It’s a little over a year since Dennis Keefe took the helm as president and CEO of Care New England, the second largest hospital system in Rhode Island. He was recruited in part because of his experience in Massachusetts as a hospital leader involved in the state’s health care reform efforts. On his office bookcase is a framed photograph of many of the people who were involved at the time, with a handwritten note scrawled across the photo: “Congratulations! Mitt Romney.” The photo, Keefe joked, “may be worth something on e-Bay some day.”
Keefe is now leading the transition of Care New England into what he calls an integrated, coordinated system to deliver health care. Recent moves include a potential merger with Memorial Hospital of Rhode Island, a new five-year contract with Blue Cross & Blue Shield of Rhode Island to create new networks of care, a restructuring of the hospital’s executive leadership to create a unified system of responsibility, and the development of a new integrated behavioral health approach within the hospital system.
Providence Business News recently sat down with Keefe for an in-depth, one-on-one interview in his office.
PBN How do you see Care New England moving in the new landscape of health care reform and delivery? Where do you see Care New England in the next five years?
KEEFE: Coming from Massachusetts, over the last five or six years, I have had direct experience in [implementing] the state’s health care reform and the state’s [policies] of payment reform. I led the Cambridge Health Alliance, a public, three-hospital system.
There are a lot of similarities between where we ended up in Massachusetts and where we should end up with Care New England in Rhode Island.
I’ve experienced the good, the bad, and the ugly of the Massachusetts health care reform law. The law was accompanied with a federal Medicaid waiver. The irony of that law is that it was … the creation of both the Romney and Bush administrations.
I think it’s unbelievable that Romney [has disowned his own plan]. He sat in my office, and we talked about the health care reform law. He toured the facility and kissed babies. You could tell he was a bit uncomfortable kissing babies, or being in a hospital in particular.
What happened in Massachusetts is not only coming to Rhode Island, I think in many ways it is already here. Whereas it took five or six years for the Massachusetts health care reform law to really take hold, it’s not going to take five or six years in Rhode Island. I think it’s going to be a much more compressed time frame to have major changes in Rhode Island in terms of health care reform, health care delivery and changes in the health marketplace.
PBN: You recently announced a major corporate reorganization within Care New England. Why was that done, and how does that play into the way that Care New England is repositioning itself in the marketplace.
KEEFE: It all comes back to the direction we’re going, toward population health. We’re moving away from the fee-for-service payment system that a lot of people think was the key reason for medical costs spiraling out of control. The fee-for-service system rewards volume. The more of whatever you do, the more you get paid, and it doesn’t necessarily translate into better outcomes, or better care, or better quality, or even better patient satisfaction. What it does translate into is a lot of expense – and unfettered growth and expansion and expense over the years.
We need to move toward a system that rewards value, where health care systems provide highly patient-centered, coordinated, efficient, effective quality care at a reasonable cost. That’s the value proposition where the health care system is headed.
In moving away from fee for service, [we’re moving toward] a fixed payment, Whether it’s a payment from the federal government, or the state or a commercial insurer, they are saying they want to pay you differently, on the basis of outcomes, and providing care to a population.
PBN: How does that translate directly into changes in corporate structure of Care New England?
KEEFE: I was recruited here for two reasons; my Massachusetts experience, and to create a true health care system for Care New England.
We were a system in name only when I got here. What I saw was a federation or an obligated group, four completely independent organizations. Care New England was more of a holding company that the four organizations reported up to; all four had separate governing structures and separate committees, and operated just like an independent hospital.
The board said: we need to rethink our future, we need to become a real system, with the four entities working together to provide coordinated, effective care across the system.
If we start getting paid differently at the Care New England, we have to have systems in place to be able coordinate care across the system.
We should be speaking with one voice in terms of quality, we should have one standard in terms of quality across the system, and the bar should be set very high.
There should not be any differences in how we deliver quality care through any of the operating units of Care New England, hence, the addition of chief corporate quality officer, and the position of a chief clinical integration officer, and a chief operating officer.
PBN: There is an increasing consolidation of hospitals in Rhode Island. By the end of the year, only South County Hospital may remain as an independent community hospital. How will that affect the marketplace? Will it lead to a limited service networks and new insurance products?
KEEFE: When we talk about forming accountable care organizations, they depend on a strong primary care base in patient-center medical homes.
You can’t succeed in that area unless you have consumers who sign up for these plans. There is a proliferation still to this day of PPO plans in Rhode Island. I have one, Health Mate Coast to Coast, which means I can go to whomever I want, I can see whatever physicians I want, and I can go whatever hospital I want.
So there is no real incentive in that kind of a plan to have your care coordinated by a primary care physician, who ends up being the architect of helping you navigate the health care system – and keeping you well and keeping you out of the hospital and free from disease.
We’re talking to Blue Cross [& Blue Shield of Rhode Island. Peter [Andruszkiewicz, the president and CEO of Blue Cross] and I share the same vision of where we need to go: there needs to be a significant reform to the health care delivery system, focused on keeping people well, on prevention, on screening, on keeping people out of hospitals, and the incentives need to be aligned between hospitals, physicians and health plans, all for the benefit of employers.
PBN: The state has embarked on a statewide planning initiative for health care delivery. Can the state keep up with the rapid changes? Will the planning effort be superceded by ongoing changes in the market?
KEEFE: The market place waits for no one. I think where we’re headed, and I will be provocative, is to two or three health care systems in Rhode Island. The configuration is still a bit up in the air. I say two or three, because one assumes – and this could be wrong tomorrow – that Steward is going to come in and [acquire] Landmark and maybe CharterCARE.
Certainly, we [at Care New England] are headed toward developing an integrated delivery system. Lifespan is doing the same thing.
Hopefully, this can end up of being very complementary with how the state sees the future.
I do think part of the state’s thinking relates to the number of inpatient beds, and whether or not there are too many in patient beds. You could connect the dots and ask, does that mean there are too many hospitals?
If you really think about it, the health care delivery system is changing in Rhode Island, and will continue to change. The day of the inpatient hospital, to me, if not over, is headed in that direction.
