The dream, as Brown University leaders described it, included Providence’s Jewelry District filled with biotech companies spun off from discoveries made by an “integrated academic health care system” combining Lifespan Corp. and Care New England Health System, with Brown front and center as a crucial partner providing researchers and highly trained doctors.
It included Brown President Christina H. Paxson’s vision of a “world-class cancer center” conducting research and providing treatment to Rhode Islanders.
“It’s this integration of research, discovery, patient care, clinical care that is going to be spurred,” Paxson said in a video announcing a signed merger agreement released by the three entities in February 2021. The plan included a $125 million investment by the university.
But Brown’s dream and those of the two health systems were suddenly dashed – at least for now – in February when Attorney General Peter F. Neronha denied the application. He chided Brown and the hospital groups for failing to outline in detail what the merged system would look like, what Brown’s role would be and how it would differ from the current relationships. Less than a week later, the application was withdrawn.
Brown has said little publicly since Neronha’s denial. The university declined requests from Providence Business News to discuss the failed merger or whether it will continue seeking a larger role on the state’s health care landscape.
But its history, which includes a role in another failed merger involving CNE and an out-of-state partner in 2019, its willingness to invest heavily in a merger, and its proximity to prominent nearby medical schools at Yale University and Harvard University suggest it will continue eyeing a more prominent position for its Warren Alpert Medical School, say observers.
“Brown is benchmarking itself against its peers in the Ivy League, and they tend to come up short,” said Robert B. Hackey, a professor of health policy and management at Providence College and an adjunct professor at Brown. “They’re constantly trying to find out, ‘How do we compete with schools like Harvard and Yale and Columbia that have much deeper pockets?’ ”
Situated between Yale and Harvard universities, each with robustly funded medical schools interwoven into their states’ health care systems, Brown operates on a smaller scale, he says.
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WHAT COULD HAVE BEEN: Brown University President Christina H. Paxson had great hopes if the Lifespan-Care New England merger had been approved. / PBN FILE PHOTO/RUPERT WHITELEY[/caption]
A stronger, more visible affiliation with the state’s major hospital systems could help Brown better keep up with its Ivy League peers. That affiliation, in turn, could translate to attracting high-profile faculty, increased funding for research and education, and a higher national profile in a highly competitive sector.
In partnership with its seven affiliated teaching hospitals, the Alpert Medical School attracts about $195 million in sponsored research funding annually, according to Brown’s website. By comparison, Harvard Medical School boasted $293.1 million in research grants and contracts in fiscal 2021.
Paxson after Neronha’s denial said only that Brown remains committed to the separate, longstanding affiliations it already has with Lifespan and CNE, which serve “the health of Rhode Islanders and [fuel] the local economy through the teaching, research and service conducted by the Warren Alpert Medical School, Brown’s School of Public Health and other academic departments and programs.” But it was uncertainty over Brown’s role in the health care system and what that would look like under a merged entity that the attorney general cited as one of the reasons for his opposition.
“I don’t think it’s intuitively obvious to many Rhode Islanders what Brown brings to the table” as part of a fully integrated health system, said Neil D. Steinberg, Rhode Island Foundation CEO and president. He was part of a committee of health care and community leaders that developed recommendations for the now-failed merger.
In community discussions, the foundation found concerns about Brown’s tax-exempt status and skepticism that its involvement would benefit state residents.
If Brown wants Rhode Islanders on board with a future merger proposal, Steinberg says, it needs to clearly explain its role and the community benefits.
“It’s up to them to answer it,” he said.
BUILDING CONNECTIONS
Brown’s current affiliations with the two health systems allow medical students to complete clinical rotations at the hospitals and outline faculty roles and responsibilities, says Kimberly Galligan, executive dean for administration at the Alpert Medical School.
These partnerships between teaching institutions and health care systems are essential to medical schools. “You can’t have a medical school without hospital partners,” Galligan said.
Brown’s partnership with Lifespan is particularly strong, she added, which the university considers as its primary teaching hospital group. And Lifespan touts that partnership.
