Every day, a patient worried about getting the care they need calls CODAC Behavioral Healthcare.
The nonprofit offers psychiatric and mental health services to some of the most vulnerable Rhode Islanders, said CEO and President Linda Hurley. For example, it treats about half of the state’s substance use patients, and 93% of them rely on Medicaid.
But recent uncertainty about federal health care funding cuts has added to providers’ and patients’ concerns about their ability to receive and give care.
“There is a lot of anxiety,” Hurley said.
Hurley was one of six panelists at Providence Business News’ Health Care Summit and Health Care Heroes Awards event April 2 at the Providence Marriott. The discussion touched upon several topics related to health care, including workforce challenges, access, affordability and inequities.
Indeed, federal policy shifts could worsen the state’s health care system – which is already in crisis, said Dr. Michael Wagner, CEO and president of Care New England Health System.
Rhode Island and several other states have already seen cuts in federal funding for research and public health programs. Further hits to health care funding could mean some programs and resources may need to get cut, the panelists said.
“We’re still in crisis,” Wagner said. “We could be heading to a catastrophe.”
But Peter Marino, CEO and president of Neighborhood Health Plan of Rhode Island, was more optimistic. He pointed out that state leaders have made an effort in the past several years to invest in health care.
Still, it’s clear the state has been, and will continue, operating with limited resources. Regardless of what the federal government does, there will likely be cuts to services, and the issue facing health care leaders is deciding which ones to keep.
“It’s a matter of making the priorities, choosing which ones we want to preserve … and those we may have to shed in order to make sure the whole system can survive,” Marino said.
Maximizing the state’s health care resources requires focus and planning, instead of spreading them across several things, he said.
But the state lacks a comprehensive health care plan, making this kind of focus difficult, said Greg Mercurio, senior vice president of radiation oncology at American Shared Hospital Services and CEO of Precision Radiation Oncology of Rhode Island.
“If you don’t have a plan, you don’t know what you need. If you don’t know what you need, you can’t supply it,” Mercurio said.
Right now, it’s up to individual companies or providers to identify and fill gaps in health care. One example recently was when American Shared Hospital Services noticed there was no cancer care offered in the East Bay region. So, the company is now building a comprehensive cancer center in Bristol to address that need.
It’s also important to efficiently address the state’s shortfalls and spend less time studying them, Mercurio said.
This is especially true for Rhode Islanders’ ongoing struggles accessing primary care services. While it’s unclear whether there is a single set of data documenting the number of available primary care providers in the state, panelists agreed that Rhode Island is in the midst of a primary care crisis.
A shortage of primary care physicians is driving this issue. As a result, more nurse practitioners and physician assistants are taking on additional responsibilities.
But the state’s lack of housing has hindered training, said Joseph Trunzo, founding associate director of Bryant University’s School of Health and Behavioral Sciences and a professor of psychology.
Every year, there are students accepted into Bryant’s physician assistant program who have put down a deposit to go but end up withdrawing, then going somewhere else because they can’t find a place they can afford to rent and pay for school.
Boosting compensation for providers is also key to attracting and retaining doctors. The best way to do that is to increase reimbursement rates for primary care services in Rhode Island, panelists said.
Right now, only 5% to 7% of health care funds are spent on primary care. But if that rises to 10% to 11%, it would have a “dramatic positive impact” to the state, Wagner said.
Also, as patients have struggled to find providers, they end up turning to more-expensive resources such as emergency rooms and specialty doctors, said Dr. Raj Hazarika, chief medical officer for commercial products at Point32Health Services Inc. Technologies such as virtual care are certainly part of the solution, he said.
Wagner said Care New England has been testing out different artificial intelligence technologies, including automatic chart summaries, recording and transcribing patient visits, as well as automated responses to patients that provide more-detailed messages. While it’s still early, the results have been promising.
“For all the doom and gloom, I’m actually pretty excited over figuring out ways of de-burdening our physicians and APCs [advanced practice clinicians] as they try to get their work done,” Wagner said.
