PROVIDENCE, R.I. [Brown University] — As Brown University and Rhode Island’s two largest nonprofit health care systems continue work toward an integrated academic health system, an independent analysis commissioned by Brown concludes that closer integration of health systems, physician practices and research can create significant economic and societal gains to communities throughout Rhode Island.

The analysis, released by consulting firm Tripp Umbach on Tuesday, Jan. 11, found that the proposed merger of the Lifespan and Care New England health systems can ignite a stronger affiliation with Brown’s medical, public health and engineering schools to establish a world-class academic medical center that serves the region.

The report, “Transforming Rhode Island’s Biomedical Economy: Economic Benefits Resulting from a Transformational Partnership among Brown University, Lifespan Health System and Care New England,” outlines how bringing together leading research, clinical practice and teaching hospitals can bring billions of dollars and thousands of jobs to Rhode Island by 2035.

Brown and the health systems signed agreements in February 2021 to create an integrated academic health system, with Brown committing to provide a minimum of $125 million over five years in support of its development.

The release of the report comes as applications for the merger of Lifespan and Care New England are under review with federal regulatory agencies and the Rhode Island Attorney General, with opinions expected to be rendered no later than March 2022. While Brown is not a direct party to the merger, the proposed system would bring together the state’s premier teaching hospitals — Lifespan’s Rhode Island, Miriam, Hasbro and Bradley hospitals, and Care New England’s Women & Infants, Kent and Butler hospitals — with Brown and its leading research and medical education from the Warren Alpert Medical School.

“We engaged Tripp Umbach because we know that one of the persisting questions about the proposed Care New England and Lifespan merger and affiliation with Brown concerns its potential economic impact,” Paxson said. “It was important to have an independent and objective assessment of the financial benefits of combining Rhode Island’s largest health care systems.”

Tripp Umbach’s evaluation found that Rhode Island lags peer states in the size of the academic medicine industry, defined by total economic impact of higher education, health care and biomedical industry. Even without the benefits of a fully integrated academic medical center, Brown’s medical, public health and biomedical engineering programs compare favorably in economic impact to medical schools in peer markets.

Lack of integration with Brown and the affiliated teaching hospitals in the two health systems restricts economic development in Rhode Island, the report found, as the teaching hospitals produce lower-than-average economic impact compared with peers in Connecticut, Massachusetts and New York. 

Key findings of the report include:

• Rhode Island currently trails neighboring states in terms of academic medicine industry impact, ranking last among peer metropolitan areas in biomedical economic impact.
   
• Brown University has the largest economic impact among independent medical schools in the United States and is on par with medical schools in peer markets, but the major teaching hospitals in the state deliver lower economic impact than in peer markets.
   
• Creating an integrated academic medical center can significantly increase the economic impact of the academic medicine sector in Rhode Island from $8.2 billion in 2020 to $11.5 billion by 2035.
   
• Creating an integrated academic medical center can significantly increase biomedical economic development in Rhode Island and create approximately 10,000 new high-paying jobs by 2035.
   
• The current bifurcation of Lifespan and Care New England undermines quality of care to patients as the need to operate across two systems makes it difficult to provide effective and efficient clinical care.
   
• Through closer collaboration with payers, including the state government, an integrated academic health center with the state’s two largest health care systems and Brown University can focus resources in medicine and public health on developing ways to prevent costly diseases by reducing smoking, obesity, substance abuse, exposure to environmental toxins, and more.

According to the report, the majority of high-paying jobs arising from the increase in economic development will be in the private sector. These will result from growth in the biomedical industry from research commercialization.

“The report’s finding that we have an opportunity to add billions of dollars to strengthen the biomedical economy in Rhode Island clearly strengthens the argument for the creation of an integrated system that brings together research, medical education and teaching hospitals,” Paxson said. “Brown remains committed to lending significant financial support to ensure its success for the people of our state and the region.”

At a panel discussion last month on the proposed integrated academic health system, Paxson noted that bringing together a cohesive organization could reduce inefficiencies in ways that benefit Rhode Islanders while enabling more sophisticated research programs that impact patient health and have the potential to improve the health of the state economy. Paxson, an economist and public health scholar, also acknowledged questions about the economics of a larger system — a key factor behind the decision to commission an independent analysis.

Beyond the economic benefits, leaders at the University and Care New England and Lifespan say the system would ensure excellence in health care from birth to end-of-life, offer a full array of complementary medical specialties, reduce health care disparities, and build on Brown’s leading research and medical education programs. Brown would participate on the governing board of the newly merged health system and play a key role in integrating medical education and research with clinical practice across the combined system’s hospitals.

More about the report’s findings

The Tripp Umbach analysis found that a stronger integration of health care systems with Brown can accelerate a stronger biomedical economy in Rhode Island.

According to Paul Umbach, founder and president of Tripp Umbach and author of the report: “An integrated academic medical center in Rhode Island could combine leading-edge research and renowned medical expertise at Brown University and established teaching hospitals to improve the quality of care in Rhode Island, advance biomedical discovery and create a vibrant driver to the state’s economy.”

Not only can the merger create needed scale, but it will eliminate the danger to the state’s economy if one or both health care systems merged with other regional systems from outside of Rhode Island. According to the report, an out-of-state purchase of Rhode Island-based hospitals would have the damaging effect of accelerating the move of high-quality specialty care out of the state, further distancing care from communities and increasing costs for Rhode Island families. Umbach added that “losing local control of one or both health systems would cause a negative impact on the Rhode Island economy as patients and their health care dollars leave for other states.”

The analysis indicates that a stronger integration of health care systems with Brown University can accelerate a stronger biomedical economy in Rhode Island. The development of an integrated academic medical center in Rhode Island can serve as a magnet for out-of-state patients while keeping Rhode Islanders in the state for care.

According to the report, a merger between Rhode Island’s largest health systems can improve population health in Rhode Island while reducing costs by using innovative “big data”-informed strategies developed and tested by leading researchers at Brown’s Warren Alpert Medical School and School of Public Health. The close collaboration between the new integrated system and payers can focus resources on both medical discovery and disease prevention.

If approached with a shared vision of improving community health, hospital mergers can result in benefits that accrue to patients in the form of better care and reduced costs, according to the American Hospital Association.  Tripp Umbach’s experience in more than 500 markets throughout the United States indicates that mergers allow competing hospitals to create connected networks of care and keep the focus where it belongs: on improving care for the patient and better community health outcomes.

The report concludes that the current bifurcation of Lifespan and Care New England makes it difficult to provide effective and efficient clinical care to patients as quality of care is undermined by the need to operate across two systems. In addition, the significant duplication in administrative and back-office support across the two systems leads to higher health care operating costs. The report recommended merging the systems to enhance high-quality and lower cost coordinated care across primary care providers, specialists, and hospitals to the benefit of consumers.

Brown selected Tripp Umbach for its work over more than three decades conducting research, feasibility analysis, planning and economic analysis in the academic medicine industry. The firm has completed community health needs assessments in more than 500 communities in all regions of the United States and has been involved in the development of 30 new medical schools. Data and analysis generated from Tripp Umbach’s studies with more than 100 academic medical centers were used to provide estimates included in the report.