While Brown, Lifespan and Care New England intended to create an integrated academic health system under its merger application, Lifespan already refers to itself as such with the Alpert Medical School on its website.
Dr. Allan Tunkel, senior associate dean for medical education and a professor of medicine at the medical school, agreed with Lifespan’s descriptor. Under this relationship, Tunkel says, student experience has thrived.
“I don’t think there are limitations we have in terms of our students doing rotations at our hospital partners,” he said. “There are clear expectations in place, clear ways that [students] need to be trained, information they need to learn about.”
The current partnership also fosters research between the faculty members and hospitals, Galligan said, with some faculty members using lab space within Lifespan.
Dr. Jonathan Kurtis, a professor of pathology and laboratory medicine, also serves as the director of Lifespan’s Center for International Health Research and performs clinical work at the hospitals, such as carrying out research for a malaria vaccine.
Faculty members also draw from patients at the hospitals who volunteer to participate in clinical studies, Galligan says, giving patients access to potential new treatment options through the medical school.
When the COVID-19 pandemic struck in March 2020, researchers at Brown and Rhode Island Hospital joined forces to develop a device dubbed The Bubbler that detected the virus through a breath test.
A study was conducted using 70 patients treated in the hospital’s emergency department between May 2020 and the following January. Researchers, led by William G. Fairbrother, a professor of biology at Brown, concluded the Bubbler was more likely to be a better indicator of infection and whether someone is contagious.
The collaboration was sparked when Dr. Jack A. Elias, then the dean of the medical school, reached out to Lifespan and suggested working together, according to Fairbrother.
Fairbrother anticipated some barriers because human subject research studies involve multiple levels of approval and permission, but the process “went really smoothly,” he said.
[caption id="attachment_401704" align="aligncenter" width="1024"]
TEAMWORK: Samuel Kaplan, right, a clinical research assistant for Lifespan Corp., demonstrates a device called the Bubbler while Dr. Gregory Jay, Brown University professor in the Department of Emergency Medicine and Division of Engineering, looks on. The device, a breath test for COVID-19, was developed in a collaboration between Brown and Lifespan. / COURTESY LIFESPAN CORP.[/caption]
“It was a very human-to-human kind of thing, where [Elias] reached out and introduced me to a physician at Lifespan, whose name is Gregory Jay,” Fairbrother said.
Elias “really wanted the development of a COVID diagnostic to go forward,” Fairbrother said. “And he really wanted to help facilitate that.”
Through the partnership, Lifespan’s medical staff carried out testing in the emergency room, and Fairbrother transported samples back to his lab for processing.
The study was eventually published in the Journal of Molecular Diagnostics.
The researchers intend to finalize a prototype, Fairbrother said, and then seek Food and Drug Administration emergency approval for broader use. At that point, the researchers also plan to set up a small company with a venture capital group while raising more funding.
“Using exhaled breath as a bio sample is a fairly novel approach,” Fairbrother added, “so we’re interested in expanding that and opening up new frontiers of research in that connection.”
But working between Lifespan and Care New England hospitals isn’t always simple for faculty members, according to Galligan.
While Galligan praised the medical school’s teaching programs and faculty, this success is “despite the challenge of having different structures, different strategic plans” of the two hospital groups, she said.
Though Brown has maintained partnerships with Lifespan and Care New England for decades, the current system divides certain types of health care between the two systems, which can slow coordination between the hospitals and their partnerships with Brown, the university has said.
One of the goals of the merger was a unified electronic records system to improve the coordination of care, research and clinical trials.
James Bailey, an assistant professor of economics at Providence College, says that while he was skeptical of the proposed merger because of concerns about monopolization and increased health care expenses, he agrees that streamlined services between the three entities could likely benefit Brown.
“Probably the most legitimate benefit of the [merger] would be the unified electronic medical records,” he said. “That would certainly be easier, which is what Brown seems interested in, and it may also help on the clinical side.”
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WILLING PARTNER: Brown University’s latest bid to expand its role in the state’s health care system was short-circuited when Attorney General Peter F. Neronha denied a merger proposal from Lifespan Corp. and Care New England Health System that included the Ivy League school. / PBN FILE PHOTO/WILLIAM HAMILTON[/caption]
WHO BENEFITS?
