Updated March 28 at 4:32am

Five Questions With: Dr. Michael Fine

Director of the R.I. Department of Health talks about the Primary Care Trust Initiative.

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Five Questions With: Dr. Michael Fine


In 1996, Dr. Michael Fine, the director of the R.I. Department of Health, was a member of a small primary care group practice located on East Street in Pawtucket. “I was sitting there, trying to figure out what it cost to deliver primary care for about 4,000 patients,” he told student who attended his talk on Nov. 27, 2012, as part of the University of Rhode Island honors colloquium. “I did the math three or four times,” he continued, because he couldn’t believe the numbers. Per patient per year, the cost was $106; yet the cost of health insurance was about $4,000. In other words, patients were paying $4.000 for $106 in value.

As a result that “eureka” moment, the realization that the health care market was “at war with health,” Fine has spent much of his career trying to change the paradigm of health care in Rhode Island. His latest initiative is called “The Primary Care Trust,” which would create neighborhood health centers in Rhode Island communities with 10,000 residents. Providence Business News asked Fine to share his plans.

PBN: What is your vision for the primary care trust in Rhode Island? How would it work?

FINE: The Primary Care Trust will create and fund “Neighborhood Health Stations” in each Rhode Island community of 10,000, which will serve as medical homes for the entire community, and offer wellness visits, sick visits, dental care, and healthcare services.

The Primary Care Trust and Neighborhood Health Stations concept will build on the pioneering work of Rhode Island's Community Health Centers, primary care providers, and the Chronic Disease Sustainability Initiative, including the ground-breaking work that has made Rhode Island first in the nation in the percentage of primary care providers recognized as patient-centered medical homes.

These Neighborhood Health Stations will see people the same day they are sick, and will be open during hours that are convenient for patients on both weekdays and weekends. Neighborhood Health Stations will provide medical and mental health, home health, and perhaps even dental services.

For example, a Neighborhood Health Station might include primary care physicians, pediatricians, internists, family physicians, dentists, nurse practitioners, physician assistants, mental health workers, social workers, physical therapists, pharmacists and home health workers.

The flexibility of the Primary Care Trust will allow each Neighborhood Health Station to tailor its services to meet the needs of the particular community it serves.

PBN: Can you provide some numbers about what would be the potential return on investment, i.e., better health outcomes, lower costs, better prevention?

FINE: The Primary Care Trust will transform the way health professionals are paid, using financial incentives to encourage improved care and better health outcomes for individuals and communities. It will make Rhode Island the first state in the nation to take full advantage of cutting-edge developments in health policy and health care system design that have studied the advantages of treating the whole individual, the whole family, and the whole community, at a predictable and controllable cost.

PBN: How would this system of community primary care facilities serve as a economic engine for Rhode Island?

FINE: Each Neighborhood Health Station will function as the anchor of local economic development. Each station is a $20 million to $30 million per year business and will bring business activity to between 75-100 neighborhoods and communities.

PBN: What are the next steps to make this primary care trust initiative happen? What do you see as the potential forces of resistance?

FINE: We are in the process of sharing the wealth of data that exists about the value and public purpose of primary care. We’ll be talking about this approach, and listening to the thoughts of collaborators.

Our goal is to build on Rhode Island's areas of strength. We have great Community Health Centers and primary care providers in this state. The Primary Care Trust builds on the seeds already planted and reflects on our ability to create better health outcomes for all Rhode Islanders at lower costs than we now pay.

PBN: Why should the business community become advocates for the primary care trust in Rhode Island?

FINE: If we can lower health care and health insurance costs, health care in Rhode Island becomes a business incubator and not a business tax. If Rhode Island has lower healthcare costs than Massachusetts and Connecticut, we can draw new businesses here. Healthier Rhode Islanders also mean a healthier workforce and an increasing number of Rhode Islanders who are ready and able to work.

Lower healthcare costs mean more opportunities to invest capital in improving our state's public services – libraries, schools, public safety, housing, and the environment – investments that also serve to strengthen our workforce.


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