Health care woes in Rhode Island

Brown-led study to examine consequences of Harvard Pilgrim closing

A one-year project led by Brown researchers will survey 1,200 patients and 500 physicians to document the health care consequences of the bankruptcy and closure of Harvard-Pilgrim Health Care of New England, the Rhode Island subsidiary of Boston-based Harvard Pilgrim Health Care.

PROVIDENCE, R.I. — Almost one year to the day that bankruptcy shut down the Rhode Island subsidiary of Boston-based Harvard Pilgrim Health Care, a Brown-led research team has begun a study to determine the closing’s impact on patients and physicians in the state.

“We’re especially interested in what happened to people with chronic health conditions who were going to the same physicians for long periods of time,” said principal investigator Susan Allen. Allen is associate professor of medical science and associate director of the Center for Gerontology and Health Care Research in the Brown Medical School.

“We want to determine how the remaining health care system in Rhode Island has absorbed these patients since the closure,” said co-principal investigator Linda Laliberte. “We will ask doctors about their current practices. We have heard anecdotally that some of the salaried physicians who worked for Harvard Pilgrim have left the state.” Laliberte is clinical assistant professor of community health and also an associate director of the Center for Gerontology and Health Care Research.

Little is known about the consequences of an insolvent health plan’s closure. Such events have not been studied in detail.

The situation provides an excellent opportunity to document repercussions of the removal of a major player from the health care landscape, the researchers said. Rhode Island’s small size allows for a comprehensive assessment of statewide impact, they said.

The study will be conducted collaboratively with the R.I. Department of Health, which is highly invested in the results, said Dr. Patricia A. Nolan, director of the department, who is also a clinical professor of community health at Brown. In particular, the Health Department wants to understand the closing’s impact on state capacity to provide primary and specialty care and on former members who are no longer able to afford the care they need under new insurance plans, she said.

“I hope the findings help us define better health policy,” said Nolan. “Rhode Island statutes authorize the Department of Business Regulation to help bridge transition to a new insurance plan and authorize the Department of Health to assure continuity of care. We worked hard to do those things. The study will test whether the efforts were successful. If we succeeded, other states may wish to adopt some of Rhode Island’s strategies. If we did not, we need to revisit our strategies.”

In January, the researchers will begin a telephone survey of 1,200 former patients of Harvard Pilgrim Health Care of New England (HPHCNE, the Rhode Island subsidiary) and a mail survey of 500 physicians, former HPHCNE providers who were engaged in ongoing professional relationships with patients. The 1,200 patients will include 400 from the plan’s general population, 400 who were enrolled in the R.I. Medicaid Rite Care program for low-income women and children (many received care at HPHCNE facilities), and 400 plan participants with chronic health conditions.

Among the topics to be covered with patients are lapses in insurance coverage, disruptions in care, cancelled procedures, and changes in premiums, co-payments, benefits, primary-care physicians and specialists. The physician survey will address financial loss due to unpaid claims, relocation of practices out of state, and post-closure questions about contracts with other plans, certification for reimbursement by other plans, and retirement from practice.

Both surveys will also explore topics such as attribution of blame and issues of trust.

The researchers hypothesize that the greatest repercussions have been on patients treated at Harvard Pilgrim health centers, including disruptions in care and forced change of primary-care providers. The researchers suspect that former patients are paying substantially more for health coverage and experienced changes in benefits.

“Identifying the problems associated with this event may help policy-makers fashion policies to reduce the chances it will happen again and to help create safeguards against such problems in the future,” said Laliberte. “Information gathered may also help the state, which is devising a health care program for working people without insurance.”

The one-year study is funded by $177,000 from the Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted exclusively to health and health care.

The researchers predict a good response rate to the surveys. “People have strong opinions about closure of this health plan,” Allen said. “We think that they will want to talk.”