Imagine a plan sitting at the RI Department of Health (RIDOH) that would reduce health care spending in Rhode Island by 15 to 30 percent. A plan with the added benefit of improving health care outcomes “with a cutting edge technology that brings every Rhode Islander into world class care – as they need it, where they need it, when they need it, in a way that builds community instead of building profit for others.”
Neighborhood Health Stations, developed by the RIDOH under the leadership of Dr. Michael Fine, is that plan.
Neighborhood Health Stations are “basically community hospitals without walls,” says Dr. Fine in conversation with Richard Asinof of ConvergenceRI. Dr. Fine planned to build one station for every 12,000 Rhode Islanders, between 75 and 100 such stations in all. The first one was to be built in Central Falls.
Neighborhood Health Stations would locate pediatricians, internists, family physicians, dentists, nurse practitioners, licensed and registered nurses, advanced practice nurses, physician assistants, mental health and social workers, physical therapists and occupational therapists, pharmacists, emergency medical technicians and paramedics, registered dietitians, home health workers, promotoras, health coaches, navigators and other healthcare workers under one roof, in a facility that would also offer programs such as “nutrition courses, Zumba classes, or group counseling sessions.”
According to Dr. Fine, if we implemented this plan, we could shrink the hospital system in our state. “When you build out the full delivery system of one neighborhood health station for every community of 12,000 people,” says Dr. Fine, “it is very likely that we can reduce the total number of hospital beds by 40 to 45 percent. That means dropping [the number of hospital beds in Rhode Island] by about 900 beds.”
Governor Gina Raimondo’s budget proposes cutting $88 million from Medicaid’s $2.7 billion in spending, a 3 to 6 percent reduction. Since “Reinventing Medicaid” is being presented as an answer to an imminent disaster, improving the quality of health care or paying adequate wages to health care workers is taking a back seat to saving money.
That’s a shame, because a fully realized health care system of the kind imagined by Dr. Fine would attract business and investment to Rhode Island, while draconian cuts in services to our most vulnerable will have the opposite effect. If we could build Neighborhood Health Stations and make them work, “then health care spending becomes a business magnet. People come and locate businesses here, just because of our health care,” says Dr. Fine.
It’s a great idea, but not one that’s likely to happen. Since Dr. Fine’s departure, Neighborhood Health Stations seem in jeopardy. The new head of the RIDOH, Dr. Nicole Alexander-Scott, has yet to comment on the plan. But a more immediate reason for the plan’s quiet demise can be intuited.
“…if I have had one failure [while serving as director of the R.I. Department of Health],” said Dr. Fine, “if I want to be self-critical, [it’s] that I haven’t made it clear enough to people that we don’t have a problem with insurance, the problem is insurance. That thinking, that insurance, as a financial mechanism, can impact health, is a fundamental, categorical mistake.”
Dr. Fine saw his Neighborhood Health Stations as saving money by cutting out for profit insurance companies, and actually reducing the size of hospitals. The Reinventing Medicaid working group is comprised of a diverse group of people, but for-profit insurers and health-care providers have a prominent seat at the table. Timothy Babineau, MD, president and CEO of Lifespan, Peter Andruszkiewicz, president and CEO of Blue Cross Blue Shield of RI and Helena Foulkes, executive vice president of CVS Health and president of CVS/pharmacy will ensure that their corporate, for-profit interests are protected.
To Dr. Fine, Neighborhood Health Stations are the future of health care. “…if we don’t do it, all we’re doing is perpetuating a costly infrastructure that doesn’t work.” An infrastructure that will remain immeasurably profitable to those sitting at the top of certain health care empires.
The “artwork was created by Roger Williams University students, in consultation with students at Rhode Island College School of Nursing, to illustrate how Neighborhood Health Stations could enhance well-being in Rhode Island communities.”