Delivery of Care
Crunching the numbers, crunching the patients
Trying to make sense of the latest data analysis of what we are spending as a state on health care delivery — and identifying ‘the hole in whose arms where all the money goes…’ (with apologies to songwriter John Prine)
Photo by Richard Asinof
State Sen. Linda Ujifusa shares her views at the OHIC-convened meeting on Monday, May 18.
By Richard Asinof
Posted 5/25/26
OHIC released a thorough and detailed report on costs and spending, analyzing 2024 data. The question remains: How does that become part of the larger public conversation on health care?
How can patients’ voices be heard and listened to — and not just recorded as part of an opinion survey? What are the risks of talking back to providers, challenging their opinions on care options? What are the financial realities for community health centers going forward in the state’s future health care landscape? When will the legacy media start reporting on health care again? Why is it that many executives are patronizing when a reporter arrives with a walker and a health care attendant when covering an event?
The national conversation needs to keep circling back to the Epstein files and belief in the survivors’ stories of abuse. Everything else, including important stories about health care spending and delivery, appears as a distraction to what is occurring.
As much as the President talks about the threat of Iran possessing a nuclear weapon, it was the U.S. that first sold nuclear technology to Iran, training its scientists at MIT. And, it was the U.S., under the auspices of the CIA, that overthrew the democratically elected government of Iran in 1953 and installed a dictator, the Shah of Iran.
The continuing lack of comprehensive health care news coverage in Rhode Island threatens to become a worrisome problem as we approach the 2026 gubernatorial election. The capability to distort and mislead news coverage as part of what is “surveillance capitalism” requires a new approach to collaboration: Independent journalists publishing in Rhode Island need to forge new alliances. Who will step up and support the work being done by ConvergenceRI?
And, please talk to and interview Ieva Jusionyte, Rebecca Altman and Linda Carpenter about their breakthrough work.
As much as the President talks about the threat of Iran possessing a nuclear weapon, it was the U.S. that first sold nuclear technology to Iran, training its scientists at MIT. And, it was the U.S., under the auspices of the CIA, that overthrew the democratically elected government of Iran in 1953 and installed a dictator, the Shah of Iran.
The continuing lack of comprehensive health care news coverage in Rhode Island threatens to become a worrisome problem as we approach the 2026 gubernatorial election. The capability to distort and mislead news coverage as part of what is “surveillance capitalism” requires a new approach to collaboration: Independent journalists publishing in Rhode Island need to forge new alliances. Who will step up and support the work being done by ConvergenceRI?
And, please talk to and interview Ieva Jusionyte, Rebecca Altman and Linda Carpenter about their breakthrough work.
WARWICK — For three hours on Monday morning, May 18, the high-level talk focused on numbers and figures, data calculations detailing the health care costs for Rhode Island, breaking down what the roughly $10.25 billion spent in 2024 had bought and delivered, at the rate of $10,901 per person.
The two key presenters were OHIC Commissioner Cory King and consultant Michael Bailit, president of Bailit Health Purchasing, a Needham, Mass, consulting firm. Their seemingly impossible mission — which they chose to accept — was to explain what the numbers meant that were contained in the dense, data-driven, 104-page report, “2024 Health Care Spending and Quality in Rhode Island.”
The audience listening included many of the top honchos in the Rhode Island health care delivery system. Yet there appeared to be no TV cameras, radio microphones, or other print news media in attendance covering the gathering — save for ConvergenceRI in the role of accurate health care reporter. (Editor’s Note: Surely $10 billion in spending should earn more in coverage.)
This was the kind of story, as a veteran broadcast journalist Steve Klamkin explained it to me, “very high on the list of stories that cannot be told in 1 minute and 30 seconds, if one is lucky enough to get that much time.”
Let me try to take on that challenge:
Take one: The high cost of living and dying in Rhode Island in 2024 — pegged at $10,901 per Rhode Islander — can be blamed on escalating retail prescription drug costs, growing at 11.8 percent, rising outpatient hospital charges, growing at 11.8 percent, and increasing long-term-care needs, growing at 17.1 percent, according to the latest data analysis conducted by the state.
Translated, Rhode Island did not meet its projected cost growth target of 5.1 percent in 2024, growing instead at a 9.1 percent rate, the largest jump in health spending since a growth cost target was established in 2018.
What caused the dramatic upswing in spending? The data analyses targeted higher retail pharmacy costs, higher outpatient hospital costs, and higher long-term care costs as the major drivers of higher health care costs in 2024.
But wait, there’s more: also included were six separate reports that provided detailed data on the state’s growing lack of primary care providers; a breakdown of prescription drug management costs and rebates; accountability measurements for health equity compared with national benchmarks, and… (I have run out of time and space. Are you willing to stay with me a bit longer?)
Primary Care under the microscope
The OHIC report released on May 18 also detailed an analysis of “2024 Primary Care Spending and Utilization in Rhode Island,” roughly one-quarter of the overall document.
The immediate problem identified and quantified by the report was the fact that Rhode Island is facing a primary care workforce shortage — the state only has about 700 full-time clinicians to serve just over 1 million residents. Translated, that is one primary care provider for 1,700 residents. “Even if each provider saw 1,200 patients annually, an estimated 343,000 residents would be left without a provider,” the report said.
