“In a healthy democracy, lawmakers are accountable for evidence-based policymaking, which can drive improvements and access and quality health care, as well as improving our public health systems,” she said. “Today's summit… is a demonstration of how academic researchers can support policymakers as they tackle the key issues right here in our state.”

Navigating an ever-changing landscape

In each of three topical discussions, the key takeaway was that health care in the U.S. is expensive, interconnected and complicated, and each proposed solution often requires a trade-off in another area.

A panel focused on how to increase primary care access in Rhode Island drew the most attention. It is an issue to which all Rhode Islanders, and all Americans, can relate, including Speaker of the Rhode Island House of Representatives Joseph Shekarchi, who admitted he had a hard time finding a new provider after his physician retired.

“As everyone in this room knows, [health care] is an ever-changing landscape,” he said. “What happens in Washington has a direct impact on what happens in Rhode Island.”

Shekarchi noted actions the state government has taken to address what he referred to as a primary care crisis, including reducing insurance authorizations required before physicians can provide specific services that qualify for coverage, limiting red tape for providers, and allocating more than $40 million into reimbursement for primary care.

“But we need to do something to create more doctors, especially primary care doctors, in Rhode Island,” Shekarchi said, referring to the establishment of a new state medical school as one potential solution.

In the spirit of the event, his fellow panelists jumped right in.

“The big question that comes to my mind is, ‘Where does the state get the most bang from its buck?’” said Jason Buxbaum, a Brown faculty member who studies U.S. health care spending. “And would it be something like adding or subsidizing residency slots, maybe in family medicine, where we know folks are going to go into primary care by definition? To the extent that dollars are limited, what is the best use of [those funds]? And it might not be a new medical school.”

Richardson noted that while medical school graduates tend to attend residency training programs across the country, data shows residents tend to stay where they train. She said that 90% of people who go through family medicine residency end up practicing primary care, and that the family medicine residency program at the Warren Alpert Medical School has trained many of the primary care doctors in Rhode Island. But there needs to be many more spots made available, she said — and that relies on federal funding.

Richardson shared that even when the state and federal government approved a plan for a new family medicine residency program at Thundermist Health Center in Woonsocket, R.I., which would have provided more much-needed training spots, a lack of federal funding meant the entire plan fell through.

“Federal investment in family medicine residency programs is important for the state,” she said.

In another example of panelists good-naturedly challenging each other, moderator Andrew Ryan, director of the Center for Advancing Health Policy through Research, noted that health care premiums have increased roughly 20%. He turned to Rhode Island Health Insurance Commissioner Cory King and asked, “Is this your fault?”

King, a master's in public policy graduate of Brown, gave a detailed explanation of how his office conducts a rate review. Echoing Shekarchi’s earlier point about being mindful of different constituencies, he talked about how he needs to balance the needs of insurance companies, health care providers, consumers and employers.

“It's complicated,” King said. “I'm absolutely open to constructive criticism that perhaps my decisions don't meet the appropriate balance of those three constituencies, but that’s what we encountered.”

Brown President Christina H. Paxson, an economist and public health expert, had offered introductory remarks at the event that set the tone.

“These are really complicated issues, and some of the policy solutions are more immediate, and some of them are much longer-term,” she said. “My hope is that this discussion can clarify the answers to some questions and get us all thinking about them so that we can make really good decisions for the future of the state.”

The conversation at Brown, as Beaudoin had noted, was the starting point, and now the work will continue on campus, in the community, with insurance providers and in the legislature.