Moving the 'Health in Rhode Island' Plan Forward

COVID-19 has reinforced the need for sustained commitment and partnership to achieve the goals identified in the long term plan.

Identifying and committing to long term priorities

In early February 2020, stakeholders from across the health sector gathered to discuss and brainstorm around the release of the Health in Rhode Island long term plan. This plan, developed by a committee of local health and healthcare experts convened by the Rhode Island Foundation, identifies the most pressing needs and outlines a commitment to addressing those needs over the long-term. From the outset, the goal of the committee was not to dictate a prescriptive set of actions or supersede existing work, but instead, to help define and communicate a broader vision and priorities to guide coordination and decision making over the next decade.

COVID-19's impact

Clearly, the COVID-19 pandemic altered the short-term focus of the members of the committee and the broader health sector in Rhode Island; however, in many ways, the ongoing pandemic has reinforced much of the Health in Rhode Island vision.

While the pandemic has caused significant pressure across our whole healthcare system, it has particularly stressed our long-term care network, reinforcing the need to strengthen the system while also ensuring access to the most appropriate forms of care, including community-based services. The immediate and long-term behavioral health impacts of the pandemic have again highlighted the need to improve access to and coordination within our behavioral health system. Finally, the inequitable impacts of COVID-19 on Rhode Islanders of color have magnified and exacerbated disparities driven by ingrained systemic racism that must be addressed through clear focus and sustained investment.

Priorities

  • Providing the most appropriate care for people in the most appropriate setting.
  • Focusing upstream on root causes and investing in affordable housing, food security and transportation to address underlying inequities and influencers of health disparities.
  • Improving behavioral health outcomes by focusing on access to care, coordination of care and prevention.
  • Reducing wasteful spending in order to redirect resources to social determinants and improve affordability.
  • Ensuring sustainability, accountability and oversight of the group’s vision and maintaining progress in key areas where Rhode Island performs well.

Informing and supporting work through data

The need for greater health equity in our healthcare system and in our pandemic response and recovery efforts has reinforced the committee’s commitment to using data to identify and address the root causes of poor health outcomes, including systemic barriers and socioeconomic factors that impact individual and community health. The committee, in partnership with Healthcentric Advisors, created a data dashboard that combines a holistic view of health with a long term vision for improvement – bringing together data from multiple sources and providing a platform where it can be monitored, and will become more valuable over time.

The data dashboard can be accessed at HealthinRI.com.

The committee will use this dashboard to track movement on quality and process metrics to benchmark and measure progress toward the goals identified in Health in Rhode Island. In addition to these indicators, the committee will also monitor the Rhode Island Health Equity Measures, as they closely align with and complement the evaluation framework.

This includes monitoring quality metrics that are likely to be impacted by existing or emerging threats, such as the COVID-19 pandemic. Most of the currently available data is from prior to the COVID-19 pandemic, but should help provide us with a baseline to better understand the impacts of COVID-19 across the health sector. The following measures provide an example of health outcomes and social determinants of health that will likely be negatively impacted by COVID-19. Tracking this data up to, during, and after the pandemic will help direct efforts to combat the negative impacts of the pandemic.

Example indicators

Note: for these measures, lower numbers are better.

Adult immunization rates are often used as an indicator of whether adults have access to and are receiving regular preventative care. In 2019 the percent of adults in Rhode Island without all age-appropriate vaccines was 52.2% (compared to 59.7% nationally). This was an improvement both in Rhode Island and nationally from 2018 (64.9% in Rhode Island, 68.7% nationally).

Frequent mental distress, drug deaths, and alcohol-related deaths are health outcomes related to behavioral health and wellness. Rhode Island was nationally ranked 27th , 38th , and 29th, respectively, in 2019. Rhode Island was ranked higher for frequent mental distress compared to our position in 2018 (ranked 24th, lower numbers are better). Mental distress in RI varied by income level; in 2019 almost one quarter of people making less that $25k per year reported their mental health was not good 14 or more days in the past 30 days, compared to less than 10% of people making $75k or more. During this period we lowered our ranking for drug deaths (down from 42nd in 2018) and for alcohol-related deaths (down from 37th in 2018).

Frequent mental distress demographic breakout
Frequent mental distress demographic breakout

Food access and stable housing are social determinants of health that are indicators of health equity. In 2019, the percent of households in Rhode Island that were food insecure was 9.1% (compared to 11.1% nationally) and the percent of households in Rhode Island that were housing cost burdened was 33.5% (compared to 30.6% nationally). This was an improvement in Rhode Island and nationally for both food insecurity (11% in Rhode Island, 11.7% nationally) and for being housing cost burdened (34.6% in Rhode Island, 30.9% nationally) from 2018.

Our continuing commitment

Our collective goal of achieving the priorities set out in the Health in Rhode Island vision will be linked, in large part, to the ability of a broad range of stakeholders to remain committed to sustaining the specific priorities and strategies identified in the vision. By committing to creating and maintaining the data dashboard, we are helping to ensure that data remains at the center of the implementation, sustainability, and accountability of the Health in Rhode Island vision, and that we remain committed to tracking disparities and ensuring equity is centered in all of our work.

Last update: March 17, 2021