To meet the unmet demand in primary care, Rhode Island will need at least 300 more primary care providers in the future, the report continued — a data point shared three years ago in September of 2023 at a similar forum by presenter Dr. Jeffrey Borkan, Assistant Dean for Primary Care-Population Health, Professor of Family Medicine, and Professor of Medical Science at Brown’s Warren Alpert School of Medicine. (See link to ConvergenceRI story, “Primary care at the crossroads.”)
Not surprisingly, the lack of primary care access has hit low-income families and residents identified by race and ethnicity the hardest, as revealed by public health and health equity measurements of care delivery.
But the market may not wait for a state-driven solution, according to Hub Brennan, in a comment he made during a question-and-answer session. Brennan pointed to the rapid growth of concierge practices in Rhode Island as a way that doctors are voting with their feet to relieve the pressure on their practices.
Public health, health equity measures
The report also detailed the data on the 2024 performance for public health and health equity measures. These included:
• Inadequate prenatal care for residents younger than 20 years old had increased by 10.7 percent.
• Adults without a usual source (such as a primary care physician) of care rose by 32 percent.
• Fatal overdoses declined to 30.6 deaths per 100,000 persons, from 37.6 deaths per 100,000 persons in 2023, relatively good news but still a high number.
• Obesity rates for Black children and Hispanic children declined by 2 percent each in 2024 performance scores, compared to 2023 performance scores, a modest improvement.
ACO Core Measures scores
The report also detailed ACO (Accountable Care Organization) Aligned Performance Measures provided data on statewide performance in both the 2024 Commercial and Medicaid segments for 10 wellness measures, including breast cancer screening, chlamydia screening, lead screening in children, immunizations for adolescents, controlling high blood pressure, and eye exams for patients with diabetes.
The RI statewide Medicaid performance on such core measures were below the National Medicaid 90th percentile, while the RI statewide Commercial performance on such core measures were above the National Commercial 90th percentile, except for three categories: controlling high blood pressure, follow up after hospitalization for mental illness, and glycemic status assessments for patients with diabetes.
What was missing or left out, in ConvergenceRI’s opinion?
Left out of the trends analysis in the latest report was any mention of how the COVID epidemic changed the delivery of care. The absence of any dialogue and data that was linked to COVID represents a blind spot in our rear-view mirror, making future projections myopic at best.
The private equity plunderers
Also missing from the report was any data that detailed the havoc created by private equity investments and ownership of hospitals, nursing home and primary care practices. Here in Rhode Island, we were witnesses to/and participants in the psycho-drama played out when two safety-net hospitals, Roger Williams Medical Center and Our Lady of Fatima, were forced into bankruptcy when their for-profit private equity owners, Prospect Medical, declared bankruptcy. The two hospitals were then sold to the nonprofit Centurion Foundation, exposing the frailty of hospital finances now and into the future.
The view from a legislative leader
State Senator Linda Ujifusa spoke out in the question and answer segments. She later shared with ConvergenceRI a more detailed analysis of what she thought was missing.
ConvergenceRI: Did you feel heard at Monday’s session? What did you think was missing from the report?
SEN. UJIFUSA: The report has four significant blind spots. First, it fails to examine the costs that private insurers impose on the health care system itself — particularly the approximately 15.5 hours per week physicians spend on insurance paperwork unrelated to patient care (Medscape Physician Compensation Report, 2023).
This administrative burden is part of a broader overhead that consumes an estimated 34 percent of all U.S. health care spending — one in three health care dollars — more than twice the administrative overhead of single payer systems (Himmelstein and Woolhandler, Annals of Internal Medicine, 2019).
OHIC has acknowledged in its own regulatory decisions that its statutory obligation to guard insurer solvency 'competes directly' with its duty to make health care affordable.
Second, the report is entirely silent on private equity's role in driving up costs. Prospect Medical Holdings, backed by Leonard Green & Partners, extracted hundreds of millions in dividends and fees from its hospital properties before driving Fatima and Roger Williams hospitals into a Texas bankruptcy court. This pattern is playing out across the country.
Third, the report proposes an all-payer model (AHEAD) without acknowledging that the evidence for such models is mixed at best. The only intervention with a demonstrated track record of significantly lowering costs while improving outcomes is single payer. Multiple reports from various research groups estimate that billions of dollars (about 1/3 of every dollar spent on "health care") will be saved from eliminating administrative waste and reducing drug prices to European levels.
Extensive data show that other industrialized nations achieve better health outcomes at roughly half the U.S. per capita cost of $12,555, with universal coverage, virtually no medical debt, and dramatically lower drug prices — all through single payer or equivalent systems.
Fourth, OHIC has been tasked with examining PBMs in the private market even though every state that has managed to achieve significant savings looked at PBMs in their Medicaid program.
To be fair, OHIC faces real structural constraints. Its first statutory purpose under R.I. Gen. Laws § 42-14.5-2 is to 'guard the solvency of health insurers' — language that is in fundamental tension with challenging the insurance system itself. Medicare Advantage plans and Medicaid MCOs are largely beyond OHIC's reach. And a growing number of employers are self-insuring, shielding themselves from state regulation through ERISA preemption (29 U.S.C. § 1144).These constraints explain why OHIC cannot solve this problem alone. The evidence points clearly toward assembling a task force or working group that considers all the evidence on the table, including evidence that points beyond protecting the current insurance structure.
What about the plans for a public option plan to be proposed by AG Neronha?
That’s a very good question. Stay tuned. More details are expected to be released in the next two weeks.
