Charting the Course for a Healthier Rhode Island

Celebrating the grand opening of the Rhode Island Free Clinic's pharmacy, which offers 50 common generic drugs – for free – to its patients. (Left to right) Stephanie Chafee, co-founder of the Rhode Island Free Clinic and Foundation director; Foundation Vice President for Grant Programs Owen Heleen; Lieutenent Governor Elizabeth Roberts; and Lynne Urbani, chief executive officer of the Clinic.

Fund for a Healthy Rhode Island, “a catalyst for change,” to focus on primary care

When the Foundation received $20 million as a result of a settlement between the U.S. Attorney and Blue Cross Blue Shield Rhode Island, it was charged with establishing a fund “for supporting projects that are designed and intended to have the greatest impact on the provision of quality and affordable healthcare services in Rhode Island.”

Several months of intensive research and consultation with professionals and community stakeholders led the Foundation to conclude that primary care would be the logical focus of the fund’s grantmaking and other resources. Primary care has also become a key priority of the national healthcare reform agenda.

“Primary care fits well with the Foundation’s overarching strategic goals of addressing issues at their root cause and facilitating systemic change,” noted President Neil Steinberg, adding, “This is a health care arena where the Foundation can have immediate impact on the greatest number of Rhode Islanders, consistent with the Fund’s charter.”

"...the Foundation can have immediate impact on the greatest number of Rhode Islanders, consistent with the Fund’s charter.”

So, what is primary care and why does it matter?

Primary care is the “medical home” for a patient, ideally providing continuity and a central point of connection with an ever more complex medical care system. Family physicians, pediatricians, internists, nurse practitioners, mental health workers, case managers and others who work with them provide primary care.

Primary care has taken on an increasingly important role within the healthcare world for a number of reasons. It provides the best form of preventive care, recognizing and treating conditions at the earliest opportunity. It coordinates all care for patients, helping them to navigate the system and precluding duplication of expensive testing and other services, especially for patients with chronic conditions like diabetes and asthma.

Access to affordable primary care allows patients to see their health care providers on a regular basis, thereby avoiding delays in treatment. Rhode Island Health Insurance Commissioner Christopher Koller, who was interviewed as part of the Foundation’s decision-making process, pointed out, “Gaps in primary care lead to patients utilizing the state’s emergency rooms as their source for primary care, driving up the costs of healthcare for everyone.”

The Fund for a Healthy Rhode Island (FFHRI) will direct resources to develop a robust system of primary care that provides all Rhode Islanders with affordable and readily accessible health services – at times and locations that meet the needs of working families. Grants of $70,000 - $750,000 will fund one-to-three year projects to promote innovations in direct services, access to affordable medications, and public outreach and awareness programs that engage all Rhode Islanders. Owen Heleen, the Foundation’s vice president for grant programs, is encouraged by the number and quality of applications for FFHRI’s first round of grants. “We received 47 applications,” he noted. “They represent really creative ideas about how to deliver primary care differently and to extend its reach and impact to all Rhode Islanders.”

"...the Fund for a Healthy Rhode Island – through strategic grantmaking, loan forgiveness, and collaborative initiatives – can be a catalyst for change."

Developing a system of affordable, accessible primary care will not be possible without an adequate supply of caregivers, of course. And Rhode Island is feeling the serious effects of a nationwide shortage of primary care physicians and other healthcare workers. A 2008 study by the Journal of the American Medical Association found that only two percent of students graduating from medical school plan to practice primary care. President Obama recently noted, "We're not producing enough primary care physicians. The costs of medical education are so high that people feel that they've got to specialize." New doctors typically owe more than $140,000 in loans when they graduate. To help address this critical issue, in July 2009, the Foundation will announce the creation of a Primary Care Loan Forgiveness Program to be funded with 25 percent of the available grantmaking dollars from FFHRI, and available for all primary care medical professionals including physicians, nurses, nurse practitioners, mental health workers, case workers and others. This program will be administered by the Rhode Island Student Loan Authority and will be funded in partnership with Blue Cross Blue Shield of Rhode Island, and the Rhode Island Medical Society. The Foundation is in active discussions with other potential funding partners.

“There is no silver bullet,” says Owen, who has overseen the Foundation’s grants in healthcare for nearly a decade. “But the Fund for a Healthy Rhode Island – through strategic grantmaking, loan forgiveness, and collaborative initiatives – can be a catalyst for change. The rewards will be tangible as we become a healthier state.”