Linda Katz, policy director of the Economic Progress Institute and chairperson of the Protect Our Healthcare Coalition, and Brenda Clement, director of HousingWorksRI, serve as their organizations’ representatives on the Protect Our Healthcare Coalition. Marjorie L. Waters, community organizer with the Rhode Island Organizing Project, contributed to this commentary.
The proposed Lifespan and Care New England merger provides a tremendous opportunity for Rhode Islanders to examine and reshape health and health care in our state. However, to achieve positive change with improvements in health, equity, access, and quality we must include diverse voices and put the public’s health — and the public’s trust — at the forefront of defining the system we need.
A merger of the scale proposed by Lifespan and Care New England will affect every Rhode Islander. Whether it’s your annual exam with your family physician, an urgent care visit, or a hospitalization, the merger will have an effect on the quality and cost of your experience. The newly merged system would also become the state’s single largest employer and would have significant power over what services are available, and how and where people can access them.
In all, if combined, Lifespan and Care New England would make up approximately 80% of health-care services and infrastructure in the state and be the recipient of the largest share of Rhode Island’s Medicaid and Medicare spending. The partnership of Brown University and its Warren Alpert Medical School adds expanded teaching and research into the mix. All of this demands close scrutiny by regulators and policymakers, with open and robust public input.
The rationale behind the growth in health system mergers across the country is that consolidation will improve efficiency, access, and quality. This could prove true for Rhode Island but only if we avoid the pitfalls of previous mergers that studies have shown most often lead to higher health costs and unsatisfactory patient experiences without quality improvements. The lesson for Rhode Islanders is to engage in advocating for strict terms and conditions for approval of the merger that would result in a system that contributes to correcting inequities in access to care and that would add to, not detract from, the economic, social and physical well-being of our community.
What could that system look like? One that prioritizes building and keeping the public’s trust led by a governing board that operates openly and is made up of diverse representatives, including those from underserved communities, patient groups, policymakers, workers, and business. A system overseen by a transparent, robust, and permanent state oversight structure with the resources needed to hold the system accountable to the public and to the terms and conditions of the merger.
A system that is responsive to patient needs, is easy to navigate, honors and promotes racial, ethnic, cultural and linguistic competency, and that is accessible to every Rhode Islander regardless of health coverage or income.
A system that acknowledges systemic racism as a health risk and acts to alleviate it within its own practices.
A system that is resilient in preventing, identifying and responding to public health crises in a measurable way.
And, a system that serves the community through investment and facilitating innovation to address the social risk factors that underlie people’s health and well-being — like safe affordable housing, accessible public transportation, living wage jobs, the need for clean air and green space, and improved access to healthy food.
We each have a chance to speak out about our expectations for a health system that is accountable and responsive to the people of our state. To learn more about the approval process, who the regulators are and their role(s), and how you can speak up, the Protect Our Healthcare Coalition of Rhode Island has published “A Rhode Islander’s Guide to Understanding the Lifespan/Care New England Merger.” It’s available in Spanish and English at www.ProtectHealthRI.org.
We urge you to learn more and to become engaged.