Coalition seeks health overhaul in R.I.

Sometime soon, most believe, Congress will pass some kind of national health care reform that will expand coverage, tighten regulation of health insurers, maybe try to control Medicare-spending growth.
And that’s good, says Ted Almon. It’s just not enough.
Almon, president and CEO of the Claflin Co., a Warwick medical-devices company, is one of the founders of HealthRIght, a coalition formed in 2006 to promote comprehensive health care changes in the state with support from business, labor, providers and consumers.
Now, with a $50,000 grant from the Rhode Island Foundation, the coalition is preparing to take a big step forward and develop a bill to submit to the General Assembly, building on three key points:
• Consolidating all public and private health care dollars into a single public or nonprofit purchaser of health insurance and/or health care services.
• Controlling costs through a coordinated health care planning process and restructuring the delivery system to more equitably and efficiently allocate resources.
• Ensuring all Rhode Islanders have timely access to affordable, high-quality health care.
How each of those points gets fleshed out remains to be seen – first, using the grant money, the coalition plans to reach out to stakeholders and build a consensus, then back it up with research and analysis of key legal, economic and public-policy questions.
In practice, that may mean consolidating payers. But it doesn’t necessarily result in a single-payer system. Rather it could create a statewide purchasing hub with uniform standards for all health plans.
But the key, says Almon, is to think big and do reform right, and to change not just health insurance, but the health care delivery system, which is deeply flawed now.
“There’s been, I think, too much of a focus on insurance reform, and not enough on delivery-system reform,” Almon said in an interview. And while insurance reform can help change the delivery system, he added, it may be like “paving cowpaths” – fixing a model that has outlived its usefulness. “Maybe we’re improving a process that should be obliterated altogether, which happens all the time in business,” he said. “And maybe that makes us miss more radical kinds of reform that would create much faster and more dramatic improvement.”
First things first, though. HealthRIght already has a broad range of members and supporters, including business leaders such as Almon; labor leaders such as Rick Brooks, executive director of the United Nurses and Allied Professionals; policy experts such as Christine Ferguson, former head of the R.I. Department of Human Services and a veteran of Capitol Hill; health care industry leaders such as Louis Giancola, president and CEO of South County Hospital, and leaders of the Rhode Island Medical Society; well-respected academics such as Terrie “Fox” Wetle, associate dean of Brown University’s Warren Alpert Medical School; and consumer advocates such as Dawn Wardyga, of the Rhode Island Parent Information Network, which also provided office space for HealthRIght.
The group has also reached out to – and worked with – government officials, advocacy groups, professional associations, community health centers, business organizations and insurers. It submitted a “placeholder” bill this year at the General Assembly to spark discussion of health care reform, and it has raised more than $100,000 from members and private donors, separate from the Rhode Island Foundation, to finance its efforts.
But now the general principles have to be turned into more concrete proposals, and that, HealthRIght leaders envision, will involve a whole other wave of discussions with members and partners, consensus-building, and then a “road show” of sorts to build more support. How that shapes the reform agenda remains to be seen. Almon, who long has argued that a single-payer system would serve everyone better than the current setup, said nobody in the coalition is “wedded” to that model or to any other specific structure. The key point, he said, is to control and reshape the reimbursement system.
“All the [providers’] behavior and the business model follows the reimbursement system,” he said. “So if you can gain control of the reimbursement system, you can change those incentives and hopefully change the delivery system.”
Asked how big a role he sees for businesses in the coalition’s work, Almon said he sees them as major stakeholders, because “businesses are hurt the most” by the current system, forced to subsidize the uninsured and the government with their premiums.
Almon said he already has reached out to the Rhode Island Business Group on Health (RIBGH), of which he is also a member, and he expects to have further conversations in the months ahead. But there’s a big difference between that group and HealthRIght, he said: RIBGH exists primarily to educate its members about health care issues and to ensure business voices are included in policy discussions, but it doesn’t have its own reform agenda.
“HealthRIght is the only group whose mission it is to produce a comprehensive legislative package and get it passed,” he said.
As for national health care reform, Almon expects something to be passed this year, but only a “relatively weak sort of framework of reform” that requires extensive implementation work. “And then the states are going to have to take the bull by the horns and do it themselves,” he said. •

To learn more about HealthRIght, go to www.rihealthright.org.