Health Reform Events in Rhode Island

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Monday
Jan262015

HealthSource RI Issue Brief

Published 1/26/15

HealthRIght is happy to announce the release of our issue brief on HealthSource RI. The HealthSource RI issue brief outlines reasons to maintain state control of HealthSource RI as well as financially sustainable options to fund it, including comparisons to other states.

This brief was written with the collective input of HealthRIght's member coalition, spanning Rhode Island health care consumers, providers, and small businesses. Please circulate this document among friends, legislators, and others interested in Rhode Island's health policy scene. We hope this brief will provide important background knowledge relevant to state policy-making and empower consumers to reach out to their local legislators.

If you are interested in joining HealthRIght's advocacy efforts, would like to stay up to date on local health policy issues, or have comments on the brief, please contact Yao, HealthRIght's research and policy assistant, at yaoliu@rihealthright.org. We would love to hear your feedback!

You can download the brief here.
Thursday
Sep252014

Projo Op-Ed (Irwin Birnbaum) - Writer was wrong about U.S. health-care woes

Providence Journal Op-Ed

"Writer was wrong about US health-care woes"

Irwin Birnbaum

September 20, 2014

Once again Peter Morici has written a Commentary piece (“Bill for Obamacare is coming due,” Sept. 10) that misstates and/or omits facts, rewrites and distorts history, and presents a slanted right-wing view on a subject. His comments are so off the mark, misleading, and in some cases untrue, that a response is required.

Here are some of the statements I believe to be misleading or wrong. Mr. Morici states that the federal government is meddling “in what was once the finest and [most] cost-effective health-care system on the planet.” His statement may have been true at some time in our nation’s history, but very few (if any) believe that has been the case for at least the last 50 years.

There are many good things about our current health-care system, but being the “finest” and “most cost-effective” are not among them. We have a bloated, dysfunctional health-care delivery system. When one looks at recognized health indicators of the quality and efficiency of a health-care system (e.g., maternal deaths, average lifespan and per capita health-care costs), the United States lags well behind most of the industrialized nations of the world. We do have the dubious distinction of being, by far, the most expensive health-care system.

...

Click here to read the full Op-Ed at the Projo

Monday
Aug182014

Opinion: Hospital mergers, cost containment and health care reform

Published 8/18/2014

By Amber Ma and Betsy Stubblefield Loucks

Earlier this summer, The New York Times Editorial Board posted “The Risks of Hospital Mergers,” detailing the impact on health care costs from Massachusetts’ 1994 Mass General Hospital and Brigham and Women’s Hospital merger. 

The merger created Partners HealthCare – which is now the largest provider system in Massachusetts. Partners had been found to exercise significant market leverage that has driven up Boston’s health care costs unrelated to quality or complexity of care delivered.

The editorial was a response to the recommendation by the Massachusetts Attorney General in a court case to allow Partners to purchase additional hospitals and physicians’ groups, giving the state’s largest hospital system even greater market share.

A cost commission, created by Massachusetts to help stem the rising costs of health care under the Massachusetts health reform effort known as “Romneycare,” found itself without any legal authority to review and weigh in on the deal. 

Rhode Island has experienced its own wave of hospital mergers, ownership conversions and consolidations.

In the last two years:
• Memorial Hospital completed its merger with Care New England.
• Westerly Hospital was acquired by nonprofit Lawrence + Memorial Hospital in New London, Conn.
• Landmark Medical Center of Woonsocket was bought by the for-profit Prime Healthcare Services of California after years in court-ordered receivership.
• Prospect Medical Holdings, a for-profit California firm, acquired Chartercare Health Partners, which owns Roger Williams Medical Center and Our Lady of Fatima. 
• Lifespan, the state’s largest hospital system, acquired Gateway Healthcare, a behavioral health provider, and Ob-Gyn Associates, one the region’s largest ob-gyn physicians’ groups

Read the rest of the article here on ConvergenceRI. 

Thursday
Jun192014

Setting the Record Straight: Why We Need to Keep HealthSource RI Local

As a greater portion of health care reform dialogue is turning toward costs, many are concerned that the Affordable Care Act, particularly the health benefit exchanges created in fall of 2013, is not delivering “affordability” as the law’s name promises. The brimming tension around the exchanges is palpable especially here in Rhode Island. Earlier this month, the fate of Rhode Island’s health benefits marketplace, HealthSource RI (HSRI), was considered by the House Finance Committee in a bill (H7817) that would dissolve HSRI and default to the federally-run exchange.

