Re-Orienting Healthcare and Long-Term Health Planning

WHEREAS, a committee of health sector leaders was convened and assembled in late 2018 through 2019 by the Rhode Island Foundation, representing hospital systems and health insurance companies, providers of medical and behavioral healthcare, academia, advocates for patients, providers, children, and families, public health experts, and government officials (the "Long Term Health Planning Committee") and developed Health in Rhode Island which includes a vision, goals, guiding principles, priorities, strategies, and outcome measures aimed at improving health in Rhode Island over 10 years or more;

WHEREAS, COVID-19 has disproportionately impacted communities of color, low-income communities and other vulnerable populations in Rhode Island;

WHEREAS, COVID-19 has exacerbated the financial fragility of Rhode Island's healthcare system;

WHEREAS, a more integrated and financially viable hospital, primary care and community-based healthcare system is critical to maintaining population health and ensuring that Rhode Islanders maintain access to quality healthcare through and following the public health emergency;

WHEREAS, COVID-19 has disrupted patterns in healthcare delivery, including through a reduction in emergency department visits and through an expansion in telehealth;

WHEREAS, in addition to long-term planning, immediate action is required to sustain Rhode Island's healthcare system and to improve the health of Rhode Islanders;

WHEREAS, Rhode Island has made great strides in improving the health of its residents through improved primary care coverage; built critical capacity and connections through community health workers and community health teams; increased the number of children and adults who are insured; invested in significant health information technology projects; tested new models of payment and service delivery; and leveraged significant federal resources;

WHEREAS, consistent with the priorities outlined in Health in Rhode Island, the State proposes to ensure that all Rhode Islanders, particularly those in vulnerable communities, have access to the supports and services necessary to decrease disparities in health, economic, educational opportunities and outcomes. The proposals include but are not limited to (1) improving birth outcomes, (2) preventing gaps in supports for pregnant women, (3) preventing maltreatment of newborns and promoting early development; and (4) addressing the socio-economic impacts on health that contribute to disproportionately negative health outcomes;

WHEREAS, the State has supported significant federal investments in behavioral health services, such as addressing the State's opioid crisis, suicide prevention, and implementing the integration of physical and behavioral health;

WHEREAS, Rhode Island has begun to focus much needed attention on factors beyond our healthcare system that underlie our state's outcomes, including a range of social, economic, and environmental conditions;

WHEREAS, up to 80% of our health is determined outside the doctor's office and inside our homes, schools, jobs, and communities; WHEREAS, generations-long social, racial, ethnic, economic, and environmental inequities have resulted in adverse health outcomes that have impacted Rhode Island's communities differently;

WHEREAS, these inequities have a greater influence on health outcomes than individual choices or one's ability to access clinical health care services;

WHEREAS, consistent with the priorities included in Health in Rhode Island: A Long-Term Vision, the State is focused on reducing health inequities to improve health outcomes;

WHEREAS, the State of Rhode Island has undertaken extensive work to address underlying influences of health disparities, including through the establishment of Health Equity Zones;

WHEREAS, the State of Rhode Island proposes to drive important investments in housing, a critical social determinant of health, increase funding to the Rhode Island Food Bank, and expand the clothing allowance for families receiving cash assistance through the Rhode Island Works Program.

WHEREAS, the State of Rhode Island has begun to monitor progress towards health equity and improving social determinants by developing and collecting Rhode Island's Health Equity Measures, which include 15 measures in five domains that affect health equity, and other leading performance measures; and the Long Term Health Planning Committee has created a group of measurements to determine the effectiveness of goals and strategies to effect Health in Rhode Island: A Long-Term Vision, over the course of ten years; and

WHEREAS, Rhode Island's Cost Trends Project, an effort to produce a multi-year cost growth target for the State, studies Rhode Island's healthcare costs and develops a strategy to leverage the State's all-payer claims database, HealthFacts RI, in order to support system performance and curb rising health care costs, and along with the implementation of alternative payment models that drive quality and efficiency, is instrumental in addressing the cost-related and system transformation goals.

NOW, THEREFORE, I GINA M. RAIMONDO, by virtue of the authority vested in me as Governor of the State of Rhode Island and Providence Plantations, do hereby order and direct the following:

1. The State of Rhode Island shall take immediate actions to address the economic impacts of COVID-19 on Rhode Island's healthcare system and sustain positive enhancements associated with the COVID-19 crisis, such as the expansion of telehealth and shall remain dedicated in the long-term to the vision, goals, principles, priorities, and strategies included in the 10-year plan, entitled Health in Rhode Island: A Long-Term Vision.
2. The Rhode Island Department of Health (RIDOH), the Office of Health Insurance Commissioner (OHIC), and the Executive Office of Health and Human Services (EOHHS) shall collaborate with internal and external partners to implement the strategies included in Health in Rhode Island.
3. EOHHS, RIDOH and OHIC shall participate in the Long-Term Health Advisory Council ("Advisory Council") convened by the Rhode Island Foundation to encourage, monitor and update the progress of Health in Rhode Island. The Advisory Council shall be composed of members of the Long-Term Health Planning Committee and may also include stakeholders with expertise in such areas as:
   
   1. Healthcare delivery;
   2. Patient and consumer rights;
   3. Healthcare insurance;
   4. Public health;
   5. Healthcare workforce;
   6. Healthcare policy;
   7. Behavioral health;
   8. Healthcare information technology; 
   9. Economics;
   10. Business;
   11. Health disparities; and
   12. Other relevant areas.

4. EOHHS, in partnership with RIDOH and OHIC, shall report state-level progress towards meeting the objectives in Health in Rhode Island to the Advisory Council by April 1, 2021. This Order shall take effect immediately.

So Ordered,

Gina M. Raimondo

Governor