Advancing health care and the R.I. economy — leaders, experts discuss proposed academic health system

Brown, Lifespan and Care New England leaders joined U.S. Sen. Sheldon Whitehouse and other experts in a virtual discussion on the potential for an integrated system to provide world-class care for the people of Rhode Island.

PROVIDENCE, R.I. [Brown University] — As Brown University, Lifespan and Care New England continue to advance plans toward a world-class integrated academic health system that serves the people of Rhode Island, leaders from those organizations and experts in health care economics shared their perspectives in a Wednesday, Dec. 15, virtual event sponsored by the Partnership for Rhode Island and produced by the Boston Globe.

The creation of an integrated academic health system would bring together a merged Lifespan and Care New England, the state’s largest nonprofit health care providers, in a partnership with Brown and its Warren Alpert Medical School. The organizations’ leaders say the system would ensure excellence in health care from birth to end-of-life, offer a full array of complementary medical specialties, benefit Rhode Island’s economy, reduce health care disparities, and build on Brown’s leading research and medical education programs.

Event moderator Laurie White, president of the Greater Providence Chamber of Commerce, said that most people are familiar with the concept of two hospital systems coming together, but what is less clear to them is how Brown fits in

University President Christina H. Paxson said that Brown for decades has played a major role in improving the health of Rhode Islanders. With the state’s only medical and public health schools, Brown educates medical students, residents, fellows and health researchers who treat patients and contribute expertise to the local community. The medical school and School of Public Health are known for their collaborative approach with leaders across Rhode Island, enabling a more nimble and comprehensive response to crises like the COVID-19 pandemic. And the schools’ reputations attract health leaders from around the world.

“We recruit really talented physicians to Rhode Island — often people who simply would not come if they didn't have the opportunity to be professors at the medical school,” Paxson said.

She said that 60% of Rhode Island physicians have some affiliation with the Warren Alpert Medical School, and 48% of all physicians in the state hold faculty appointments. Many of those recruited remain in the state and contribute over the long-term. And the biomedical research happening at Brown, in which physician-scientists often have a role, makes a direct and positive impact in the care that patients receive at the doctor’s office.

“You have faculty physicians who are at the leading edge of studying things like Alzheimer's disease, like cancer, like population health, and they're bringing that knowledge into their practices,” Paxson said.

When Brown researchers work with hospitals to set up clinical trials around those discoveries, patients all over Southern New England have access to treatments they wouldn’t have had otherwise, she added.

While the University has long-standing relationships with both hospital systems, Paxson said a major challenge of the current bifurcated system is that the majority of medical school faculty have appointments with only Lifespan or Care New England, making it unnecessarily difficult for them to work together on clinical care as well as research.

In remarks during the event, U.S. Sen. Sheldon Whitehouse expressed support for the integrated academic health system. He painted a picture of the negative implications likely to emerge should the merger, currently under regulatory review, and affiliation with Brown not proceed.

We can make this happen in a way that delivers on the benefits without the costs.

Christina H. Paxson President of Brown University
 
Christina H. Paxson headshot

“We will for sure see out-of-state buyers, probably first for Care New England and then for Lifespan,” he said. “We will see far-away headquarters and CEOs. We will see loss of jobs and professional support. We lived this experience with Rhode Island banks, when the merger moved the real headquarters out of state, and we saw downtown Providence just dry up as accounting, professional, legal and other jobs went to Boston, Scotland and other places. We would lose local control.”

Whitehouse added to that list the loss of research that benefits Rhode Island’s economy, as research programs relocate and new federal investments decline. Avoiding that scenario is value in and of itself, he said, in addition to the myriad benefits the integrated academic health system presents for the state and its residents.

Dr. Timothy Babineau, Lifespan’s president and CEO, used a metaphor to explain the benefits.

“Imagine the [New England] Patriots being split into two different teams — an offensive team and a defensive team,” he said. “They’d still be pretty good, but something would be lost. And that's what we have right now. We have great, hardworking, compassionate, educated caregivers within each organization, but we're on different teams. By coming together on the same team, you're able to do things that we are not able to do today.”

The CEOs of both Lifespan and Care New England discussed the patient and physician benefits of integrated electronic health records. Babineau explained that while the current records systems can “talk to one another,” they need translation. Dr. James E. Fanale, president and CEO of Care New England, described the challenge and said that with a shared system, providers would be able to quickly access a patients' records and use them to make decisions about care.

"As a clinician, I may send a patient with a problem to Lifespan,” Fanale said. “If they can't find the CAT scan that I did, it's a heck of a lot easier just to repeat it, and the cost is $700 or $800. Imagine if we had a system where you didn't have to do that anymore… There are enormous opportunities where we can collaborate, improve access and prevent duplication.”

Lifespan, Care New England and Brown signed agreements to create an integrated academic health system in February 2021. Applications are currently under review by federal regulatory agencies, which are expected to render opinions by early 2022, and principals from all organizations are working cooperatively with the state attorney general’s office as well as the Rhode Island Department of Health and other community leaders on the regulatory process in Rhode Island.

James Bailey, an economist and assistant professor at Providence College, focused on questions about price increases. If you look at health care mergers across the country, Bailey said, research suggests some price increases, while quality of care often remains flat. And while hospitals see cost savings, that’s not always for reasons that benefit patients — for example, hiring fewer staff at slightly lower pay. But Bailey strongly supported the economic benefits of the integrated electronic health records, and remarked positively upon the transparency and proactiveness of stakeholders.

"There are lots of ways this can go wrong," Bailey said, "but I'm encouraged by seeing how everybody is trying to get out in front and think about things they could do realistically to make Rhode Island the exception."

Paxson drew on her expertise as a health economist to explain why the partnership is worth what some perceive as risks. Lifespan and Care New England are currently undersized, she said. Bringing one organization together will not only reduce expenses and inefficiencies, but enable larger, more sophisticated research programs that will have a far-reaching impact on patient health. Life sciences research also has the potential to improve the health of the state economy, she said, citing growing biotech industries in Boston, Pittsburgh and Cleveland.

She acknowledged that in theory, bigger health systems present the risk of monopolies that can drive cost increases. “That doesn't have to happen” in Providence, she said, stressing the importance of appropriate oversight regulation, to which the health systems have already committed.

“We can make this happen in a way that delivers on the benefits without the costs,” Paxson said.