In Rhode Island, when one hears the words “health care” these days, far too often they’re followed by another word: “crisis.”
Examples abound. There’s been the fallout from Harvard Pilgrim’s withdrawal from the Rhode Island market at the end of 1999, which left tens of thousands of employees scrambling to find new primary care physicians.
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Both large and small businesses in the Ocean State have been hit with double-digit jumps in health insurance premiums — often more than 20 percent in one year.
At Rhode Island’s hospitals, executives complain that margins are disappearing as health-care costs soar and reimbursement rates dwindle.
Then there’s the choking shortage of certified nursing assistants, which, among other problems, has left dozens of nursing homes in dire financial straits.
But at a meeting of New England health-care policy-makers and government leaders in Cambridge, Mass., last week, Rhode Island health-care officials took some solace in the clear reminder that they’re not alone.
“The health-care delivery system in New England is not confined to individual states,” Sen. Jack Reed, D-R.I. said at the summit. “There are so many cross-border situations.”
Reed joined Sen. Susan Collins, R-Maine and dozens of officials representing New England’s health insurers, providers and policymakers at Harvard’s Kennedy School of Government May 14. The objective: to explore the idea of taking a regional approach to solving some of the fundamental problems that affect all players in the six-state region’s health-care delivery system.
And there seems to be no shortage of challenges: an aging population, a labor shortage, spiraling health premiums, quality-of-care concerns, the problem of the uninsured, to name just a few.
“It’s a critical time,” Reed said. ” If we act now, we might be able to forestall a worse situation.”
The six states have forged a few formal collaborations on health care issues in recent years. For example, New Hampshire, Vermont and Maine have formed the country’s first prescription-drug purchasing pool, which is set for an official launch this summer.
The program is expected to save the states as much as 15 percent on their prescription-drug programs. Rhode Island, Connecticut and Massachusetts have strongly considered joining the pool, according to Vermont Gov. Howard Dean.
Also, the New England Center for Health Promotion and Disease Prevention has worked to encourage disease-prevention measures among the region’s health-care providers.
But more should be done on a regional level, officials say. Reed, Collins and health-care policymakers highlighted several other problems that could benefit from regional solutions: the labor shortage, medical errors, prescription-drug access and the hodgepodge of health-insurance regulations among the six states.
While a regional approach potentially could help alleviate some of these problems by pooling resources and sharing ideas, officials admit that the tangle of state and federal regulations will make it difficult in many instances – and impossible in a few – to collaborate.
“An important next step for the region is to begin looking at best practices within each state,” said Karen Voci, vice president of special projects at the Rhode Island Foundation, who participated in a discussion at the summit on the problem of New England’s uninsured. “But I think people recognize that without some major political will or financial incentive, it’ll be difficult.”
Players in New England’s health insurance market, for example, say that greater standardization among the six states’ regulatory schemes would produce more of a single marketplace for insurers to do business.
“You can’t go anywhere else in the country and find a region that has so much mix in the marketplace,” said Joel Cooper, vice president of Americana Financial’s benefits division and former assistant vice president of Blue Cross & Blue Shield of Rhode Island.
But, the regulatory barriers to that sort of standardization — with each state’s legislature handing down its own unique mix of mandates — are extremely high.
While all six states share similar problems, each also has strengths that can be an example for the others, officials said. Much discussion at the summit centered on how each state can learn from the “best practices” of other states.
Maine, for example, is a national leader in helping residents get affordable prescription drugs. Vermont leads the nation with the highest percentage of residents with health insurance (more than 93 percent). Massachusetts has initiated a program to help small businesses provide health insurance.
“The six New England states already have taken a very innovative approach to health care,” said Sen. Susan Collins, R-Maine. “There’s a lot of talent here in New England, and it’s a matter of bringing people together to share ideas.”
While participants at the summit tossed around a bundle of ideas for collaborating on health care issues, no formal initiatives were created as a result of the gathering. But a number of embryonic ideas were floated, which policymakers say could later lead to more concrete collaboration between states.
A few informal proposals included:
- Creation of a system to standardize data among states, which could allow more accurate comparisons of factors such as costs and disease statistics
- Formation of a regional coalition to seek ways to stem the shortage of health-care workers
- Development of a uniform tobacco tax across all six states to help pay for public-health programs
- Establishment of a “me-too” waiver, whereby if one New England state receives a waiver from a federal program such as Medicaid, the region’s other states would be granted fast-track approval
- Creation of a permanent working group to explore regional solutions to health-care problems
The Kennedy School of Government’s Malcolm Wiener Center for Social Policy sponsored the summit, along with the Commonwealth Fund, a private foundation that supports research of health and social issues.
