Health council mapping out ways to curb costs

R.I. HEALTH INSURANCE COMMISSIONER Christopher F. Koller wants a better understanding of medical cost drivers to inform efforts to control health care inflation in the state. / PBN FILE PHOTO/STEPHANIE ALVAREZ EWENS
R.I. HEALTH INSURANCE COMMISSIONER Christopher F. Koller wants a better understanding of medical cost drivers to inform efforts to control health care inflation in the state. / PBN FILE PHOTO/STEPHANIE ALVAREZ EWENS

Having documented Rhode Island’s projected future need of hospital beds in a report delivered on April 30 to the R.I. General Assembly, the state’s Health Care Planning and Accountability Advisory Council is laying the groundwork for a statewide plan to help control ever-rising care and insurance costs.
At the top of its list is quantifying the “total spend” of the state’s health sector, to help evaluate whether Rhode Island should follow a similar path to Massachusetts. In the Bay State, the state legislature created a cost commission, setting an annual target of total health care spending, with the goal of keeping costs in line with the overall growth of the state’s economy.
At issue is whether the legislature will move toward setting a cap of health care expenditures in Rhode Island, tied directly to the performance of the state’s economy, as a way to control ever-increasing health costs. The first step in that process is an accurate measure of the state’s total spending on health care.
The council’s second task will be to develop a detailed financial analysis of the state’s behavioral health and substance-abuse services, including the public and private sectors, as well as the costs incurred by gaps in services – such as the de facto role played by the state’s correctional facilities in caring for substance abusers because of lack of access to treatment.
A third task on the agenda will be to look at the makeup of the primary-care workforce in Rhode Island, providing analysis that includes nurse practitioners, nurse managers, physicians’ assistants and other staffing related to the expansion of primary-care practices and patient-centered medical homes.
A fourth task will be to develop a comprehensive database related to pediatrics and the care of children in Rhode Island, focused on cost and outcomes.
“Understanding what drives total medical expense is essential to developing good policies and plans,” said Christopher F. Koller, Rhode Island health insurance commissioner, and co-chair of the council. “I support the priorities identified.” Sen. Joshua Miller, chairman of the Senate Committee on Health and Human Services, praised the new agenda, particularly the focus on cost containment. “I am very pleased that the council has determined to pursue an agenda which reflects these important priorities,” said the Cranston Democrat. “I will be incorporating these priorities into the health care, cost-containment legislation I have sponsored this session. We share a common goal of keeping health care costs in line with the growth of the economy and ensuring the best use of health care resources.”
Mark Montella, senior vice president of external affairs at Lifespan, sees distinctions between what Massachusetts did and what Rhode Island is doing, when evaluating the tasks the council has set for itself.
“I think that the challenge about the Massachusetts experience is that Massachusetts went about it by driving universal access first [through state health care reform],” Montella told Providence Business News. “They actually increased their ‘spend’ considerably in doing so. Then, six years later, they said: ‘Now, we need to tackle the cost equation.’ ”
In Rhode Island, Montella continued, “We’re trying to do both simultaneously, and the challenges can be somewhat difficult. I don’t know that the Massachusetts example is always a perfect one for us.”
Montella also stressed the importance of the second research priority, creating a detailed financial analysis of the state’s mental- and behavioral-health services.
“I don’t think there’s any question that the issue of behavioral-health services is an enormous one in Rhode Island,” Montella said. “We know that the numbers of persons who seek those services seem to be greater than in many other places [and] we don’t know the reason why. We also know that many chronic conditions have a behavioral-health component.” Better managing those behavioral-health services, Montella continued, “being much more astute about it, being earlier in the intervention, will be beneficial.” While there are probably more areas in the delivery system where we spend more dollars, he added, “Our ability to manage [behavioral health] costs down the road will probably be helpful.”
The council, created by the R.I. General Assembly in 2013, consists of 26 of the top echelon of leaders of Rhode Island’s health care delivery system – including Dr. Timothy J. Babineau, president and CEO of Lifespan; Dennis D, Keefe, president and CEO of Care New England; Peter Andruszkiewicz, president and CEO of Blue Cross & Blue Shield of Rhode Island; Jodi Bourque, R.I. assistant attorney general; Dale Klatzker, president and CEO of The Providence Center; pediatrician Dr. Patricia Flanagan; Edward Quinlan, president of the Hospital Association of Rhode Island; Dr. Michael Fine, director of the R.I. Department of Health; Jane Hayward, president and CEO of the Rhode Island Health Center Association; and the council co-chairs: Steven M. Costantino, secretary of the R.I. Executive Office of Health and Human Services; and Koller.
With so many ongoing health care reform initiatives under way, such as the launch of the R.I. Health Benefits Exchange, the online marketplace to purchase health insurance for individuals and small businesses, the question of overlapping work plans was raised at the May 13 council meeting.
Lifespan’s Babineau asked for more information about Rhode Island’s State Innovation Model (SIM) initiative, and how that effort led by Lt. Gov. Elizabeth H. Roberts to develop a value-driven, innovative model for health care delivery funded by the Centers for Medicare and Medicaid overlapped or converged with the council’s efforts. At the May 20 groundbreaking of the second phase of the $45 million project with the Providence Community Health Centers, Walgreens and Lifespan, Babineau and Roberts met to discuss the two ongoing efforts before they spoke at the event.
“The last thing we want to do is to have conflicting or different approaches,” Roberts said, explaining the gist of her conversation with Babineau. “We have reached out to all members of the statewide Health Planning Council to invite them into our process as well.”
Roberts said that while the SIM process was on a slightly different time frame, “We are building on the work they have already done and will be collaborating with them. We want to make sure that the work is done in tandem.”
On April 30, the council had sent a final version of its report to the R.I. General Assembly, analyzing the future demand for hospital capacity in the state.
“What the council tried to do was put together some meaningful findings about the future demand for hospital services – what the legislature asked us to do,” Koller told PBN. “They are facts, findings, conclusions; not recommendations. What’s going to happen next depends on the policymakers. One of the findings was that in five years, there would be 200 extra hospital beds.”
Before the report was sent to the legislature, council member Herbert Gray, the executive director of the Rhode Island Business Group on Health, had attempted to place policy recommendations in the report asking that the legislature create a special hospital commission similar to the Base Realignment Commission used by the military to examine the future need of military bases.
Gray’s proposed recommendations were voted down by the council at its April 15 meeting, with only Gray voting in favor.
The council’s next meeting is July 17. •

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