Dartmouth-Hitchcock Health and GraniteOne Health announce merger

by Lucy Turnipseed | 2/12/19 3:10am

Two top health care organizations have announced a merger that aims to more effectively meet the health service needs of the state’s residents.

Dartmouth-Hitchcock Health and GraniteOne Health — which consists of Catholic Medical Center, Huggins Hospital and Monadnock Community Hospital — have just begun the lengthy process of combination. The organizations announced that they signed a letter of intent — a non-binding agreement — on Jan. 24. The new combined nonprofit health care system will be named Dartmouth-Hitchcock Health GraniteOne and is expected to be finalized sometime in 2020, although the letter of intent states that “the combination will not take effect until and unless” the two organizations reach a “more definite agreement.”

Input from the public as well as each organization’s board of trustees, federal and state regulators and the Bishop of Manchester — due to his association with the Catholic Medical Center — will contribute to the decision.

“As the healthcare landscape continues to evolve,” Dartmouth-Hitchcock Medical Center CEO Joanne Conroy said in a press release. “It is important for healthcare systems to evaluate how we can best serve our patients and communities and prepare for the future so we can continue to provide the high level of care that people expect.”

DHMC is the only teaching hospital in the region and home to a cancer institute and children’s hospital. GraniteOne is a more community-oriented non-profit agency that also encompasses leading medical treatment areas.

Eugene Nelson, Geisel professor of community and family medicine and The Dartmouth Institute specialist on health policy and clinical practice, noted that the merger is part of a larger national trend.

“Large health systems are merging forces with other large health systems to increase the size of the population served, geographic reach, access to both primary and specialized services and access to coordinated health and community services,” Nelson said. 

Unique to the DHH and GraniteOne merger is its potential to implement a more educational approach to health services in New Hampshire — in terms of teaching and research — due to the academic nature of DHMC, according to Nelson. 

According to Dartmouth-Hitchcock Health board of trustees chair Vincent Conti in the press release, the merger of the two organizations will “ensure that we can continue to offer high quality, lower cost, New Hampshire-based care.”

Conroy said that cost savings would occur through data-sharing and back-end service combination. She noted that this would allow for a greater focus on patient care, especially access to specialty services.

Ellen Meara, The Dartmouth Institute specialist on health policy and clinical practice and economics professor, noted that there were necessary trade-offs when merging heath systems.

“Whenever there’s a merger ... the two have to coordinate and integrate to a larger scope to become more effective in the health care market,” Meara said. “You absolutely worry that there’s more market power on the part of that organization.”

She said that benefits include sharing of resources, but prices may rise.

“At the end of the day, you have to weigh the outcome of the benefits from being able to integrate resources, particularly in smaller places in New Hampshire and rural areas that may struggle with access to health care, and the increase in prices when they merge,” Meara said.

“For 15 years, our two organizations have worked closely together to improve the lives and health of our patients and their families,” GraniteOne Health CEO Joseph Pepe said in a press release.

In 2010, a merger between the DHMC and the Catholic Medical Center was denied by the state attorney general, due to a fear that the former would overpower the latter. There were also concerns surrounding conflicting moral views of the DHMC and CMC regarding health care. These concerns were addressed in a Jan. 24 joint Dartmouth-Hitchcock Health and GraniteOne Health press release that stated each organization would continue its current methods, with CMC continuing its “Catholic model of care.”

“Health care is a deeply personal experience and it is important to assure all our patients that they will continue to receive the health care services they want and need, at the place and time they want them,” Conroy said.

Resident of Mason, New Hampshire Katherine Gregg expressed her opposition to the proposed merger in a Concord Monitor opinion piece. Gregg wrote that she had “read with dismay” of the proposed merger. She wrote that she sees the merger as a monopoly-like domination the new conglomerate will have in the state. 

“What they refer to as efficiency — by which I think it commonly means rolling costs all into one — actually doesn’t help consumers,” Gregg said in an interview with The Dartmouth. “It doesn’t promote competition and therefore prices can go up. If there’s no competition, there’s no incentive to keep prices low.”

“Combining systems would allow us to advance [our intended] vision, expanding access to primary and specialty care for all New Hampshire residents, including vulnerable patients and communities,” Pepe said. 

The two groups’ new website, forahealthiernh.org, boasts the phrase “together we are stronger” on its home page and informs visitors that their decision to merge was based on a precedent of “successful collaboration.”