New center at Brown to take on the 'behemoth' problem of health care spending

Lead off discussion looks at the impact of private equity on health care

Brown University

Dr. Jha. Photo by Kenneth Zirkel

Unchecked and ineffective health care spending is the biggest social policy challenge facing the U.S., says Dr. Ashish K. Jha, dean of the School of Public Health at Brown University. Not the biggest health policy challenge, Jha stressed, but the toughest social policy challenge — one that’s costing $4.3 trillion, close to 20% of the United States’ gross domestic product.

While there are no silver bullets, Jha says there are definitely better, more data-driven ways to attack what he calls a “behemoth of a problem.” And that’s the idea that underpins the new Center for Advancing Health Policy through Research at Brown’s School of Public Health.

The dean formally launched the center in front of a packed room of faculty and students from public health and medicine, as well as policymakers, community leaders and legal scholars. The early-October launch event took place at South Street Landing in Providence’s Jewelry District — within easy walking distance from the School of Public Health, the Warren Alpert Medical School and the city’s major hospitals.

“The Center for Advancing Health Policy through Research is predicated on the idea that if we're going to make progress that's sustainable, that's actually going to move the needle, it has to be data-driven,” Jha said. “Because if you go to Washington and you lay out this problem, you'll immediately get everybody giving you their favorite solution. And almost all those solutions are data-free.”

The center was approved by Brown’s Academic Priorities Committee in June, and was officially up and running with the start of the 2023-24 academic year.

Brown already had top researchers in this field, Jha said. They are now joined by Andrew Ryan, director of CAHPR (pronounced “CAY-per”) and a professor of health services, policy and practice who has been at the forefront of health policy research for over a decade.

“The mission of CAHPR is to generate the highest-quality evidence to advance and form discussions around health care, affordability, access and value in the United States, and to translate this information toward policy change,” Ryan said.

What makes CAHPR unique, Ryan said, is a focus on translating research into policy. Often, he noted, scholarly research remains sequestered in peer-reviewed journals; it doesn't get to the policy makers and community stakeholders who are trying to improve health care systems. CAHPR scientists hope to do more than conduct great research; they also hope to influence health policy at the national and state level.

“This is something that's important to us and something that we're really trying to address in the center,” Ryan said. “How we're doing this is through targeted dissemination to policy makers and engagements with community stakeholders and policy makers.”

Upcoming CAHPR events include a panel discussion in Washington, D.C., during which Brown researchers and national policy makers will come together to talk about Medicare Advantage; and a seminar series focused on health policy research. Ryan said that center priorities also include supporting national initiatives with respect to transparency and Medicare Advantage and private equity.

Faculty are currently mentoring a number of public health Ph.D. students who are working as research assistants on CAHPR projects, where they’re learning about research methods as well as how to translate findings into policy. The center also launched a Health Data Science Summer Fellowship Program, designed to equip students at Brown with essential skills in data management and programming in the field of health data science.

A realistic approach to problems caused by private equity

To illustrate CAHPR’s approach, the School of Public Health hosted a panel discussion on the impact of private equity in health care — what it means for patient care, costs, outcomes, access and more. In private equity, investment firms purchase mature businesses like physician practices or hospitals or nursing homes, seek to revamp them and then resell them in a short period of time.

Panelists included Brown public health faculty members Christopher Whaley, an expert on markets and regulation in health care, and Yashaswini Singh, an expert on private equity; Erin Fuse Brown, a law professor at Georgia State University College of Law, expert on health and administrative law and a collaborator of CAHPR; and Cory King, acting health insurance commissioner of Rhode Island.

The panelists not only made the topic of private equity ownership of health care sound as riveting as a true crime novel, but they also provided clear examples of how research could be used to influence policy levers and solutions to identify and address some of the harms of private equity ownership.

One question from the crowd: Where is the money going to come from, if not private equity?

Jha and Ryan had previously acknowledged that “uprooting private equity from the health care system” wasn’t a feasible solution. But the answer from Fuse Brown was more nuanced.

“So it's about, ‘How do we manage the risks and the harms?’” Fuse Brown said. “Is there a way to access the capital, but put some guardrails around the worst harms to patient care, to physicians, and to costs and consolidation, of course… I think that's actually something worth doing, even if it sort of just slows down the worst effects of it.”