When medical schools formally partner with hospital systems, they tend to garner more funding, attract top faculty members and graduate more physicians, says Dr. Janis Orlowski, chief health care officer of the Association of American Medical Colleges.
Today, “the bulk of medical school financing is not [only] from tuition but also from the faculties and clinical work,” Orlowski said, “so clinical dollars end up being an important revenue stream to support education and research.”
With medical schools observing these benefits, mergers, acquisitions and partnerships with hospitals were becoming increasingly common prior to the pandemic, according to Orlowski.
Though COVID-19 put a hold on this type of activity, Orlowski expects to see these partnerships increasing once again when the pandemic subsides.
Brown recognized the benefits of these partnerships in the past.
In 2018, as Care New England was negotiating a sale to Boston-based Partners HealthCare – now called Mass General Brigham – Brown and a California for-profit hospital chain teamed up with plans to make a rival bid. Months later, Brown reached an agreement with Partners and Care New England to become the “primary academic research and teaching institution of record” for the two health systems if the sale happened. Partners backed out of its plans to buy Care New England in 2019 after CNE reopened merger negotiations with Lifespan and Brown.
The benefits Orlowski detailed for medical schools have been apparent at the neighboring Yale New Haven Health System, according to Vin Petrini, a spokesperson for the health care entity.
As part of an integrated academic health system that dates back to the 1960s, the Yale Medical School already partners with five hospitals and will soon add three more in Connecticut, following acquisitions announced in February.
The system expanded over the Rhode Island border in 2013 when it acquired Westerly Hospital.
Under the system’s integrated academic health system with the Yale School of Medicine, Petrini says, faculty and residents have more opportunities to care for patients at the hospitals, and patients have increased access to clinical trials. In some cases, Petrini says, patients may be seen by the expert who pioneered the new treatments, and the institution’s prestige helps to attract expert faculty.
The wide variety of patients using the health care system also allows researchers opportunities to work with rare illnesses that need further innovation, he says.
“The medical school benefits because we have a broad base of patients we see,” Petrini said. “And we can enroll these patients with very specific needs in clinical trials that will not only help them immensely but allow the research to get to a number of patients.”
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UNCONVINCED: R.I. Attorney General Peter F. Neronha said in his rejection of the Lifespan-Care New England merger that he didn’t know what Brown University’s role was in the proposal. / PBN FILE PHOTO/RUPERT WHITELEY[/caption]
WHAT’S NEXT?
Many observers were surprised by how quickly and definitively Neronha and the Federal Trade Commission blocked the Lifespan-CNE-Brown proposal.
The swift decision and its results signaled some clear messages: one system overseeing 80% of the state’s hospital infrastructure won’t pass with state and federal officials, and the state’s health care system is once again “in limbo,” according to Hackey.
The decision “seems to suggest that these two systems are not bound to come together,” Hackey said. “But that now means the whole system is in flux because they both clearly felt the need to come together with someone else.”
The question, he says: Who?
Just two weeks after Neronha rejected the proposed merger, Care New England CEO and President Dr. James E. Fanale told PBN that the hospital system has already fielded offers from more than one organization, although he declined to specify who or how many.
One offer has already gone public. It made clear that Brown is not alone in seeing more opportunities for academic-health care affiliations in the state.
Pennsylvania-based StoneBridge Healthcare LLC, a for-profit system, in early March made an unsolicited $250 million bid for Care New England, with an additional $300 million set aside for capital investments over seven years. Stonebridge said it intended to keep Care New England as a nonprofit while collecting its own management fee.
StoneBridge said it would also bring in an unnamed academic medical center as an affiliate partner. An academic partner would have a 20% stake in StoneBridge’s nonprofit acquisition of Care New England, StoneBridge said.
Jacquelyn Voghel is a PBN staff writer. Contact her at Voghel@PBN.com.
Neronha needs to go, he’s been a DISASTER as Attorney General!
Bring back Jeff Pine!