The hearing may be over, but the shockwaves are not. Amidst the testimonies given and the continued debate, HealthRIght would like to acknowledge why keeping HSRI local will be part of the solution to providing affordable, high value health care for all Rhode Islanders

Is HealthSource RI Viable? Absolutely

Opponents of HSRI staked their claims from a 2009 Robert Wood Johnson Foundation report discussing the viability of the Exchange. Among the reasons listed was that the exchange would not be effective because—prior to the ACA—our small state had just one insurance carrier (BCBS) that offered plans to individuals.  Josh Archambault, who flew in from Florida’s Foundation for Government Accountability, testified, “You can't expect dramatic impact with a statewide exchange of 28,000 people." In GoLocal Prov on June 3rd, Mike Stenhouse with the Rhode Island Center for Freedom and Prosperity wrote, "This report shows that cost containment is not a viable goal”.

HealthRIght agrees that 28,000 people is not enough to lead to a viable Exchange. However, we believe that rather than just getting rid of it, the solution is to keep bringing in more people and use HSRI to address the cost challenges we face in the state. Making the best of HSRI, our only tool we have to address the cost problem, entails aggregating purchasing dollars and using that as leverage against administrative bloating, incentivizing insurers and providers and consumers to do their part to contain costs. 

According to Lieutenant Governor Elizabeth Roberts’ response piece on GoLocal Prov, Rhode Island is leading the nation with resounding success in health care reform implementation. Not only can Rhode Islanders expect less expensive plans next year on HSRI, there is growing competition in the health insurance market, and new innovative options for small businesses. Neighborhood Health Plan has filed lower rates for next year, and will offer individual plans on the exchange- plans which Rhode Islanders otherwise would not be able to access. We should not rely on a 5-year old report that at this point may be too outdated. Rather, we should capitalize on Rhode Island’s forward-moving health care reform momentum and recognize that success takes time and is within our reach if we work together.  

HSRI is Part of the Solution for Rhode Island’s Cost Issue

HealthRIght recognizes that while the problem of cost is widely recognized, what to do about it is an ongoing debate. The scale of the problem is no small matter – Rhode Islands spends $9 billion per year on health care, which is about 17% of Gross State Product[1]. Our healthcare costs have doubled every 9 years over the past 30 years[2]. According to another study, at its current trajectory, average household health care costs will exceed household median income by 2038.

 If HSRI can save half of a percent of the $9 billion Rhode Island spends on health care, it would save $80 million. The problem in RI, however, is that while we want the benefits of HSRI, people are very concerned about how to pay for it, hence bringing up the possibility of turning over to the federal exchange.

During the hearing for H7817, voices from both sides provided testimony. HealthRIght mobilized several advocates for HSRI in opposition to the bill. The Projo’s HSRI hearing coverage incorrectly stated that supporters of H7817 were "lined up.” However, it was the reverse with groups and individuals representing small business, community advocates, state agencies, and policymakers testifying to oppose H7817, the need to keep HSRI for all of the many benefits we have reaped (i.e. employee choice), and for its potential as a driver of cost-containment. These supporters include:

  • HealthRIght
  • Dr. Hittner, the Health Insurance Commissioner of OHIC
  • The Lieutenant Governor
  • Small Businesses
  • Rhode Island Kids Count
  • Economic Progress Institute
  • Rob Cagnetta (owns Heritage Homes and sits on the HIAC)
  • Small business owners
  • Rhode Island Parent Information Network (RIPIN)

The gist of the message to keep HSRI is that it fits into the larger picture of reform. It is a tool for negotiating with insurers, aggregating purchasing dollars, promoting price transparency, streamlining eligibility determinations for Medicaid and other state health aid systems. Other points given during testimony: 

  • RIPIN’s community-base testified that the exchange is working, and while we *do* need a sustainability plan, we need time to make this tool work for us.
  • Elizabeth Burke Bryant (RI Kids Count) and Linda Katz (Economic Progress Institute) agree that HSRI needs to stay in RI and that we need to build it as a cost-containment tool on behalf of consumers.
  • The Lieutenant Governor stated that we need to keep the exchange here in order to maintain control of decisions made within it, provide RI-focused customer service, and to make it a lever for controlling costs and driving reform in RI. Most of the testimony in support of HSRI was along those lines. 
  • Several gave their critical perspective as business owners, saying that HSRI is working
  • HSRI Director Christine Ferguson also emphasized that this opportunity to be a voice for consumers is unprecedented: until now, reform has been in the hands of insurers, hospitals, and--to a limited degree-government agencies.

