The last year has been a season of change within the leadership of Rhode Island’s health care community – at hospital systems, at health insurers, at community health centers. And, there have also been a series of new mergers and partnerships underway.
One of the most recent changes has been at HealthRIght, with Elizabeth “Betsy” Stubblefield Loucks becoming the new director, succeeding Amy Black.
Loucks, who earned her B.S. in American Civilization at Brown University and an M.S. in Social Epidemiology at Harvard’s School of Public Health, had been directing the Dell Social Innovation Competition Fellowship at Brown
Providence Business New asked Loucks to talk about what she sees as her organization’s role in the rapidly changing health care landscape in Rhode Island.
PBN: As the new director of HealthRIght, what do you see as the organization’s evolving role in Rhode Island's changing health care landscape? When did you become the new director?
LOUCKS: HealthRIght’s mission is to establish a high-quality, equitable, and affordable health care system for all Rhode Islanders. Our role is still to drive health care reform by working with public officials, insurance payers, health care providers and consumers to create, influence and implement successful statewide health policy. Working with these multiple perspectives, we define uniquely Rhode Island policy proposals that enact the most efficient system for delivering high-quality, affordable and accessible health care to all Rhode Islanders.
I started at the beginning of June. Amy Black, the previous director, left to join the Economic Progress Institute and run the Rhode Island Health Coverage Project, which means she is still – luckily for me – on the scene. My position was made possible by a grant from the Rhode Island Foundation, matching funds from Delta Dental, a collaboration with the Providence Plan, and individual donations.
PBN: Moving forward, what roles do you see businesses playing in helping to define the health care reform initiatives now underway in Rhode Island?
LOUCKS: Employers – as purchasers of health care – are critical to the success (or failure) of health care reform in Rhode Island. The voices of both for-profit and nonprofit employers are so important because along with health care consumers, they pay the bills – but they are often not heard.
HealthRIght’s leadership team includes a significant number of employers, who help us understand the balance of caring for their employees while running their companies, from their perspective.
The goal of our project with the Providence Plan is to engage more and more employers in the Health Insurance Commissioner’s rate review process as well as including them in the reform debate. The more that employers become involved in reform – and advocate for a less expensive, higher quality and more efficient health care system – the more competitive Rhode Island will be on the national and international stage.
By doing health care right in Rhode Island, we can make our state a much more attractive place to do business, and we can help drive the economic recovery Rhode Island so desperately needs.
PBN: Rhode Island hospitals are currently involved in a number of consolidation moves: Steward Health Care is poised to acquire Landmark Medical Center, Care New England and Memorial Hospital have entered into merger talks, the judge overseeing Westerly Hospital's receivership has accepted a stalking horse bid for $69 million from Lawrence & Memorial Hospital in New London, Conn., Lifespan and Gateway have announced plans to partner, and CharterCARE is actively seeking financial partners. How does this change the health care equation, in your opinion?
LOUCKS: It is hard to predict how this consolidation will impact health care reform. HealthRIght has often said that providing health care is not like making widgets – and so competition does not work the same way in health care as it does in other industries. This means that the coming hospital consolidation could have an impact on health care reform in one of two ways. In a positive development, the consolidation could mean that hospitals will use their new-found market power to lower the cost of care while increasing the quality. However, the consolidation could lead the hospitals to use their new market power to take more resources out of the rest of our health care system.
Further, increased market power almost always raises concerns about increasing costs.
We need a detailed needs assessment for our hospital network, and a transition plan for how to achieve the change. HealthRIght is urging the Statewide Health Care Planning Committee to move more quickly to devise a better management plan.
The hospital representatives on the HealthRIght leadership team are very important contributors to our understanding of how to support their pivotal role. The role of hospitals in health care reform is to make sure the system that we implement allows them to deliver the best possible care in the most resource-efficient manner. We must hold state regulators accountable to ensure that within the changing hospital landscape, hospitals (especially newly for-profit hospitals) are required to deliver the best possible care in the most resource-efficient manner so that patients receive the health care they deserve, and can return to their productive and healthy lives as quickly as possible.
PBN: How do you think the new R.I. Health Benefits Exchange will change the health insurance equation for small businesses?
LOUCKS: HealthRIght is concerned that rising health insurance premiums are overwhelming business owners and working people. Health care has become the greatest and least controllable share of state and local budgets. These urgent issues demand solutions now. However, the power of the Exchange to influence the health insurance equation for small businesses depends entirely on how it is structured and regulated. These organizations are given a health insurance rate without any transparency or information about how the insurer arrived at that rate, other than a mention of the demographic composition of their participating employees. Further, the Exchange model itself does not necessarily hasten the kind of changes necessary to control costs or increase transparency.
We are glad that the Governor appointed Christine Ferguson as the Executive Director of the Rhode Island Exchange, and we encourage her to implement a visionary Exchange that actively uses its negotiating power to reform the system.
To really change the health insurance equation for small businesses, first we need to direct the purchase of health coverage for all state, city, and municipal employees to occur solely through the Exchange, beginning when it opens in 2014. Such broad public sector purchasing of insurance would immediately give the Exchange a large, stable base of consumers that can demand better coverage at lower prices. An Exchange of this size could then attract small businesses to purchase in the same manner. Additionally, a large and vigorous Exchange will help spur efforts to wean hospitals and doctors from inflationary fee-for-service payments and move toward bottom-line global budgeting and other payment reforms. We need to move providers away from being paid by the number of patients they see, and towards the number of people they keep well.
Second, HealthRIght is beginning the debate regarding the establishment of one state-based non-profit payer of care in Rhode Island. Vermont has already begun moving down this path, proving that bold ideas are politically attainable. With the right kind of public leadership, Rhode Island can move more quickly to a system that ensures responsible, affordable, accessible and high quality care. We are organizing a forum in October to plan for the 2013 legislative session, when HealthRIght will push for the next step toward more comprehensive health care reform.
PBN: How has your past experience working with the impact of the James Bay Hydroelectric Project in Quebec prepared you for the challenge of your new position?
LOUCKS: My role at HealthRIght is to inspire and facilitate the work our state needs to do to bring affordable, accessible and high quality health care to all Rhode Islanders. The chief skill sets I bring have to do with building collaboration – and consensus when possible – among individuals and organizations that do not see themselves as starting on the same side of an issue. My work in James Bay required that I lead a very diverse group of people to arrive at a shared solution for how to mitigate the community health impacts of new hydroelectric power plants being built on native land in James Bay in Northern Quebec. That meant that I had to get French Canadian government engineers, public health doctors and nurses and First-Nations community representatives to discuss very sensitive and personal health issues together in the same room, in three languages.
My work in Rhode Island as well as James Bay has prepared me well for the setting and people with whom I will work. I have led collaborative processes across the state, from the R.I. Economic Development Corporation to public-private partnerships with universities, non-profits and businesses.
While each collaboration is different, most groups need the same tools and structures to function well: a transparent process that shows each participant when and how their concerns will be addressed; a sense of trust among the group; a belief that the leaders understand and respect their perspectives; and appropriate influence over the outcome of the group’s work. While it certainly takes a lot of work to put these components into place, my motto is “go slow to go fast.”
By taking the right amount of time to establish these relationships and clear communications, we can be successful. Luckily, HealthRIght already has many of these relationships in progress, and I very much look forward to leading us toward a health care system with high-quality, affordable and accessible care for all.