PROVIDENCE – With more than five hours of presentations and number-crunching by the leaders of Rhode Island’s health care industry sector, the Rhode Island Business Group on Health’s annual Health Care Summit on Oct. 17 was very much a health care policy wonk’s idea of a fun day.

However, if news is not so much what happens, but what you don’t know, then there was a helluva lot of news that was shared at the summit, despite the talking-at lecture format.

• Blue Cross & Blue Shield of Rhode Island announced plans to try to eliminate the fee-for-service payment model by 2018, with rate increases tied to the Consumer Price Index, according to Peter Anduszkiewicz, the health insurer’s president and CEO. “Inertia is not our friend,” Andruszkiewicz said, promoting the need for strategic collaboration. “The cost of the status quo is always greater than the risk of change,” he said, quoting a formula developed by the co-founder of Fast Company magazine.

• Care New England will announce on Monday, Oct. 20, a new Maternity Bundle payment system, as part of its strategic partnership with Blue Cross, with a single rate for all normal deliveries and normal C sections at Women & Infants Hospital, putting $125 million of its revenue stream at risk, according to Dennis Keefe, Care New England’s president and CEO. The new partnership is part of a larger effort to become move to an Accountable Care Organization payment model, away from the perverse incentives of fee-for-service. “I believe that there’s more than enough money in the health care system to invest in the front end, promoting healthy communities and healthier lifestyles,” Keefe said, saying that public health was part of his DNA.

• Lifespan will launch the conversion of its new health IT Epic platform on March 29, transferring the electronic health records of 2 million people into the new system, according to Dr. Timothy Babineau, president and CEO of Lifespan. Rhode Island’s largest hospital system is halfway to its 36-month goal of reducing its expenses by $150 million, having cut $77 million, according to Babineau. A big part of the reduction has been the creation of a tiered network for its employees to reduce its $140 million annual cost of health insurance. “Tiered networks are here to stay,” Babineau predicted.

• UnitedHealthcare’s strategic marketing direction is to engage with the customer, in real time, in the ways that customers want to be engaged, instead of pushing information at them, and Optum, its division separate from the business of selling insurance, is leading the charge to change the way customers receive information, including the development mobile apps and telemedia platforms, according to Stephen Farrell, president and CEO of UnitedHealthcare of New England.

• Louis Giancola, the president and CEO of South County Hospital, the only remaining independent community hospital in Rhode Island, repeated his call for a health insurance card that function similarly to his American Express Card, so that wherever he went, he could pay for his health care with a swipe of the card. Giancola decried the army of employees on either side of the hospital and insurance cost equation that spend enormous amounts of time and money trying to decrease or increase what is paid.

• CVS Health is now the largest health care by revenue in the United States, serving 100 million Americans a year and 5 million people every day, according to Dr. Andrew Sussman, chief medical officer at CVS Health and president of CVS MinuteClinic. CVS Health has 943 MinuteClinics, making it the fastest-growing retail clinic chain in the country and the largest retail clinic chain in the world, according to Sussman. It also manages the pharmacy benefits for 65 million people in its programs. “We will be opening our first MinuteClinic in Rhode Island at the end of October,” he said. The retail clinics provide walk-in care, seven days a week, without an appointment. “We do not intend to replace the critical role of primary care provider,” Sussman continued, saying that CVS MInuteClinics have partnered with more than 40 health care systems across the nation. [When asked by ConvergenceRI after his presentation whether such a partnership was pending with a hospital system in Rhode Island, Sussman declined comment.]

• Dr. G. Alan Kurose, president and CEO of Coastal Medical Group, departed from his planned Powerpoint slideshow to talk about the presentation he and other Rhode Islanders made in Washington, D.C., to the Centers for Medicare and Medicaid Services, to pitch Rhode Island’s State Innovation Model plan, in order to win $58 million in new federal funds. Among the delegation were Neil Steinberg, president and CEO of The Rhode Island Foundation and Dr. Michael Fine, director of the R.I. Department of Health. Kurose said that Rhode Island’s presentation was well-received. When asked if there had been any businesses who had been part of the delegation, Kurose said no, apparently not counting his medical group practice as a business.

What wasn’t talked about
Until Sen. Sheldon Whitehouse brought up HealthSourceRI during his lunchtime talk, more than five hours into the event, with a tangential reference to the fact that Rhode Island’s rollout of the Affordable Care Act was “unbotched,” there was not any discussion on the future of the state’s health insurance benefits exchange.

Also missing from the conversation, were the small business perspective and the community health center perspective – although Dr. Pano Yeracaris, co-director of the R.I. Chronic Sustainability Initiative, was invited to talk as part of the statewide organization panel, along with Laura Adams from the Rhode Island Quality Institute and Kurose. Yeracaris – as did Giancola and Keefe – praised the ongoing collaborations with community health teams in Pawtucket and South County, with the ability to access patients in their homes. Keefe singled out both Blackstone Valley Community Health Care and Thundermist for praise for their ongoing collaborative work with Care New England. Yercaris also praised the work being done by HealthCentric Advisors.

Finally, what was missing from the conversation was a patient perspective and a community perspective– what the customer wanted and needed, as well as what the community wanted and needed. These omissions could be easily remedied for next year’s summit – if RIBGH wants to make the conversation more inclusive.

Is there a disconnect?
Following the session, ConvergenceRI asked Betsy Stubblefield-Loucks, the director of HealthRIght, who had attended the annual health care summit: why do you think there is a disconnect between health care policy and economic development policy?

She answered: “This is an excellent question. I think it gets at some severe divisions in worldviews among those who are addressing economic and health care policy. Is spending on health an investment or an expense? Do you think that improving population health will ultimately drive economic recovery? Common sense tells me that healthier societies are wealthier societies. The reverse is also true. I cannot see how one could talk about economic development without talking about health care.”