Perhaps the latest turn of events is that the federal government is NO LONGER requiring Rhode Island to commit $4.5M in state funds to fill out the HSRI budget for FY 2015. Ferguson does not know how much federal support we will receive in FY 2016-2017, but the federal government wants to work with RI because of our successful exchange.

Ferguson said HSRI exploring many options for sustainability, including selling technical expertise to other states and possibly the federal exchange, seeking payment for back-office services to other state's exchanges, and potentially engaging in regional exchanges. To answer the concerns that the exchange would take funds away from other state priorities, she emphasized that HSRI could NOT levy an assessment NOR use general funds to support the exchange without express legislation from the RI General Assembly.

The House fiscal staff presented a PowerPoint summary of the history of HSRI and the relative comparison of keeping the health benefits exchange here versus giving it to the feds. This well-presented information was the first time many committee members have heard it. It is critical that our lawmakers are thoroughly informed of the actual costs and benefits of the exchange and can make decisions that are in the best interest of Rhode Islanders.

HSRI opponents were Mike Stenhouse (Center for Prosperity and Freedom) and Josh Archambault (from a national conservative think tank) and Al Charbonneau of RI Business Group on health, and a broker.

Moving Forward

Focusing on cost alone rather than on value takes us off in the wrong direction. Reducing health spending while preserving or improving quality and access is where the hard work comes in. We’ll begin to build a framework for doing just that in a future blog. Now with reform underway, what are the mechanisms we can use to bring the US back to a more moderate ratio of GDP:Healthcare spending?

We can’t wait to see what’s next.


[1] Centers for Medicare & Medicaid Services. (2011). State Health Expenditure Accounts by State of Residence. Retrieved June 2, 2014 from http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/res-tables.pdf

[2] Ibid

Thursday
Jun192014

Lou Giancola: How Can We Curb Healthcare Spending?

Lou Giancola, CEO of South County Hospital and member of HealthRIght Executive Committee shares in his blog that the staggering impacts of health care costs warrants a need for more public policy debate on the issue, particularly on a governor level. Ted Almon, CEO of Claflin Inc. and co-chair of HealthRIght's Executive Committee left a comment affirming that we are running out of time to fix this issue, and need to collectively develop solutions rather than criticize one another.

From Lou:

"I was somewhat heartened when growth in 2011 through 2013 slowed to about twice the rate of inflation (3.6 percent in ’11; 3.7 percent in ‘12; and 4 percent in ‘13). Estimates suggest, however, that growth in the first quarter of ‘14 may be approaching 10 percent. Here in Rhode Island, a state with high healthcare costs and with one of the highest rates of unemployment, this means existing businesses are struggling under the weight of healthcare costs and new businesses see it as a barrier to doing business in the state.

As we’ve previously discussed, the state seems to be pinning its hopes on transforming the way providers are compensated, moving from fee-for-service to some form of global payment, what we use to call capitation. Understandably, insurers and providers are hesitant to make this transformation too rapidly. Both parties have built their business models around fee-for-service and are not confident about managing under a new form of payment. Although this transformation seems inevitable, I wonder if it can happen fast enough and have enough impact to get us out of our troubles." Read the entire post here

Ted's comment:

The problem he [Lou] notes which is so true is that we really are running out of time to fix this problem. I too see potential problems with rate setting and a pure utility model, but the point is we can no longer just be negative about plans we think are too radical, unless we have a workable plan of our own. I can tell you there was much emotional testimony at the State House using terms like “un-American”, “rationing” and even “communism” to describe the admittedly central planning HealthRIght effort, but nary an alternative plan to be heard.

Perhaps some form of rate setting with protections for providers on the cost side could be worked out (similar to a temporary cost-based reimbursement system but with declining cost targets?)Then at least the payers and providers would be forced to face the issue, which is that large portions of the existing system are collapsing. TA

Read the entire post here with Ted's comment