A New Chapter for Rhode Island Healthcare

Would you continue investing in a business that continuously loses money, repeatedly seeks higher revenues to stay afloat, yet refuses to redesign its business model?  That’s the situation we face in Rhode Island’s healthcare system, particularly its hospitals. According to RIBGH’s analysis of National Association of Insurance Commissioners data, hospitals drove almost 48 percent of the year-over-year growth in commercial healthcare spending compared with less than 20 percent each for specialist physicians and prescription drugs.  

The substantial commercial health insurance premium increases approved for 2026, followed by the proposed increases for 2027, are not isolated events. Employer survey data show that since 2010, Rhode Island has experienced six years in which commercial health insurance premiums increased faster than the Consumer Price Index (CPI).  Meanwhile, the Rhode Island Office of the Health Insurance Commissioner recently reported that statewide healthcare quality improvement has largely stalled over the past three years. Rising costs and languishing quality should prompt an important question: Is it time to rethink how healthcare is organized, financed, and delivered?

We believe the answer is yes.

Collectively, the undersigned have spent decades engaged in healthcare leadership and health system reform in Rhode Island and other states. Our experience spans employer-sponsored healthcare, hospital leadership, physician practice, and healthcare policy. Although we have viewed the healthcare system from different perspectives, the evidence has led us to the same conclusion. Rhode Island has reached a point where meaningful improvements in affordability, quality, and long-term sustainability will require more than incremental change. They will require innovation.

Innovation should not be confused with criticism. Rhode Island's healthcare system is staffed by extraordinarily dedicated professionals and supported by organizations that have made important contributions to the health of our communities. But every successful industry eventually reaches a point where changing circumstances require new ways of thinking. Healthcare is no different. Innovation is not about replacing what works. It is about building on what works while having the courage to rethink what does not.

The goal is not simply to spend more or spend less. The goal is to create greater value. Every additional healthcare dollar should improve health, strengthen quality, enhance access, and make coverage more affordable while supporting those who deliver the care. Achieving these goals will require more than good intentions. It will require a healthcare payment system that aligns financial incentives with the outcomes Rhode Islanders value most—better health, higher quality, greater affordability, innovation, and a sustainable healthcare workforce. That is the standard by which every healthcare system should ultimately be judged.

Rhode Island is particularly well positioned to meet this challenge. Our state's size, history of collaboration, outstanding healthcare institutions, academic resources, engaged employers, and tradition of public-private partnership create opportunities that many larger states cannot easily replicate. Rather than accepting today's challenges as inevitable, Rhode Island can choose to become a national leader in developing innovative approaches that improve health while making healthcare more affordable and sustainable.

We intend to produce a series of informative essays about the healthcare system, explore potential solutions, and stimulate conversations. This series is not intended to offer an answer nor assign blame for every problem. Its purpose is to examine the major cost drivers and quality metrics reflected in the evidence, and to pose the questions that warrant thoughtful consideration in a transparent and informed public discussion. How are healthcare resources being invested? Which investments are producing the greatest value? Where are innovation and reform already succeeding? Where should Rhode Island think differently? These are not questions that belong only to healthcare professionals. They belong to every employer, taxpayer, elected official, and citizen with a stake in the future of our state.

Meaningful reform begins with informed discussion. Our goal is to help Rhode Island build one of the nation's highest-value healthcare systems. The question before us is not whether change will occur; it must.  Will Rhode Island choose to lead that change?