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The Dartmouth
June 21, 2024 | Latest Issue
The Dartmouth

Pilot program seeks to streamline health care

Five health care sites comprising the New Hampshire Accountable Care Organization pilot program, a health care system designed to increase cost efficiency, received a grant from the Robert Wood Johnson Foundation on May 20, according to Foster's Daily Democrat. The Dartmouth Center for Health Care Delivery Science and the Dartmouth Institute for Health Policy and Clinical Practice created the ACO program in order to streamline the health care process and increase the accountability of health care providers, Ned Helms, director of the New Hampshire Institute for Health Policy and Practice, said.

The five institutions which include the Central New Hampshire Health Partnership in Plymouth, Exeter Health Resources, Southern New Hampshire Health System in Nashua, Cheshire Medical Center/Dartmouth-Hitchcock Keene and a North County consortium of area hospitals will transform into an ACO throughout the next four years, Helms said. Since ACOs only provide medical services to one group of patients, they are encouraged to deliver quality care while keeping costs low, according to Helms.

Helms credits Elliot Fisher, director of the Center for Population Health at TDI, with the development of the idea of the ACO. Fisher is responsible for the "conceptual framework" on which the pilot program is based, Helms said. Don Caruso, the associate medical director of Cheshire Medical Center/Dartmouth-Hitchcock Keene, will serve as the ACO's clinical director, Helms said.

Fisher and Caruso did not return requests for comment by press time.

The program took shape after a year of intensive planning among representatives of both organizations, along with Dartmouth-Hitchcock Medical Center faculty, according to Helms. The implementation of the pilot program will last three years, followed by a year of "intensive review" to judge the pilot's success, he said.

ACOs aim to increase the quality and cost efficiency of health care for a local target population, according to Helms. The pilot program is a major step toward correcting inefficiencies in the American health care system, he said.

"First you have to sit down and determine what your population area is, attribute your membership," Helms said. "A given ACO is then accountable for the care of that population, in terms of both quality and in terms of cost."

The existing national health care system prioritizes profits over maintaining a healthy populous, according to Helms. The ACO model would place an increased focus on primary care largely by increasing the average salary for recent medical school graduates, he said.

As the federal government moves to increase accountability among Medicare providers by basing their operations in the ACO model, the national healthcare system will undergo a "fundamental transformation," Helms said.

"Medicare represents about 55 percent of the money that goes into the health care system in the country," he said. "My hope is that the system will not be driven by business people who are just trying to figure out how they can increase market share, and will focus on how to keep this population called America healthy, rather than how do we run this business called health care."

The pilot program will seek to avoid unnecessary hospitalization and medical tests as well as repeat examinations, Helms said.

"[The pilot sites] will also try to reach out to folks and see them when they're healthy as opposed to when they're already sick," he said.

Dartmouth's leadership and expertise have been "integral" to the formation of the ACO, Helms said.

"Faculty from DHMC and [TDI] serve on our executive committee and the payment reform committee that formulated the whole plan in the first place," he said. "In addition, this whole notion of an accountable care organization is an idea that has been developed by [TDI] in conjunction with other think tanks around the country."

Although competition often exists among various health care providers, those involved in the ACO pilot program have brought "their expertise to the table in a way that is really collaborative," Helms said.

The ACO model is unique among universities focused on working toward health care reform, according to Stephen Smith, family medicine professor emeritus at Brown University.

"At Brown I was on the student health insurance committee and we would gnash our teeth every year trying to figure out how to keep premiums down just for students," Smith said. "Over in New Hampshire, Dartmouth has been working to provide affordable health care to local people, and I'm not aware of many other examples of that."

The New Hampshire pilot has the potential to have a large impact on health care accountability, Smith said.

"The idea is a good one, essentially saying that you have a fixed budget for an enrolled population which will prompt you to control cost," he said. "The nice thing about these universities in New Hampshire is that you have a very defined population that you know a lot about, so it's very interesting as a laboratory study."

The University of New Hampshire is spearheading the program in coordination with the New Hampshire Citizen's Health Initiative and the New Hampshire Institute for Health Policy and Practice, Helms said.