Change watchword for 2011

EXTRA CREDIT: Dr. Edward J. Wing, seen above outside Brown University's Warren Alpert Medical School, saw 2011 as a year marked by great opportunity for the state's health care and life sciences efforts. / PBN FILE PHOTO/RYAN T. CONATY
EXTRA CREDIT: Dr. Edward J. Wing, seen above outside Brown University's Warren Alpert Medical School, saw 2011 as a year marked by great opportunity for the state's health care and life sciences efforts. / PBN FILE PHOTO/RYAN T. CONATY

By any measure, 2011 has been a year when the health care landscape in Rhode Island has shifted.
New leadership has been chosen at the state’s largest health insurer and its second-largest hospital system. New policies under health care reform have been put into place, including a health-insurance benefits exchange created through executive order by Gov. Lincoln D. Chafee.
A new home for the Brown University Medical School has helped to redefine the city’s Knowledge District and its opportunities to serve as a catalyst, attracting new businesses in the life sciences sector; a new information technology infrastructure for electronic health records and a health-information exchange is being built out in Rhode Island; the Prince Neurosciences Institute has its first director and established a partnership with Brown University’s Institute for Brain Science; and the purchase of Landmark Medical Center in Woonsocket, a nonprofit community hospital that had been in receivership for about three years, by Steward Health Care, a for-profit hospital system owned by a equity firm in New York City, was sanctioned by the Rhode Island Superior Court, pending state approval.
The new generation of leadership that has taken the helm at many of the Ocean State’s most venerable health care institutions is symptomatic of the changes taking place.
&#8226 Peter Andruszkiewicz replaced seven-year veteran James Purcell as president and CEO of Blue Cross & Blue Shield of Rhode Island, the state’s largest health insurer with more than 600,000 members, nearly 1,000 employees and $1.6 billion in annual revenue.
In November, Andruszkiewicz announced plans to restructure Blue Cross to streamline the company, with the goal of reducing administrative costs in 2012 to less then 15 percent of every premium dollar. As part of the restructuring, 42 employees were laid off.
Two days earlier, Blue Cross announced that, under contract provisions now in place at 10 of Rhode Island’s 11 acute-care hospitals, the health insurer, using evidence-based metrics, would provide increased financial compensation to hospitals based on high-quality patient care. The new quality incentives shift health insurance reimbursements away from “fee for services” toward outcome-based measures, a direct result of the contract conditions established by R.I. Health Commissioner Christopher F. Koller in July 2010. “Blue Cross’ quality incentive programs are consistent with the conditions we established. This is not the last we’ll be seeing [in terms of] provider payment reform,” Koller said. “The momentum will only increase in the futu&#8226e.”
n Dennis D. Keefe replaced John J. Hynes as president and CEO of Care New England, Rhode Island’s second-largest hospital system. Hynes had led Care New England since its formation in 1996.
The significance of new leadership under Keefe is illuminated by the decision of the new CEO to work with Koller, rather than fight him in court. The change helped to resolve a yearlong legal dispute that challenged Koller’s authority. In a settlement announced on Oct. 11, Care New England dropped its lawsuit claiming that Koller had exceeded his authority to examine and regulate health insurance contracts. Hynes had claimed the lawsuit sought to block “the rogue actions” of Koller.
“We have to find ways to work together,” Keefe explained. “The success of health care reform in Rhode Island depends on it.”
Other leadership changes incl&#8226de:
n Martin E. Tursky was selected as the new president and CEO at Memorial Hospital of Rhode Island in Pawtucket, replacing, Francis R. Dietz, who has served in that position since 1966, earning him the distinction of being the longest-serving hospital executive in the nat&#8226on.
n George Vecchione announced that at the end of 2012 he would be leaving as president and CEO of Lifespan, Rhode Island’s largest hospital system and the largest private employer, after 13 yea&#8226s.
n In addition, Maria Montanaro, the CEO of Thundermist Health Center, left her position after 14 years as head of the community health center in Woonsocket. And Rick Brooks, the director of United Nurses & Allied Professionals, departed after 17 years with the union. “Change is what health care is all about right now; we have to talk about it,” said Louis R. Giancola, president and CEO of South County Hospital in South Kingstown. Giancola, however, did not see changes in leadership by itself as being likely to alter the state’s health care landscape. “It’s not about how long one’s been in the role, or his or her age. It’s about what that individual feels is best for the institution.”
Dr. Michael Fine, the director of the R.I. Department of Health, who assumed his new role in 2011, was also wary of putting too much emphasis on change in leadership. “What is most remarkable is how little health care has changed in 2011,” Fine said. “We anticipate change, hope for change, and work for change, but little is different.”
“We still have a health care marketplace, not a health care system,” Fine continued. “And we are still ruled by health care profiteers, instead of being cared for by unselfish … human beings, working together to further the common good.”
Democratic U.S. Sen. Sheldon Whitehouse, however, said “Rhode Island’s health care sector has led the national movement toward better health information technology and exchange, improved quality of health care, greater emphasis on primary care and prevention, and payment reforms in our health care delivery system.
“The recent turnover in leadership at Blue Cross & Blue Shield of Rhode Island, Care New England, and Lifespan so far has signaled continuing – even expanded – emphasis on these key goals. The benefits for patients, businesses and taxpayers could be immense,“ he said.
Yet to Ted Almon, president and CEO of the Claflin Co. in Warwick, Rhode Island’s changing health care landscape is like “watching a train wreck in slow motion.
“But some of the more positive aspects of the story are that rescue attempts are already being formulated,” he said. “The question is really whether these steps are meant to prevent the crash or merely help the victims as best as we can afterward. That is sometimes hard to say.” The health care system will crash, Almon predicted, it is now only a question of when, and which links in the chain will be first to break. Indeed, there are signs of fraying edges. Two years removed from potential merger that would have combined Lifespan and Care New England into one hospital mega-system, the two hospital systems appear to be in competition, as doctors change alliances between the two large systems.
For instance, in September, Lifespan launched its own Women’s Medicine Collaborative, a new outpatient center, where all 16 of its doctors were former employees of Care New England’s Women & Infants Hospital, according to Lifespan officials.
Dr. Edward J. Wing, dean of the Brown University’s Warren Alpert Medical School, saw 2011 as a year characterized by new opportunities to improve the state’s health care system and economy, with the opening of the new home for the medical school at 222 Richmond St.
“The building suggests that if the institutions in our community work more closely together, we can realize clinically important and economically beneficial medical advances,” Wing said. He hoped that the community would come together in 2012 to seize these opportunities.
Nancy Thomas, the principal of Cranston-based Tapestry Communications, with numerous health care clients, expressed concern that amidst all the changes in leadership and systems, the world of the patient has become too small. “In my parents’ and grandparents’ generations, the physician’s office was a partner in the family’s wellness. Today, the health care systems are so large with frustrating redundancies that the personalization has been lost.”
Mark E. Reynolds, president and CEO of Neighborhood Health Care of Rhode Island, said “2011 should be remembered as a year in which Rhode Island seized the opportunity to shape the health care delivery system reforms.
“Whether it was the new exchange, health homes, technology or improving care for people eligible for both Medicaid and Medicare, there was active community conversation and debate about how to affordably and effectively expand coverage to more people.” &#8226

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