By Richard Asinof
By Richard Asinof
In the jigsaw puzzle that is the current landscape of the health care delivery system in Rhode Island, it appears that not only are the shapes of the pieces changing the way they fit together, but the colors and images of the puzzle pieces are changing, too.
Dennis D. Keefe, the president and CEO of Care New England, Rhode Islandâ€™s second largest hospital network, provided Providence Business News with an in-depth look at the many ways the system is rapidly changing â€“ Care New Englandâ€™s acquisition of Memorial Hospital in Pawtucket, the decision by Rhode Island health insurance commissioner.
Christopher F. Koller to take a new job and leave Rhode Island, the opportunities for new kinds of insurance products on the R.I. Health Benefits Exchange that create new networks of hospitals, payers, and physiciansâ€™ groups, and the realignment of womenâ€™s health care services.
PBN: Were you surprised to learn that Chris Koller was leaving?
KEEFE: There arenâ€™t too many times in this business that you are shocked. But, I was shocked. I had not hint of it, in any way.
I have a sense that itâ€™s an opportunity for him. Sometimes things come from out of the blue, youâ€™re recruited, and maybe you werenâ€™t looking, but you get involved.
I do meet with Chris on a regular basis, we have a very good relationship, and I have tremendous respect for Chris. I think heâ€™s been a shining beacon of health care and payment reform in Rhode Island. Heâ€™s been very innovative. He is someone you can talk to, heâ€™s someone you can work with, heâ€™s incredibly intelligent, and he knows his stuff like few others around the country. I think itâ€™s an immense loss for Rhode Island.
PBN: Can you share any plans regarding the role that Care New England intends to play, or not play, with the R.I. Health Benefits Exchange?
KEEFE: Weâ€™ll have to see the way it all plays out. Weâ€™re a provider, a very important critical provider, and the potential products that are offered on the exchange may include a venture between a provider and an insurer and maybe a medical group as well.
What I can tell you is that we are actively engaged with all parties, to see if we can come up with a product that meets the requirement both for coverage and for costs on the exchange. It wouldnâ€™t necessarily be a tiered product, but it would be a network product.
One of the reasons Iâ€™m being vague about it is because itâ€™s not like weâ€™re just talking to one insurance company. We are talking with all the insurers. Weâ€™re also looking at other options with physiciansâ€™ participation.
PBN: The push and pull of consolidation in the hospital marketplace is happening. The same week that your application to bring Memorial Hospital into the Care New England network was deemed complete by state regulators, Lifespan announced a new partnership with one of the stateâ€™s largest ob-gyn practices. What are pressures of collaboration and competition?
KEEFE: This Thursday [April 25] is our first session with the [state regulatorâ€™s] Project Review Committee [about Memorial Hospital], and I was just meeting to go over our presentation. Thatâ€™s going to move forward. We feel that we have a very solid application and rationale for why we are doing this. And we will tell out story.
In terms of Lifespanâ€™s [employment contract with OB-GYN Associates], itâ€™s sort of like dĂ©jĂ vu. When I first got here in August 3011, we were dealing with a major defection of a number of physicians to Lifespan. It did create a series of challenges. For me, was that it was a first instance where the new Care New England, in terms of how we think about changing from free operating units into a system of coordinated and integrated care, came into focus. And it really started to pay dividends immediately, with a lot of cooperation between Kent and Women & Infants. In terms of overall patient care and safety, we didnâ€™t experience significant problems or issues.
From then until now, what Iâ€™ve been trying to do is find a way to be more cooperative and collaborate in a number of different ways [with Lifespan]. One of the areas that Iâ€™ve been trying to be far more collaborative is in academics and research, where weâ€™ve be able to find some common ground, trying to get together with Lifespan and Brown University. We had a first meeting of our joint research task force in March.
Itâ€™s about how we can strengthen research and academics across Rhode Island, and how we get all the players at the table, Care New England, Lifespan, the VA, and Brown, and really start to do this together, share infrastructure where we can, share resources, and generally, just grow research, which is a huge opportunity for Rhode Island.
PBN: And, in terms of competition and OB-GYN Associates?
KEEFE: They are an independent group, they certainly have the ability to make their own decision. I am not opposed to employment [of physicianâ€™s groups], If they want to be employed by a hospital, thatâ€™s their decision. Itâ€™s an open market, itâ€™s a free market, and physicians and physiciansâ€™ groups have a lot of opportunities to choose their future in this market.
I wish them good fortune.
I have often said, and Tim [Babineau] has actually quoted me, I think weâ€™re heading toward two major health care systems in Rhode Island, Care New England and Lifespan.
I think personally thatâ€™s a good thing, I think that competition is a good thing.
You never know where the end game is with two health care systems, so I would never say never.
But when I talk about competition, itâ€™s competing on the basis of patient safety, quality, and patient experience and care. Itâ€™s about being the best and offering consumers a clear alternative in terms of these parameters.
Iâ€™m not sure it serves either organization well to try and recruit each otherâ€™s physicians. Itâ€™s a free and open market. But I donâ€™t think it serves the industry well if weâ€™re out there trying to compete with each other by trying to recruit each otherâ€™s groups. It doesnâ€™t help with coordination and integration of care when a physician has to split their ob and gyn practice between two hospitals, and the information technologies are not in place to seamlessly provide the information flow back and forth.
PBN: Does Care New England have a emergency plan in place that you would implement in case of a flu pandemic from H7N9? Have you been notified at all by the R.I. Department of Health?
KEEFE: Not yet. We certainly have an emergency response plan, each hospital has its own plan, and we have an overarching Care New England plan as well.
You hate to be in a position to have to implement that kind of plan, but you have to have a plan, and you have to test them periodically, as we do.
The Joint Commission requires that you test [the plans] twice a year, or you canâ€™t be accredited, so Iâ€™m sure each operating unit has met those requirements.
After what seems like a few years of mild flu seasons, we actually had a fairly significant flu season last year. A lot of our policies about how we managed surge capacity were really stretched.
Quite honestly, if this is somethingâ€™s that out there, we should be revisiting our policies to make sure that we could handle something of this kind of scale. I have a strong public health background, having served as public health commissioner in Cambridge, Mass. As we have more information that this is a possibility or a probability, we should absolutely be looking at this to make sure that we can handle it.