McKee outlines his plan to tackle Rhode Island's primary care shortage

Yahoo

29-04-2025

Rhode Island Department of Health Director Dr. Jerry Larkin speaks during a press conference at the State House on Tuesday, April 29, 2025. Behind Larkin left to right are Gov. Dan McKee, Rhode Island Executive Office of Health and Human Services Secretary Richard Charest, Rhode Island Medicaid Director Kristin Pono Sousa, and Rhode Island Health Insurance Commissioner Cory King. (Photo by Alexander Castro/Rhode Island Current)
Gov. Dan McKee and top health care officials unveiled a new set of plans to mend Rhode Island's ailing primary care system Tuesday, with strategies like grants for helping clinics serve more patients and asking big commercial insurers to pay more.
The Ocean State's dearth of primary care doctors won't be solved entirely, or even quickly. And the plan announced at a State House news conference by McKee and his Health Care System Planning Cabinet came a day before Anchor Medical Associates closes its Warwick office with two more set to close by June 30.
'We know that fixing these challenges will not happen overnight,' said Richard Charest, secretary of the Rhode Island Executive Office of Health and Human Services (EOHHS). 'These problems have developed over very many years, and we take and it will take time to rectify that.'
The state is short about 300 primary care providers, according to Dr. Elizabeth Lange, a pediatrician at Hasbro who attended the conference.
The all payer claims database shows Rhode Island currently has about 520 primary care providers, said Dr. Jerry Larkin, the state health department's director.
'So right now, we're a little bit short,' Larkin told the crowd.
Solutions offered — like bigger primary care payments from commercial insurers, speeding up the Medicaid rate review process, and $5 million in grants for primary care practices — are all part of what McKee called 'a full deep dive into all factors that are related to primary care delivery.'
'There's still important work ahead, and we remain steadfast in our commitment to identify other strategies to strengthen our primary care system,' McKee said. 'We know that it is alarming when people in the state of Rhode Island are unable to find a primary care doctor, and we're going to do everything we can to connect them with the help that they are looking for.'
Anchor Medical Associates on Wednesday will close its Warwick office — the first of the physician group's three locations which will all be shuttered by June 30. The Anchor closures announced earlier in April will affect about 25,000 patients, mostly children, who now need to find new primary care doctors. Charest told reporters he'd 'rather not get into the specifics of that practice,' but characterized the closure being due to 'internal operational challenges.'
'If we had been notified earlier, we may have been able to help stabilize that practice,' Charest said. 'I think that they were at a position that they had no liquidity at the end.'
McKee's big ideas to tackle primary care crisis
Accelerating Medicaid rate review for primary care.
Requiring commercial health insurers to increase funding for primary care reimbursements
Reducing red tape by easing prior authorization requirements
Providing grants to help primary care practices serve additional patients and hire new providers
Strengthening fiscal oversight of Rhode Island's health care system
Expanding the primary care student loan forgiveness program
Low reimbursement the state's Medicaid program pays providers have frequently been cited as a major contributing factor in the state's primary care troubles. McKee said he is moving to stabilize the state's primary care system by filing a budget amendment that would require the Office of the Health Insurance Commissioner (OHIC) to complete the primary care provider rate review process on an accelerated timeline. The rate review would be completed within a year instead of the usual two afforded to the rate review process for human services.
Cory King, the health insurance commissioner, said the rate review would be completed by September 2026 on the new timeline.
'I don't set rates. I make recommendations after data driven analysis,' King said.
That data and King's recommendations inform EOHHS' annual budget ask of the governor, which is submitted to the General Assembly in January. If the budget passes with the rates intact, it then goes to the federal government, which pays about half of Medicaid rate increases. If approved by the feds, the rate increases would take effect at the start of fiscal year 2028.
'There's some administrative tasks that have to happen before the actual rates are implemented,' Kristin Sousa, the Medicaid program director, told reporters. 'Traditionally, when the legislature passes the budget, it's effective on July 1. In this case, July 1 of 2027, we may not be ready to implement on July 1, but it will retro back to July 1.'
Several studies published on primary care in Rhode Island in recent years, including a 2024 study by the Rhode Island Foundation, have found the Ocean State's reimbursement rates lag far behind Connecticut and Massachusetts. Could that data be used to inform the rate review process?
'I would say, 'Share the data with us.' Cuz I haven't seen it,' McKee said.
King encouraged people to dig into that report's numbers a little more. The Rhode Island Foundation report was not exclusively focused on provider reimbursement, he said, but rather 'hospitals and patient and operation services.' Yes, reimbursement rates in other New England states are higher, King said, but this is consistent with higher health insurance premiums in those states.
We know that it is alarming when people in the state of Rhode Island are unable to find a primary care doctor, and we're going to do everything we can to connect them with the help that they are looking for.
– Gov. Dan McKee
'In Massachusetts, of the 53 hospitals in the inpatient data set, only six hospitals are actually reimbursed at or above the statewide average, And in Connecticut, of the 26 hospitals in the inpatient data set, only eight of those 26 hospitals are reimbursed at or above that statewide average. So there are great variations that we need to consider when looking at reimbursement rates more granularly.'
Still, King cited the importance of primary care investment as a preventative measure for even more health care spending.
'My position has always been that putting money into primary care is a wise investment, as opposed to, say, putting money into emergency department reimbursement,' King said. 'Primary care accounts for approximately 6% of what commercial payers pay for health care business services, but it helps control the other 94%.'
For a more immediate fix, McKee is proposing $5 million in grants to help existing practices serve more patients. Clinics can apply for up to $75,000 to take on new patients or up to $300,000 to hire primary care physicians or 'mid-level' providers such as nurse practitioners or physician assistants.
Applications for grants are available online through May 16.
Separately, the state is imposing new regulations on commercial insurers requiring them to double their primary care spending by 2029. The rules also mandate a 20% reduction in prior authorization requirements to help lower administrative burdens on primary care doctors.
Rhode Island Attorney General Peter F. Neronha blasted McKee's plans in a press release issued about 40 minutes after the press conference ended.
'The Governor's health care announcement today is a slapdash response to political and public pressure because of the dissolution of Anchor Medical, and unfortunately, I expected nothing more,' Neronha said.
Neronha, who has established himself as one of McKee's most vocal critics, said the governor is 'hanging his hat' on conducting future studies and reviews.
'Our PCPs are overworked and overburdened by a state health care system that doesn't support them,' Neronha said. 'Our residents are scrambling to find primary care physicians to care for them through illnesses and fill prescriptions for live-preserving medications. We are in crisis. And some of us have been sounding the alarm for years.'
McKee said at the press event that Rhode Island surpasses many other states for health care access in quality, citing U.S. News and World Report's ranking of Rhode Island as fifth in the nation in health care overall.
Neronha took issue with McKee's rosy outlook, saying McKee was 'once again showing how out of touch this Governor is with the reality of the situation.'
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