ESPHL PROJECT HIGHLIGHTS

RHODE ISLAND

July 2014

Team Members:

Michael Fine * Christina Batastini Benjamin Copple

Marie Ganim David Heckman

Joseph McNamara Joshua Miller Jane Morgan Herb Olson

Roy Jason Smoot

* Team Leader

For additional information, contact: Sophie OConnell

Strategic Communication Specialist Center for Public Health Communications

Rhode Island Department of Health Email: Sophie.OConnell@health.ri.gov Phone: 401-222-5913

States policies shape where we live, learn, work, and play, and impact the publics health. While there is evidence for what works to improve populations health outcomes, many states lack robust partnerships capable of mobilizing stakeholders, re-examining existing legal models, and innovating through statue and regulation. The Excellence in State Public Health Law (ESPHL) program sought to strengthen the relationships among health policy decision-makers in and among selected states and to increase the ability of these states to understand how policy could improve the publics health. States determined

their own priorities, and ESPHL did not pre-determine states outcomes.

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Rhode Islands Excellence in State Public Health Law (ESPHL)* project focused on advancing the creation of the Primary Care Trust (PCT), which will provide the mechanism to direct primary care dollars already in the medical care funding stream to create robust primary care practices known as Neighborhood Health Stations. Neighborhood Health Stations will be supported and rewarded for a unique mission: to maximize population-based health outcomes for the whole community within their service area. The team envisioned a sustainable funding model for statewide public health programs to be funded through contributions from health insurance plans, including self-insured plans. At the second ESPHL retreat in January 2014, the team refined an approach that could be successful as a funding mechanism. The model as envisioned will broaden the funding base to include many self-insured plans, and put Rhode Islands immunization purchasing program on a more sustainable and equitable basis. In the long term, this budget component may serve as a model for how the state can fund the PCT and develop Neighborhood Health Stations. The PCT and its Neighborhood Health Stations will explicitly focus on health for all Rhode Islanders. The Stations will be community-configured hybrids of both care delivery and preventive care, and include public health components. Beyond a standard capitated rate, Stations will receive incentive payments based on how well they perform in the following domains:

community penetration

breadth of services offered

hours of operation

quality assurance/quality improvement By pooling all of the primary care dollars in the state and moving away from inefficient and cost-driving fee-for-service reimbursements, the PCT will have the funding and flexibility to pay for the public health services that are needed in each community, improving public health and cutting costs. Private health insurance companies in Rhode Island have been receptive to this idea, conditioned on a PCT ready for operation. All health insurance plans currently use a certain percentage of premiums to reimburse primary care. The PCT will be configured to pool this primary care money from the various plans into one fund and efficiently pay this money out to the Neighborhood Health Stations, eliminating significant administrative costs for the plans while also providing administrative efficiencies for the Stations. We are looking at various funding opportunities to create one or two pilot Stations, but the PCT will be the eventual funding mechanism to both collect this money from the health insurance plans and

* ESPHL, a program of the Aspen Institute Justice & Society Program, was made possible by a grant from the Robert Wood Johnson Foundation.

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apply it to Stations operating costs. The states immunization purchasing program, which has recently faced a sustainability issue, presented a unique opportunity to establish just such a funding model. Rhode Island has some of the best vaccination rates in the nation, and much of this is due to the availability of vaccines through statewide purchasing (which also saves money as the state purchases vaccines at the same rates charged to the Centers for Disease Control and Prevention). However, this immunization purchasing program had been funded through an assessment only on the plans insured by health insurance companies, avoiding all self-insured plans. As more Rhode Island-based employers have become self-insured, the base for this assessment has shrunk.

Our goal was to gain a better understanding of the arguments both in favor of and against funding public health programs such as the Primary Care Trust through health plans. Technical assistance funding from ESPHL allowed us to conduct meetings with key stakeholders to better understand their perspectivesboth those in favor of and those against funding statewide public health programs, such as the immunization purchasing program, through contributions from all health plans in the state. The ESPHL model of configuring inter-agency teams that include a member from the Senate and the House has been so successful for this project that it is now being used to find solutions for other statewide policy issues. The all-cohort leadership retreats were essential for us, and team discussion fostered the development of a plan to establish sustainable funding for public health programs.

Under ordinary circumstances, it is all too difficult to bring together so many high-level government stakeholders for long discussions. The ESPHL retreats gave our team the time and space necessary to explore innovative policy solutions. The development of relationships across branches of government, the fostering of well-considered and nuanced policy dialogues, and the deepening of a joint commitment to drive policy can be seen as the means for achieving the progress made to date. The most fundamental issue facing the creation of the PCT was establishing a funding model to gather money from all health plans in one place for the purpose of a true public health program, one that is meant to provide an essential health serviceprimary careto all Rhode Islanders. ESPHL provided convenings and room for

We are talking seriously about starting a public health law advisory committee to the department, to bring together the health law bar, our lawyers, and possibly some of the policy people from the legislature, so we can develop a more collaborative approach to regulation.

- Dr. Michael Fine, Director, Rhode Island Department of Health

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discussion that allowed the examination of all available options and the formulation of new approaches to the states immunization purchasing program and neighborhood health stations under the PCT. Similar projects in other states may benefit greatly from the team-based approach we used in the ESPHL program. Having a representative, a senator, and individuals from the Governors office, Office of the Health Insurance Commissioner, Rhode Island Legislature, and Department of Health is arguably what made our advancements possible.