Issues & Advocacy
Hospitals play a critical role in providing affordable healthcare by providing medical care and services to individuals who need it, regardless of their ability to pay. Balancing affordability and sustainability in healthcare is an important challenge that requires careful consideration of a range of factors. On the one hand, healthcare needs to be affordable for everyone, so that individuals can access necessary medical care without being financially burdened. On the other hand, healthcare systems also need to be sustainable, meaning they need to be financially stable and able to provide high-quality care over the long term. Hospitals in Rhode Island understand these challenge and are eager to work with other stakeholders to tackle this challenge.
Behavioral healthcare, which includes mental health and substance abuse treatment, is critically important for promoting overall health and well-being, addressing the prevalence of mental illness and substance abuse, improving overall healthcare outcomes, and addressing social determinants of health.
The continuum of care is designed to ensure that individuals receive the appropriate level of care and support at each stage of their healthcare journey. By providing a coordinated and integrated system of care, the continuum of care can help individuals achieve better health outcomes and improve their overall quality of life.
The hospital revenue cycle is critical for the financial health and sustainability of healthcare organizations. It ensures appropriate reimbursement, manages cash flow, enhances patient satisfaction, maintains compliance, and facilitates data-driven decision making to drive continuous improvement.
Medicaid is a joint federal and state government program that provides healthcare coverage to eligible low-income individuals and families. It plays a crucial role in ensuring access to healthcare for more than 300,000 Rhode Islanders.
Medicaid operates under two primary models: Fee-For-Service and Managed Care. Under the FFS model, healthcare providers are reimbursed for each individual service they deliver to Medicaid beneficiaries. Providers bill the state Medicaid program for each service, and payment is made based on predetermined fee schedules or rates. Under managed care, Medicaid contracts with Managed Care Organizations (MCOs), which are private health insurance companies, to deliver healthcare services to Medicaid beneficiaries. MCOs receive a fixed monthly payment per enrollee from the state Medicaid program.In Rhode Island approximately 90% of the Medicaid population is covered under the managed care model.
White bagging occurs when insurance companies make coverage of needed patient-specific medications contingent on the medication being distributed from a third party specialty pharmacy versus allowing providers to buy and then bill for the medication and its administration. White bagging disrupts the patient experience and impairs the provider’s ability to provide optimal patient care.
The healthcare workforce plays a crucial role in the functioning and success of the healthcare system.
All segments of healthcare in Rhode Island have been impacted by workforce shortages, including hospitals, physicians offices, nursing homes, home care, and social services.
Some of the key challenges leading to unprecedented healthcare worker shortages include: the shortage of healthcare workers, an aging healthcare workforce, burnout, skills gap and evolving healthcare technology, and diversity and cultural competency.
Addressing these challenges requires a multifaceted approach, including increasing investment in healthcare education and training, implementing workforce planning strategies, promoting work-life balance, improving access to healthcare in underserved areas, and fostering a supportive and inclusive work environment.