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.

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.

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.

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

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 service
primary careto all Rhode Islanders. ESPHL provided convenings and room for
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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.