Updated March 24 at 12:29am

Five Questions With: Elaina K. Goldstein

Professor of associate research at the University of Rhode Island talks about a $14 million, three-year innovation award that will fund a program for cognitively-challenged adults.

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Five Questions With: Elaina K. Goldstein


Elaina K. Goldstein, a professor of associate research at the University of Rhode Island, authored a grant application that recently won a competitive, $14 million, three-year innovation award from the Centers for Medicare and Medicaid Services.

The program plans to use an interdisciplinary team to treat the health care needs of cognitively-challenged adults in Rhode Island with chronic conditions and Alzheimers at the Living Rite center. It will employ a “disruptive” solution that promises to save more than $29 million over the next three years in medical costs. Two such centers will be set up during the first year of the grant.

Providence Business News asked Goldstein to explain in more detail how her “disruptive” solution will achieve its results.

PBN: How does your business model for “Living Rite” serve as a “disruptive solution” for chronic care disease?

GOLDSTEIN: First, the theory of change we used was that of Havard Business School Professor Clayton Christenson and his co-author Dr. Jason Hwang in their book, The Innovator's Prescription: A Disruptive Solution for Health Care.

We tweaked a few of the components of their chronic disease management solution.

We will have an interdisciplinary team of providers located at a Living Rite center. We will include as many of the current providers, generally specialists, that the patient is currently seeing, using telehealth technology.

We will also seek to create an engaged patient. We are retaining Dr. James Prochaska and the company Pro-Change to develop a way to use his renowned behavioral change model for people with cognitive disabilities.

We are also focusing on where the patient receives care. Christenson and Hwang suggest a patient should receive care in a place where that person goes everyday. We will be developing Living Rite centers in agencies and adult day centers where these individuals come for recreation, employment and socialization.

PBN: What can other businesses in the health care industry learn from your new model of care?

GOLDSTEIN: What we are hoping for is that Living Rite centers will become a better model for treating chronic disease. Also, that a new holistic kind of provider will become part of the continuum of care for individuals, and be incorporated into Medicare, Medicaid and private health plans.

PBN: By your calculation, your program wills save $29 million overall, so that through the investment of $14 million, Living Rite will create a net savings of about $15 million. How do the numbers work?

GOLDSTEIN: There is a specific financial calculation that the feds had requested we use. This includes: reducing the costs of Medicare and Medicaid expenditures by reducing hospitalization for things like pneumonia – a preventable hospitalization; reduced ER visits, primarily through the use of telemedicine; delaying or avoiding nursing home placement, by working with people to better manage their chronic conditions or prevent them altogether; and, the use of prescription therapy management.

PBN: Your work translates the principles of Chistensen and Hwang into real-world applications. How will they be involved in the project?

GOLDSTEIN: I’m excited that Dr. Hwang has agreed be an adviser throughout the grant’s duration.

As a matter of fact, he was here in Rhode Island on July 25 to conduct a workshop with our Living Rite Center providers and other contractors in the project.

He was just terrific. We have already gained from his insights and experience with other programs that have developed using this theory of change.

PBN: How will the new interdisciplinary center at the University of Rhode Island serve as a workforce initiative in health care?

GOLDSTEIN: We are looking to create an Interdisciplinary Education Center at URI. Our focus in the first year is to get the Living Rite centers operational and then, in year two, build a coalition of professional and paraprofessional-degreed programs within the URI and among other universities in the state, such as [the Warren Alpert] Medical School at Brown and the nursing school at Rhode Island College.

We want to train students on how to operate as part of an interdisciplinary team.

URI’s College of Pharmacy and Nursing has already begun working with the medical school at Brown on this type of inter-professional training.


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