Doctor spurs plan to improve town's health

A small city in Rhode Island hopes to merge the preventive approach of group-model HMOs with the choice of consumer-driven plans.

By Julie A. Jacob, amednews staff. July 22, 2002.

Michael Fine, MD's professional life is defined by activism -- in particular pushing for increased access to family medicine and advocating more community involvement by physicians as a way to improve public health. Now Dr. Fine, working with a small city in Rhode Island, believes he's found a way to merge these passions into one grand experiment.

Dr. Fine is leading the development of the Scituate Health Plan, named for the town whose people it will serve. By next year, Dr. Fine plans to have in place a system in which Scituate's 10,000 residents will be able to buy into a health plan combining medical savings accounts with a high-deductible indemnity plan.

The Fine file
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Region: Northeast

An individual buying into the plan would see $200 of his or her money used annually to support a "population-based primary care practice," which would aggressively seek out patients to stay on top of their health, regardless of their insurance status.

"It is in some ways a realization of the dream in primary health care," Dr. Fine said, "the ability to take care of the health care needs of the entire community."

The town council of Scituate -- a suburb with a rural feel, bordering a reservoir that provides most of the drinking water to Providence, 14 miles east -- believes enough in Dr. Fine's plan that they will offer it to municipal employees starting in September 2003, as well as taking on the task of finding commercial MSA and indemnity providers to administer it.

One city offered a pilot MSA to its employees; 56% opted in.

Paul Ginsburg, PhD, president of the Center for Studying Health System Change in Washington, D.C., said the philosophy of the Scituate plan is like group-model HMOs such as Harvard Pilgrim and Kaiser Permanente.

"It's a pretty innovative model in the sense of accommodating primary care and a population-based approach to health care, which is positive, and combining that with current trends in the health care system with patients assuming more financial responsibility," Dr. Ginsburg said. But he cautioned that the Scituate plan might run into financial trouble if it accepted every individual and small business that wanted to join.

"I'm somewhat concerned about the vulnerability of the plan to adverse selection," he said, "but as long as they are not too idealistic about offering this to everybody, they may be able to avoid that."

Community-minded physician

It was Dr. Fine's activist past that helped him get the ears of the leaders of Scituate.

Dr. Fine has spoken before state and local governments frequently -- whether representing himself, the Rhode Island Academy of Family Physicians or other groups -- about the need for more family doctors in his state, which generally ranks among the bottom 10 in percentage of doctors in primary care. That's a big reason why Rhode Island also generally ranks as an expensive state in terms of health care costs per person.

Meanwhile, Dr. Fine also gained renown as the leader behind a drive to reinstate David Kern, MD -- who was fired in 1996 and saw his occupational health clinic closed -- in a conflict over publishing findings about a serious lung condition affecting workers at a Pawtucket plant. (His employers, Memorial Hospital and Brown University School of Medicine, said Dr. Kern had violated confidentiality agreements when he published his findings.) Dr. Fine couldn't get Dr. Kern's job back, but his efforts did lead to the opening in 2000 of the Occupational and Environmental Health Center of Rhode Island, funded by the state's Dept. of Labor and a fellowship Dr. Fine received from financier George Soros' Open Society Institute.

Wanting to hear from someone with his expertise, the Scituate Town Council two years ago asked Dr. Fine to give a presentation on health insurance and medical savings accounts. Council members were worried because Harvard Pilgrim Health Care had just left the state, with only Blue Cross Blue Shield of Rhode Island and UnitedHealthcare remaining.

In Dr. Fine's talk he mentioned his own passion -- the importance of population-based preventive health care.

Then, "we had the same 'a-ha' moment," Dr. Fine said. The town council and Dr. Fine realized that there was a way to combine MSAs and a community-based approach to health care. By doing this, they believed, they could improve townspeople's health and access to health care, offer more choices and control costs by approaching health insurance coverage as a community service such as sanitation or public education.

"He is looking for a way to improve the health of the community," said town council member John Marchant, chair of the health plan committee, who recalled that Dr. Fine organized an immunization clinic in Scituate a few years ago.

"We have in Dr. Fine someone with national renown," said Rhode Island state Rep. Carol Mumford, who represents Scituate and sponsored a bill allowing its residents to get a $200 state tax credit for participating in the plan. "He is probably the most popular physician in Rhode Island."

Although the town council isn't sure how many people will decide to join the plan, research the town council has done on MSAs suggests it will be a popular option. When Jersey City, N.J., offered a pilot MSA program to its city employees, for example, about 56% opted for the MSAs.

Marchant described community response as cautiously optimistic. Council members, Dr. Fine and Mumford have been speaking with community groups, churches and the teachers' union to promote the program.

"We tell them, 'This is not a free lunch; you are going to have to pay for it, but it will save you some money,' " Marchant said. "Members will pay less for health insurance and get better care."

ADDITIONAL INFORMATION:

The Fine file

Name: Michael Fine, MD
Specialty: Family medicine
Medical school: Case Western Reserve University, Cleveland
Residency: Brown University Hospitals, Providence, R.I.
Career highlights: Worked as a family physician in Appalachia for three years before returning to Rhode Island. Leads the largest family practice group in Rhode Island, the eight-physician Hillside Avenue Family and Community Medicine in Pawtucket and Scituate. In 2001, became founding physician-in-chief of the Rhode Island Hospital's family and community medicine department. Serves as board chair of the Occupational & Environmental Health Center of Rhode Island. Also was a George Soros Fellow in Medicine as a Profession, 2000-2002.
Latest project: Medical consultant for Scituate Health Plan, which seeks to combine medical savings accounts, a high-deductible indemnity plan and a local primary care clinic to make care available to all of the town's 10,000 residents.