Meet a Key RI ACA Architect, Brown EMHL’s Sandra Ferretti

Sandra H. Ferretti, MHSA

HealthSource RI (HSRI), the health insurance marketplace for the state of Rhode Island, has a lot to crow about. Since its inception in 2010, as a part of the Patient Protection and Affordable Care Act (ACA), the exchange has cut the state’s uninsured rate to 4%, achieved a competitive environment with multiple providers, maintained stable costs to consumers in sharp contrast to other states, and saw new entrants increase nearly five-fold during the open enrollment this year.

To better understand HSRI’s success, we reached out to Brown Executive Master of Healthcare Leadership (EMHL) program’s Sandra Ferretti, a key architect of RI’s exchange. Ferretti shares how, as part of a small consulting team working with a broad set of stakeholders (government officials, elected representatives, private providers, non-profits and citizen groups), she played a major role in the construction of one of the country’s most effective exchanges.

Find out how Ferretti helped seize this moment to reinvent the provision of healthcare across the state and launch a down-to-the-studs remodel of the state’s IT infrastructure resulting in the country’s first and only integrated platform for all eligibility programs. Discover what this experience brings to her EMHL senior role advising students on their Critical Challenge Projects. And, for fun, test your knowledge of EMHL by identifying the names of all the EMHL program members in this story that participated in the development of the state’s exchange. (Hint, there are four.)

Starting from scratch:

When asked how she started working on HSRI, Ferretti answered,

“I got involved in the construction of HSRI in a very Rhodie way. I worked for UnitedHealthcare in a number of different roles, ultimately managing their Medicaid product. During the course of this work, I spent a lot of time interacting with state officials and navigating a highly regulated, multi-stakeholder environment. Then I had triplets.”

Ferretti started working again in 2012 after a contact referred her to a consulting group contracted to shape RI’s response to the ACA.

With no blueprint, this small, newly formed team had to envision and build a statewide program from scratch that met federal regulations outlined in a complex, 1500 page bill, and a nearly impossible timeline with open enrollment beginning in 2013, and a program launch in 2014.

According to Ferretti, “It got very intense very fast.”

When the going gets tough, get smart:

Faced with the impossible, the team rounded up the best intelligence to throw at the problem. They hired Jon Kingsdale, managing director at Wakely Consulting, and now an EMHL faculty member. Kingsdale brought an unparalleled perspective to bear on the subject having constructed and run the precursor to the ACA, Governor Mitt Romney’s Massachusetts Health Connector. The team also worked closely with other state teams in health exchange affinity groups established by the Center for Medicaid Services that oversees ACA.

“Kingsdale and these affinity groups were very helpful early on,” said Ferretti. “We weren’t in complete isolation and were able to learn from other state actors as well as a best in class consultant.”

Bringing everyone to the table:

Under the direction of Governor Lincoln Chafee and his health commissioner, Christopher Koller, who later became an EMHL faculty member, the state committed to the creation of a state-based exchange.

“With the governor’s support of our proposed active purchaser model,” said Ferretti, “we had the flexibility we needed to connect ACA requirements with already existing state mandates and the varying needs of the state’s population.”

While they had support from the top, Ferretti explained the complexity they faced from all the other stakeholders.

“There were a lot of different groups at the table – low-income people, families and children, pregnant women, the elderly, and people with disabilities. All the payors had to be there too.

We went through five or six public meetings with all these different groups trying to figure out the essential healthcare benefits that would define what carriers would have to use as the basis for their plans.”

Long-term vision:

Everyone on the team had different responsibilities. Ferretti focused on the regulatory process for getting plans approved. Others had to think about the IT component – the actual buildout of the program’s infrastructure. The RFP for this job fell to team member Angela Sherwin, who later served as the program director for EMHL. She is now vice president, Medicaid Accountable Care at Steward Health Care.

This part of the story fully exposes the team’s secret superpower – thinking big. They didn’t just imagine an IT platform for HSRI. Working with numerous state stakeholders, the team went for a single integrated system across all eligibility programs.

“Sherwin pulled all-nighters with that RFP,” said Ferretti. “We didn’t want to create the exchange on an island. We figured, if the state was going to invest all this money into a system that’s going to qualify people for benefits, why not have it gauge eligibility for all state and federal benefits.

You aren’t empowering people struggling with financial, family or health challenges if you’re making them run to different agencies and buildings to get their needs met.”

After winning the RFP, Deloitte set up shop in the Marriott. Ferretti and the HSRI team spent days in that hotel defining the requirements and then working with the insurance companies to get their plans to state and federal government officials and eventually onto the HSRI site. Then Ferretti, demonstrating her truly magnanimous spirit, took one for the team by managing the pain-staking testing phase.

“It was so important that consumers be able to comparison shop for their health plan, and have accurate information in front of them.”

Working with EMHL students:

When asked what her HSRI experience brings to her EMHL work, Ferretti shared,

“A big chunk of the complexity that our students deal with comes from working with multiple stakeholders in a fast-paced environment. I understand this pain point having worked with businesses, interest groups and government officials to create a new statewide service that didn’t exist before.

The other challenge, of course, is the uncertain regulatory environment that healthcare professionals operate in today. I’m proud to lend my experience in all these areas to help our amazing students advance their groundbreaking Critical Challenge Projects to transform healthcare and create a more healthy, just and prosperous society.”

Testing your EMHL program knowledge? There are four EMHL faculty members mentioned in this story:

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