Sen. Pamela J. Lauria, D-Barrington, says she could easily make the drive from her home in Barrington to Massachusetts and make much more money as a primary care nurse practioner in the Bay State than she does in the same job in Rhode Island.
“I don’t intend to do that,” said Lauria, who practices at Coastal Medical Physicians Inc., which now does business as Brown Health Medical Primary Care. “But that’s a real problem.”
Indeed, Rhode Island is facing a shortage of primary care providers, an aging health care workforce and lagging Medicaid reimbursement rates.
Lauria noted the salaries for providers and reimbursement rates are 20% to 25% lower than in Massachusetts and Connecticut. Also, 50% of children and one-third of the population are covered by Medicaid.
“Our rates are not sustainable to keep our health care workers here or to attract a health care workforce to Rhode Island,” Lauria said during PBN’s Fall Health Care Summit held Oct. 24 at the Crowne Plaza Providence-Warwick.
Lauria participated in a five-person panel discussion focused on the state of health care in Rhode Island, collaborations and partnerships, and health care access, equity and cost containment.
Fellow panelist Dr. Michael Wagner, CEO and president of Care New England Health System, pointed out two major events that have exposed the weaknesses in Rhode Island’s primary care system.
The first was when VillageMD acquired primary care practices in Rhode Island with 40 to 50 physicians. Then the pharmacy chain Walgreens Co. acquired a controlling stake in VillageMD in 2022 and eventually decided to close clinics in the primary care network in several states, including Rhode Island. This put approximately 60,000 Rhode Islanders at risk of losing their primary care provider – until Arches Medical Partners bought 11 practices in March and kept them open.
Wagner said the second event was the recent financial struggles of Thundermist Health Center, which cares for another 60,000 Rhode Islanders.
“So when you add up the 120,000 [patients affected by the two events] … there is no capacity in the state of Rhode Island to accept those patients,” Wagner said. “So from my perspective, primary care is a crisis.”
Wagner said providers have been pleased with new artificial intelligence developments that can reduce strain on health care workers, including an ambient-listening technology that can document conversations with patients with less of a need for providers to undertake time-consuming recordkeeping.
“[Doctors] were blown away and said, ‘This might actually keep me in the practice,’ ” Wagner said.
Panelists noted technology comes at a cost and agreed improving the state’s reimbursement rates is key to addressing the health care challenges.
“The idea is how do we focus on making sure we fix the money part and then the many other problems,” said John Fernandez, CEO and president of Brown University Health, the state’s largest hospital group.
One of Lauria’s priorities for the next legislative session is introducing a bill requiring regular reports to the General Assembly on rate reimbursements, including a recommendation of rates for primary care services. The bill, introduced by Senate Majority Leader Ryan Pearson, D-Cumberland, passed the Senate last session but did not make it out of the House Health & Human Services Committee.
At the same time, R.I. Health Insurance Commissioner Cory King said the cost of health insurance is only expected to keep rising.
“We have to think about the consumer of health care. As we sit here in October 2024, health insurance is more expensive than it was last year, and it’s going to be a lot more expensive next year,” King said. “So we have to ensure that we’re getting value out of the scarce resources that Rhode Island’s workers are putting into the health care system.”
The average household cost for insurance now is more than $20,000 for a family, said Dr. Raj Hazarika, chief medical officer for commercial products at Harvard Pilgrim Health Care of New England Inc., a Point32Health company.
“It’s like buying a new car every year, and not spreading out the payments over five or seven years but paying for it in cash every year,” Hazarika said. “It’s going to reach $30,000 at this current rate of growth in five or six years. It’s just unsustainable.”
Hazarika also said net costs for pharmaceuticals have risen 40% since 2021. While costs for generic drugs are low, the volume of use is at an all-time high. The rising costs are mainly coming from specialty drugs such as Ozempic and Wegovy.
But panelists said there’s no easy solution at the state level. And the efforts that have been made, such as legislation to establish a Drug Affordability Review Board, have received a lot of pushback, Lauria said.
King said there are hundreds of millions of dollars of drug rebates passed between drug manufacturers and pharmacy benefit managers. This is meant to benefit consumers, but it would be better for drug makers to just lower prices, King said.
“I say to the drug makers, ‘Why don’t you just give us your best price?’ ” he said. “The fact that there are rebates passing around indicates a market failure that has to be addressed.”
