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Outgoing Care New England CEO reflects on merger attempts and the future of health care in R.I.

“Pandemic. Health care financing mess. We had a cyber attack in the middle of it all,” said Dr. James E. Fanale. “Who knew the last couple of years were going to happen?”

Dr. James E. Fanale is the outgoing president and CEO of Care New England, which is Rhode Island's second largest health care system.HANDOUT

PROVIDENCE — Since 2017, when he became interim CEO, Dr. James E. Fanale has written a weekly update to all employees of Care New England, documenting his perspective of the system, conversations the executive team was having with unions leaders, and good news of new rankings or hires.

As COVID-19 spread across the state, Fanale’s messages detailed the staffing crisis that has plagued the health care industry, and offered words of encouragement along with updates about CNE’s attempt to merge with Lifespan Corp., Rhode Island’s largest health care system.

After more than 270 of these messages — he has never missed a week — Fanale typed his final update last Wednesday.

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His career in medicine has spanned nearly five decades, but leading Care New England “was the most challenging, the hardest work,” Fanale told the Globe in a phone interview from his home in Falmouth, Mass., just hours before he officially retired. “But I think it was the most rewarding.”

“Pandemic. Health care financing mess. We had a cyber attack in the middle of it all,” he said. “Who knew the last couple of years were going to happen? But watching the eyes of people that work for you still find success in the middle of it all is worth its weight in gold.”

It’s time now, he said, to spend time with his family: his wife Deb, of 21 years; his 20-year-old daughter who is in art school in Chicago; and his three adult sons. He’s had some unexpected health issues (he asked to keep the details private) and, after many pandemic-induced delays, they’re heading on a family vacation next week to Aruba. For years, he hasn’t taken more than a week off.

Fanale became president and CEO of Care New England in 2018 after serving as interim CEO and, before that, as the health care system’s executive vice president, chief clinical officer, and chief operating officer. Care New England had just reported a nearly $60 million loss and was working on a turnaround plan in order for Boston-based Partners HealthCare (now Mass General Brigham) to acquire it and flush it with cash.

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Lifespan, the largest system in the state, launched an opposition campaign against the deal and former governor Gina M. Raimondo stepped in, asking for an “in-state solution.” Partners backed out.

On Wednesday, Fanale said he thought Raimondo, now President Biden’s commerce secretary, “overstepped.”

“I think a major regret for Care New England is, ‘Why couldn’t we get the Partners deal done?’ It was a political situation that ended it,” said Fanale. “But our people are incredibly resilient. They didn’t sit and cry in their soup for a long time about this.”

Care New England moved on, and began working on an “in-state solution”: merging with Lifespan. Together, the two health care systems would control 80 percent of hospital beds in Rhode Island. Brown University committed a minimum $125 million to make it happen. The merged entity would have been the largest employer in the state, which executives said was the “only solution” to the financial woes affecting both health care systems.

Earlier this year, the deal was blocked by state and federal regulators, which said a single health care system of that size would not be good for patients or employees.

“I knew early on that it was really unlikely this thing was going to get approved. Just do the math,” said Fanale. “You put so much effort, so many dollars behind it that when you get closer, you want to see it all the way through. Once you’re in the middle of it, you don’t even think of not completing it.”

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The two health care systems, along with Brown, signed a new aligned research collaboration in November to codify a pledge that the boards would continue working together. Fanale said the boards recently came to an agreement to collaborate on cardiology services and open a medical surgical unit at Women and Infants Hospital.

“For the first time in a long time, Lifespan and Care New England are figuring out how they can work together and still compete,” said Fanale.

Front row left to right: Charles Reppucci, chairman of the Care New England Board of Directors, Lawrence A. Aubin, Sr., chairman of the Lifespan Board of Directors, and Samuel Mencoff, chancellor of the Corporation of Brown University. Back row left to right: James E. Fanale, M.D., Care New England president and CEO, Jack A. Elias, M.D., dean of Tthe Warren Alpert Medical School, Timothy J. Babineau, M.D., Lifespan president and CEO, and Christina H. Paxson, president of Brown University. Bill Murphy/Lifespan

The systems’ histories had prevented this kind of collaboration in the past, he said. “And that doesn’t make any sense. I would say even during the merger discussions that we could not be imprisoned by the past, but only be informed by it. The organizations were always in some kind of a squabble, which were really not worth it,” he said.

Though the boards of directors for Care New England and Lifespan took longer to come to an agreement than the CEOs, Fanale said the leadership of both groups — Care New England chairman Charles Reppucci and Lifespan chairman Lawrence A. Aubin Sr. — are “dedicated to the new approach.”

“But they’re not going to be around forever,” said Fanale, who will be a consultant to the board for the next year. “The question is, can they bring the rest of the boards together to feel the same way?”

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Outgoing Care New England president and CEO Dr. James E. Fanale (left) and Care New England chairman Charles Reppucci (right). The Acute Care for Elders Unit at Kent Hospital in Warwick, R.I. was named in honor of Fanale in recognition of his leadership and dedication to patients.HANDOUT

Fanale graduated from Pennsylvania State University and earned his medical degree from Chicago Medical School in 1976. He did residencies at Worcester Memorial Hospital before becoming the chief of geriatrics there for a decade. The hospital, now named UMass Memorial Medical Center, is where he continues to see geriatric patients. When he told them he was retiring about eight months ago, a few of the sickest patients asked if he would continue seeing them. He agreed.

Fanale previously served in executive roles for Blue Cross Blue Shield of Massachusetts, where he oversaw clinical and administrative programs, and at Mercy Medical Center in Baltimore.

When he returned to Massachusetts, he was named the senior vice president for system development at Jordan Hospital in Plymouth in 2008. It’s also where he met Dr. Michael Wagner, an executive at Tufts Medical Center at the time. On Thursday, Wagner will officially become the president and CEO of Care New England.

“In many respects, he does have a lot of the attributes that I would hope whoever succeeds me would carry on,” said Fanale, who was recently honored by Care New England after the board named a floor at Kent Hospital — the acute care for elders unit — in honor of Fanale, for his leadership and dedication to patients.

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When Wagner takes over at Care New England, he’ll oversee a system with three major hospitals — Kent, Women and Infants, and Butler — compared to Lifespan’s eight. But Wagner will face a large percentage of patients on Medicaid and a balance sheet where financial pressures predate the pandemic. In early 2023, John Fernandez, the president of Mass Eye and Ear (part of Mass General Brigham), will become the president and CEO of Lifespan.

Fanale said the two need to work together in Rhode Island.

“Rhode Island is not Massachusetts. You have to recognize it’s different. It’s really important to collaborate and be collegial with everybody in the state. You just come out with better outcomes that way,” said Fanale. Lifespan and Care New England have “historically been competing hard and heavy and not thinking about how they could work together for the good of the state.”

While Care New England has the women’s health and psychiatric hospitals and runs the state’s only neonatal intensive care unit, Lifespan operates the state’s only Level 1 Trauma Center and a pediatric hospital. “Neither organization can exist without the other,” said Fanale.

It’s an idea he stressed in his last message to Care New England’s employees on Wednesday.

“My only request to you is to keep it up and continue to work together to do so. I know times are not often perfect and all of health care is stressed with staffing, etc., but always keep your eye on the prize, as they say, our patients,” wrote Fanale. “You can never go wrong.”


Alexa Gagosz can be reached at alexa.gagosz@globe.com. Follow her on Twitter @alexagagosz and on Instagram @AlexaGagosz.