PROVIDENCE – Trying to discern the meaning of the latest developments last week concerning the proposed merger between Care New England and Partners Healthcare in Boston was a bit like trying to decipher what the charges in an emergency room bill for care were actually paying for: it was impossible to know without access to – and sharing of – more detailed information.

First, Partners Healthcare, Care New England and Brown University announced on Tuesday, Aug. 7, that they had signed a memorandum of understanding [MOU] to formalize the partnership between the school and the two health systems.

The news release provided some tantalizing breadcrumbs to follow where the path of the new partnership might lead:

• Care New England, Partners and Brown were said to be “exploring the potential for a new medical research institute in Providence and shared governance to support the goals of the partnership.”

However, neither Cass Cliatt, the spokeswoman from Brown, or Jim Beardsworth, the spokesman for Care New England, said that they were able to respond to any questions about the details contained in the MOU.

In response to a series of specific questions asked by ConvergenceRI, including what would be the potential focus of the new academic research institute, no information was forthcoming.

Cliatt said: “With formal negotiations pending, we’re not at liberty to disclose much beyond the content of the release itself.”

Beardsworth said: “These are all important issues that will have to be addressed throughout this process and wouldn’t be appropriate to speculate at this stage.”

Was it possible, ConvergenceRI wondered, that the creation of a new research institute in Providence could be linked to a decision about a new innovation campus by CommerceRI?

Brown had been mentioned as a potential collaborator in a number of the 16 proposals now under review. [See link below to the ConvergenceRI story, “A giant step forward for the RI innovation economy.”]

ConvergenceRI asked Matt Sheaff, director of communications at CommerceRI, to find out what the status was for the decision-making on choosing one or more proposals to invest $20 million in a new innovation campus, underwritten by a voter-approved bond.

The schedule, according to the RFP, was to announce the grant award winners in the spring or summer of 2018 and to sign the final contracts in the summer of 2018. There were now only four weeks left in summer.

“What is the news on the innovation campus? How close are you to a decision?”

“Nothing new to report at this time,” Sheaff responded.

To be determined at a later date
Some of the horse-trading involved in the negotiations had been revealed as part of the news release about the MOU: Brown University President Christina Paxson would have a seat on the board of directors of the new entity; and the agreement established Brown’s Warren Alpert Medical School as the primary academic research and teaching institution of record for the Partners/CNE entity in Rhode Island.

Further, the news release said that Dr. Jack Elias, the dean of the Warren Alpert Medical School, would sit on any academic and research subcommittees of that board.

Also, the signing of the MOU marked a dramatic change in Paxson’s tenor about the proposed merger between Partners and Care New England.

In January of this year, Paxson had voiced strong opposition to the merger, saying it threatened the vitality of Rhode Island’s future academic research enterprise and job creation. Paxson had even floated a potential alternative proposal to have Brown and CharterCARE join together to purchase Care New England.

The question was: What changed her mind?

Another question posed by ConvergenceRI that went unanswered was about the future alignment of Brown Physicians, Inc., the newly created nonprofit division of Brown that housed a number of Brown faculty physician group practices. [See link below to ConvergenceRI story, “New large group practice, Brown Physicians, Inc., created.”]

• There was indeed a second helping of breadcrumbs to follow in the news release, which talked about one of the objectives articulated in the MOU being: “Evaluating ways to strengthen the relationship between Care New England physicians and physicians in Brown-affiliated faculty practice groups.”

It was one thing to create an umbrella for Brown-affiliated faculty practice groups as Brown Physicians, Inc., it was quite another to take on the expense and management of health IT and population health analytics required.

Translated, if and when details of the MOU are shared and made public, look for the Brown-affiliated physician group practices to be integrated into Care New England’s accountable care organization known as Intregra, which includes both primary care and specialty practices.

Second big news dump
On Wednesday, Aug. 8, the day after the news release, the R.I. Department of Health received a request from Partners Healthcare and Care New England for an expedited review for a future Hospital Conversion Act application.

The news of the request was made public by the R.I. Department of Health the next day, on Thursday, Aug. 9.

In an email, Joseph Wendelken, the agency’s public information officer, wrote:

“Applications for transfers in hospital ownership are reviewed under the state’s Hospital Conversion Act. We did not receive a Hospital Conversion Act application. What we received was a request from the two parties for a future Hospital Conversion Act application to get an expedited review.”

According to Wendelken, some of the more significant differences involved in an expedited review are that “a decision needs to come from the R.I. Department of Health within 90 days, not 120 days,” as well as differences in the documentation that needs to be submitted.

In the past, Wendelken continued, the R.I. Department of Heath “has responded to applicants’ requests for expedited reviews within roughly two weeks.”

Further, there were specific criteria that will be used by Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, to determine whether or not the request for an expedited review will be granted, primarily economic.

As an example, Wendelken shared one of the criteria: “The acquiree operates one or more distressed Rhode Island hospitals facing significant financial hardship that may impair its or their ability to continue to operate effectively without the proposed conversion and have been determined to be distressed by the director of health.”

What happens next?
Without detailed financial information about the proposed merger between Partners Healthcare and Care New England, and without further clarification on what is exactly contained in the MOU with Brown University, it will be difficult to read the tea leaves and make any pronouncements about what happens next.

What can be said is that the merger is picking up steam, given the full-throated support of Brown University and the apparent participation of Lifespan in the ongoing negotiations.

That said, it will not stop candidates such as Cranston Mayor Allan Fung, Republican candidate for governor, from interjecting politics into the process, citing a study conducted by the R.I. Office of the Health Insurance Commissioner about the potential for increased health insurance costs to consumers as part of the merger. [Of course, if anyone from Fung’s campaign had actually read the study, they would find that the findings came with a big caveat: without the participation of either Care New England or Partners Healthcare, the authors of the study admitted that the findings were incomplete and lacked any corroboration. The study consisted of questions asked of health insurers by a consultant, where the conversations were off-the-record, not what one would call rigorous research.]

Health care is personal, health care is complicated, and the trillions spent on medical costs do not translate into better health outcomes. The disliked fact is that the current Rhode Island health care delivery system has already been colonized. What happens next on the roller coaster ride promises to be a thrilling adventure.