners Healthcare in Boston, Massachusetts. The proposed acquisition of Care New England by Partners in June of 2019 had led then-R.I. Gov. Gina Raimondo to intervene to halt the proposed merger. [See link below to ConvergenceRI story, “Matchmaker, matchmaker, find me a find, catch me a catch.”]
Ongoing conversations focused on primary care
Currently, there are at least four different ongoing conversations occurring to address the shortfalls in Rhode Island concerning the lack of primary care providers – conversations that often seem to be occurring in their own bubbles of self-interest. They include:
- On Friday, Jan. 24, the Rhode Island Business Group on Health [RIGBH] hosted a conference, “Reducing Hospital Costs: What Employers Should Know about RI’s Participation in the AHEAD [Advancing All-Payer Health Equity Approaches and Development] program.The gathering featured House Speaker Joseph Shekarchi and Cory King, Rhode Island’s Health Insurance Commissioner.
- In December of 2024, Rhode Island was accepted as a member of the latest cohort of the federal AHEAD program. According to R.I. Health Insurance Commissioner Cory King, Rhode Island will received up to $12 million in cooperative agreements to implement the model over the next 5-6 years.
“My expectation is that participation will help us achieve more affordable and equitable (care) for Rhode Island residents,” King said, responding to questions asked by the Care Transformation Collaborative-RI. “AHEAD offers some very appealing strategies to get us there. Foremost among these strategies is a core focus on primary care across all-payers and new Medicare investments in primary care practices.”
In addition, King continued, “AHEAD also creates a platform for aligned approaches to health care payment and care management across Medicare, Medicaid and commercial payers while testing a new payment model for hospitals. AHEAD is a voluntary program, meaning that hospitals and primary care practices must choose to join. This will require collaboration and partnership among all parties, including the state, to move forward.”
In his experience in Rhode Island, King said, “Collaboration and partnership have been the key to driving success in the health care space.” Further, King believes that AHEAD is a piece of an overall strategy that Rhode Island needs to deploy “to support and build the primary care workforce over time.”
- On Monday evening, Jan. 27, at 5:30 p.m., the Special Legislative Commission to Make a Comprehensive Study of Rhode Island’s Healthcare Workforce related to Educating and Retaining Primary Care Physicians and Establishing a State Medical School at the University of Rhode Island will meet. It will feature presentations by Debra Hurwitz, executive director of the Care Transformation Collaborative, Dr. Stephen J. Spann, the recently retired dean of the Tilman J. Fertitta Family College of Medicine at the University of Houston, and Dr. Robert M. Califf, the former head of the U.S. Food and Drug Administration under Presidents Biden and Obama.
Practical interventions
Last week, State Sen. Linda L. Ujifusa and State Rep. Brandon Potter introduced legislation to help reduce prior authorization requirements in order to free up primary care physicians from time-consuming roadblocks to patient care.
“Prior authorization is a tool used by insurance companies to block patients from getting what their doctors ordered,” Sen. Ujifusa said. “It’s based on the false assumption that doctors and patients ‘over-utilize’ goods and services and need to be ‘managed’ by private insurers.”
In fact, Sen. Ujifusa continued, “requiring primary care physicians [often] delays or prevents patients from getting tests and treatments – making diseases harder to treat or requiring trips to the emergency room.” This legislation, she said, “allows primary care physicians to spend more time caring for patients, not fighting for permission from corporations who profit from limiting care.”
Rep. Potter framed the importance of enacting the legislation as a practical intervention to ease the time burden placed on primary care physicians so that they can spend more time treating patients. “We know all too well that Rhode Islanders are struggling to find primary are doctors, and those fortunate enough to have one are facing longer waits for appointments. The situation is only made worse when doors have to spend their time battling insurance companies instead of treating patients.”
Rep. Potter said that passing the law “is a step to expand access to basic health care, and ensure that medical decisions are made by doctors based on what’s best for patients – not by insurance companies prioritizing their bottom line.”
Specifically, the legislation would prohibit insurers form imposing prior authorization requirements for any admission, item, service, treatment, or procedure ordered by an in-network primary care provider, including general internists, family physicians, pediatricians, geriatricians, OB-GYNs, nurse practitioners, physician assistant and other health care providers who are licensed to provide, coordinate, and supervise primary care and order health care services and goods, including preventive and diagnostic services for patients.
If approved, the bill would take effect on July 1, 2026.
According to the data provided by the American Medical Association, the average physician practice completes 45 prior authorizations per physician per week – and 94 percent of physicians believe prior authorization delays care.