(Editor’s note: This is the second in a two-part series exploring issues surrounding the training of physicians in Rhode Island and its effect on local health care.)
A name change, a commitment to multimillion-dollar investments, a shift in academics and governance.
When Brown University and Lifespan Corp. announced in June an enhanced affiliation agreement between the Ivy League university and the state’s largest health system, it was clear the pact marked a crucial juncture for both institutions that includes a rebranding of Lifespan.
Yet months after the enhanced affiliation was announced, its future effects on Rhode Island’s health care ecosystem remain unclear.
Under the agreement, Lifespan will rebrand as Brown University Health later this year, although the health system and the university will remain separate, independent entities. Brown will invest a total of $150 million in Lifespan, divided into annual payments of $15 million to $25 million over seven years.
After that, Lifespan plans to invest $15 million annually to support the medical school’s education and research efforts.
The deal gives Brown what some observers have long suspected it sought: a more prominent position for its medical school, much like at nearby Yale University and Harvard University, where each of their robustly funded medical schools is interwoven into their state’s health care system.
The pact also seemingly gives Lifespan an upper hand.
“I would certainly be nervous if I were any of the other hospitals in Rhode Island,” said James Bailey, an associate professor of economics at Providence College who researches health economics.
Bailey says he opposed the proposed merger between Lifespan and Care New England Health System, Rhode Island’s second-largest hospital group, that was eventually rejected by Attorney General Peter F. Neronha in 2022 over monopoly concerns.
But “even with [the new affiliation agreement], I worry a little bit about it,” Bailey said.
“[Lifespan is] already just in such a dominant position that I think the Brown name, plus the other deals they’re about to do – buying some of these failing Steward hospitals in Massachusetts – that all that together is going to make them even more dominant,” Bailey said.
A spokesperson for Care New England declined an interview for this story, reiterating the company’s statement after the Brown University Health deal was announced, saying the agreement does not change its relationship with Lifespan or Brown, which uses CNE’s Women & Infants Hospital, Kent County Memorial Hospital and Butler Hospital for teaching.
“Care New England will continue to partner with Lifespan on some initiatives and refer patients to some of their high-end subspecialties,” the statement said. “We will also continue to focus on our academic partnership and our unique role in providing foundational health care for all Rhode Islanders.”
Lifespan acknowledged in emailed responses to questions that the enhanced agreement with Brown “strengthens our ability to attract and retain the very best physicians, residents and medical students,” and also allows for a “truly synchronized” approach to biomedical research.
[caption id="attachment_477468" align="aligncenter" width="1024"]
CLASS OF ITS OWN
The thousands of licensed doctors in Rhode Island attended more than
680 different medical schools, according to data provided by the R.I. Department
of Health. The most popular school was, by far, Brown University’s
Warren Alpert Medical School, with 370 Rhode Island doctors graduating
from there. Next on the list is Tufts University School of Medicine at 145.[/caption]
That said, Lifespan said it intends to continue to work with other local hospitals on research and care “when it is in the best interest of patients,” referencing the coordination that takes place between Women & Infants and Hasbro Children’s Hospital, a Lifespan property.
It’s clear Brown covets a deeper alignment with a large health system, much like its peer Ivy League universities already have, enabling them to attract high-profile faculty and increased funding for research and education.
After the $150 million investment over seven years from Brown, Lifespan will contribute $15 million annually to the university’s Warren Alpert Medical School. Currently, Brown’s Division of Biology and Medicine has an operating revenue of $230 million.
“It will not be a major revenue driver, but it will still be very impactful on medical education and research and it helps to move the relationship between Brown and Lifespan to a more contemporary model in line with other affiliation agreements seen across the country,” Dr. Mukesh K. Jain, dean of the Alpert Medical School, said in an emailed response to Providence Business News’s questions about the enhanced affiliation.
This type of investment from a health system is common among integrated academic partnerships, says Jonathan B. Jaffery, the chief health care officer at the American Association of Medical Colleges.
Over the last 50 years, medical schools have increasingly relied on clinical partnerships for financial support, according to Jaffery.
“It’s really important to have this kind of support and these kinds of partnerships,” he said.
This trend differs at Brown, Jain said, noting that the majority of Brown’s funding comes from research and philanthropy.
“While Brown greatly values and appreciates the contributions our affiliated health systems make to the medical education infrastructure here in Rhode Island, contributions to date have not been on par with national standards and are not a major portion of our revenue,” he said. “Even with the increased financial support from this new agreement [with] Lifespan [that we’ll be receiving] beginning in 2031, we will still trail our peers in reliance on clinical revenue.”
Jain believes that the medical school could attract additional research funding from the recruitment of “high-quality academic-oriented physicians” and “infrastructure investments associated with the deal.”
Financially, the deal seems to benefit Brown more than Lifespan, according to Bailey.
“Strictly based on the direct money going back and forth, based on what they’ve said, it looks like Brown gets the better end of this,” he said.
Moreover, Lifespan will rebrand itself as Brown University Health. Both Lifespan CEO John Fernandez and Brown President Christina H. Paxson see the name change as helping recruit physicians to Rhode Island, thereby supporting patient care.
One of the biggest benefits of an enhanced affiliation is greater alignment on missions and values, Jaffery says.
The deal calls for the dean of the medical school to become Lifespan’s chief academic officer in addition to serving as an ex-officio member on Lifespan’s board of directors alongside the Brown president.
This governance restructure is “grounded in the fact that these health systems are truly dedicated to supporting all the missions of academic medicine,” Jaffery said.
This makes strategic planning easier, helping the hospital group and the university work together to realize shared goals such as patient care and biomedical research. This tighter link, he said, can also help support research initiatives, medical training and “cutting-edge specialty care that you only get at these kinds of places.”
“The idea of having a dual association agreement and pursuing common goals … I think is very positive,” said Al Charbonneau, executive director for the Rhode Island Business Group on Health Inc.
Academic medical centers are extremely difficult to operate due to their complexity, Charbonneau says. He hopes the agreement will bring “a higher level of evidence-based medicine to the community.”
Jaffery believes this alignment seen in the agreement has benefits to both academics and patient care.
“One of the ways you contribute to the long-term viability of your academic mission is to support clinical care,” Jaffery said. “This enables you to maintain not only the kind of local primary care for your community but also delivering some of that [specialty] care that you don’t get anywhere else.”
Bailey doesn’t expect any significant changes for patients, at least not soon.
“In the long run, research should help patients everywhere,” he said. “It’s possible that if they could use the Brown name to attract more or better providers, that would also be helpful for patients.”
