Its recent hunt for rich patients in China didn’t work out. So now, Mass General Brigham — or MGB — the sprawling, Harvard-affiliated health care network, is hungry to grow back home, in the wealthy suburbs of Massachusetts.
As reported by the Globe Spotlight Team, Brigham and Women’s Hospital — which falls under the MGB umbrella — partnered with a sketchy Chinese company, chose a poor location, and ultimately helped build a facility that never attracted the well-to-do patients who were supposed to flock to it. “This is catering to elites, and the elites didn’t show up,” Dr. Vikas Saini, president of the Lown Institute, a Needham-based health care think tank, told the Spotlight Team.
That the mission of a Harvard teaching hospital involved catering to elites should come as no shock. The business model of MGB, formerly Partners HealthCare, relies on expansion into “more affluent territory,” said John McDonough, a professor of public health strategy at the Harvard School of Public Health and a former state lawmaker. In recent years, however, executing that business model has been challenging. After an effort to acquire South Shore Hospital in Weymouth was blocked in 2015, MGB looked to China. But the Brigham faltered in its effort to bring its brand to a remote island off the Chinese mainland. Refocusing on Massachusetts, MGB is now trying to build two new outpatient surgery centers in Westborough and Woburn, and expand an existing facility in Westwood.
The proposal pits MGB’s need to grow against the state’s interest in maintaining a competitive health care marketplace. In a November report, Attorney General Maura Healey urged state health officials to scrutinize the extent to which the MGB proposal would “contribute to or threaten the state’s goals for cost containment,” based on MGB’s own projections that expansion in Eastern Massachusetts would yield $385 million a year in profits and increased market share. Officials at the state Department of Public Health, who will decide the plan’s fate, then required MGB to hire an independent consultant to study health care costs. Unsurprisingly, an analysis paid for by MGB concluded its proposal would help control costs. Meanwhile, the Health Policy Commission, a state agency that studies the health care market, may or may not weigh in. (MGB didn’t respond to an e-mail seeking information about its expansion agenda.)
From the Lown Institute’s perspective, the MGB plan raises questions about the underlying values that are driving a nonprofit institution. If you’re a hospital with tax-exempt status, “you could be asking, ‘what are you doing locally for the community?‘ ” Saini told me. “Or, you can figure out where there are paying customers and build a clinic.” MGB insists their outpatient centers would simply provide greater access to care. But opponents, who include competitors and consumer advocates, say MGB is targeting patients from the wealthiest ZIP codes. Meanwhile, MGB is also planning a new addition at Massachusetts General Hospital and an expansion at Brigham and Women’s Faulkner Hospital.
On one hand, MGB simply embodies the market-driven spirit of American health care: “They have to find revenue, and the revenue is fragmented in terms of geography and social class,” said Saini. Yet Massachusetts is supposedly committed by law to keep health care costs down; in 2012, the state set a health care cost growth benchmark. There’s a national movement, too, to rein in big business, said Harvard’s McDonough. “The temperature of the times is changing,” McDonough told me. “The notion of ‘let them grow as big as they can and the free market will take care of it’ has run into an abundance of evidence that the free market won’t take care of it.”
This controversy, of course, comes with a political overlay. In a year when Healey might be running for governor, her report takes on the powerful business interests represented by MGB. The MGB board is headed by venture capitalist Scott Sperling; Jack Connors, one of the founding forces behind the original Partners network, is chairman emeritus. Will Healey — who also opposed the South Shore Hospital acquisition — hold firm on this, or yield to the pressures of politics and fund-raising? Meanwhile, this is also Governor Charlie Baker’s last year in office. Unfettered by reelection concerns, will Baker, a former health care executive, let the DPH sign off on this expansion or will he stop or restrict it?
If MGB hoped that after China they could grow their outpatient space back home and no one would notice, they were wrong. From the intersecting worlds of politics and health care, people are watching.
This column has been updated to clarify that Brigham and Women’s Hospital helped build the facility in China.