In his first year on the job as director of the R.I. Department of Health, Dr. Michael Fine has not been afraid to use his position as a bully pulpit to promote a public health agenda for Rhode Island. Fine is most proud of his efforts to reconfigure the state’s health care enterprise to be completely collaborative. The agency used to act like the cops, he said, “but now we’re acting like the conveners.”
PBN: Now that your agency has approved the sale of Landmark Medical Center to Steward Health Care, what are the top health priorities that the state needs to address in comprehensive planning for hospital system and the delivery of health care in Rhode Island?
FINE: The top health priority in comprehensive planning is comprehensive planning. Our goal is to get everyone to the table, focused on a single set of goals and objectives.
PBN: You recently said that there needs to be more investment in treating to pre-conditions, not just conditions, in health care delivery in Rhode Island. Is there a business model for how that would work? Can you give an example?
FINE: Ultimately, our goal is to modify risk factors – some of which are socially determined – for a variety of health issues, such as smoking, obesity and sexual responsibility.
We can best address this risk-factor modification at the primary care level. If we had primary care for all Rhode Islanders, we would have a system that works around complaints and risk factors before we get to diagnosis.
Primary care is a place to intervene and in doing so, to reduce emergency department costs by 50 percent and hospital visits by 20 to 30 percent. Primary care for all Rhode Islanders would offer a huge return on investment.
PBN: Blue Cross & Blue Shield of Massachusetts recently launched its own program to address the problem of prescription pain killer abuse. Do you think that Rhode Island’s commercial health insurers should consider a similar approach?
FINE: Rhode Island’s commercial health insurers are already taking a similar approach. I’m aware of programs at Blue Cross & Blue Shield [of Rhode Island], and at UnitedHealthcare [of New England]. Medicaid has a program, as well. What’s most needed is a collaborative effort, and we are well on our way.
PBN: Some 60 percent of physicians in Rhode Island are not currently using electronic health records. How do you think Rhode Island should address this problem?
FINE: Rhode Island should identify an open-source solution and attach it to currentcare. That will help encourage the whole system to use it. What I envision is a model that lets providers log on to the Internet, and access electronic medical records right there, without the cost-prohibitiveness and hassle of purchasing software.
PBN: What accomplishments are you most proud of during your first year as director of the R.I. Department of Health? What are your top priorities for the next year?
FINE: I’m most proud of starting the conversation about reconfiguring the state’s health care enterprise to be a completely collaborative one. The department used to act like the cops, but now we’re acting like the conveners.
As for priorities, I’m now focused on creating that single set of goals and objectives that will drive all participants in the health care delivery system, as well as turning attention to how to build a primary care delivery system that will reduce costs and improve access to care for all Rhode Islanders – while also improving the care experience.