Common Questions & Answers
Why have Dartmouth-Hitchcock Health (D-HH) and GraniteOne Health (GOH) agreed to combine their systems?
The demand for high quality, affordable health care in New Hampshire is high and continues to grow. D-HH and GOH are committed to meeting that demand and fully responding to the community’s needs. We can most effectively do that by combining systems. By combining, D-HH and GOH can expand access to primary, specialty, ambulatory and inpatient care, and invest jointly in critical infrastructure to support those expanded services, to offer patients a high quality, lower cost, New Hampshire-based alternative choice to out-of-state providers.
Dartmouth-Hitchcock and Catholic Medical Center (CMC) have worked together to care for patients and communities in southern New Hampshire for over fifteen years, providing services in obstetrics and pre- and post-natal care, oncology and cancer care, rheumatology, endocrinology, and critical care. Dartmouth-Hitchcock already works with Monadnock Community Hospital to provide oncology and cancer care and gastroenterology. Combining our health care systems will allow us to build on that collaborative experience to offer more specialized, higher quality services in southern New Hampshire and in rural communities across the state. We can do this more quickly and efficiently as a combined system than if our systems remain separate. We strongly believe that we can accomplish more for the people we serve by working together to coordinate care.
What does this mean for patients and the community?
Patients in southern New Hampshire have already benefited from numerous clinical collaborations and programs coordinated by Dartmouth-Hitchcock and CMC, including child and maternal health through the family-centered special care nursery and The Mom’s Place at CMC, and cancer care and oncology services through the Norris Cotton Cancer Center.
By combining, we will be able to respond to community needs with an even broader array of seamlessly integrated and coordinated specialty services in pediatrics, surgical oncology, oncology infusion therapy, weight and wellness programs, breast health, pulmonary intensive care, orthopedics, spine and neurosurgery, trauma (surgical and orthopedic), emergency, and intensive care to better meet the needs of our patients and communities – including those in NH’s rural areas – now and in the future. Patients in southern New Hampshire will have access to highly specialized services, like pre- and post-surgical transplant care, and increased clinical trials. By combining, we can bring these benefits to patients more efficiently and at a lower cost.
Both D-HH and GOH share a deep commitment to expanding access to care throughout New Hampshire, including in rural areas. Both Dartmouth-Hitchcock Medical Center and CMC are New Hampshire’s leading transfer centers, meaning they take patients from all over the state who can’t receive specialized care locally. As rural health care providers struggle with recruitment and resources in specialty services, it is increasingly difficult for D-HH and GOH to meet community needs working alone. This combination would allow us to strategically use our human and technological resources to ensure continued access to care locally in rural communities, transfer patients to the most clinically appropriate and convenient site of service, and expand the use of telehealth services to the local bedside.
We also believe that working more closely together will allow us to devote more resources to strengthen veteran’s health care and address the state’s behavioral health and substance use disorder crises.
What does “combination” mean? Is this a merger?
The proposed combination means that Dartmouth-Hitchcock Health and GraniteOne Health will join their health systems together to operate as distinct but related organizations under a common governing body. This combination is not a classic merger because each member of the combined system will maintain its unique identity and mission, and be governed by a local board of trustees and managed by local leadership.
What will the new organization be called and who will control it?
The corporate name of the new organization will be “Dartmouth-Hitchcock Health GraniteOne.” The governing body will be the “Dartmouth-Hitchcock Health GraniteOne” Board of Trustees, comprised of appointees from both D-HH and GOH. It will be responsible for the overall strategic direction and clinical, operational, and financial oversight of the system and its members.
Why a combination? Why can’t the two organizations continue to remain separate and simply collaborate?
There are legal, regulatory and practical limits to how closely organizations can collaborate to achieve mutual goals. Dartmouth-Hitchcock and Catholic Medical Center have worked together to provide care to patients and communities in southern New Hampshire for over fifteen years. Dartmouth-Hitchcock and GOH member Monadnock Community Hospital already collaborate on clinical services. Combining our health care systems will allow us to build on that collaborative experience, offer more specialized, higher quality services in southern New Hampshire and in rural communities across the state, jointly invest in critical infrastructure, increase the level of high-quality across all locations, and share strategies for achieving our mutual goal to improve health and health care in New Hampshire more quickly and efficiently than if our systems remain separate. By uniting these two top health care systems we can be better, together. Patients will have the right care at the right time in the right place.
How is this combination different from the prior affiliation effort between Dartmouth-Hitchcock and Catholic Medical Center?
A lot has changed since 2009. This proposed combination transaction differs from the previous affiliation attempt in important and multiple ways. This transaction seeks to combine two strong systems – not individual hospitals.
First, under the combined system, each member of Dartmouth-Hitchcock Health GraniteOne will maintain its unique identity, mission and charitable purpose, and will be governed by a local board of trustees and managed by local leadership in close contact with patients and the local community.
Second, unlike the previous affiliation attempt, CMC Healthcare System (CMCHS) will not fall under the control of the new system organization. Consequently, this combination will not result in any change to the mission, governance or operation of CMCHS. As he said in our press release, the Roman Catholic Bishop of Manchester, the Most Reverend Peter Libasci, believes the “combined system would strengthen Catholic Medical Center’s ability to care for the suffering and sick in our community, while at the same time maintain the integrity of its Catholic identity.”
Third, health care delivery today also requires greater alignment among hospitals and providers in order to efficiently coordinate care, manage the total cost of care, ensure consistent quality, and improve the health of populations. Both organizations have gained greater experience in alternative payment models like shared savings programs and risk-based payer contracts and they’ve earned a proven track record of finding cost savings in health care delivery.
Fourth, the economic and social circumstances today are far different than they were ten years ago, and we face new challenges, from the effects of the Affordable Care Act, to caring for the chronic conditions of an aging population, to New Hampshire’s opioid and behavioral health crises.
Fifth, health care delivery in New Hampshire has changed dramatically in recent years with the national, regional and local growth of systems, the combination of hospitals in Nashua and Manchester to form SolutioNHealth, and the entry of higher cost, out-of-state providers. There are many instances – both regionally and nationally – where hospitals wait too long to affiliate, only to do so when they are struggling. D-HH and GOH are both strong and vibrant organizations, taking a more proactive and forward- looking approach to coming together.
This proposed combination is driven by the necessity of meeting growing patient demand for existing and new services, particularly in southern New Hampshire, more conveniently, efficiently and at a lower cost.
CMC is a Catholic hospital, operating in accordance with the Ethical & Religious Directives for Catholic Health Care Services (the “ERDs”). D-HH is a secular health system, providing some services that are contrary to the ERDs. How will this issue be resolved?
CMC and Dartmouth-Hitchcock have been collaborating in compliance with the ERDs for many years and both D-HH and GOH agree that maintaining and furthering CMC’s Catholic health care mission is paramount. CMCHS will share Reserved Powers over CMC and will continue to be the corporate vehicle for Bishop Libasci to ensure CMC’s full compliance with the ERDs. Bishop Libasci and respected ethicists from the National Catholic Bioethics Center, have been engaged early in this process to provide guidance and ensure that any agreement reached assures compliance with the ERDs and the Code of Canon Law, as they did in the process of forming GOH.
CMC will not be required to conduct any procedures that are inconsistent with the ERDs. Meanwhile, D-HH will continue to serve its patients as it does today in all their existing health care facilities and the secular hospitals of GOH will continue as they have in providing the health care services their patients want and need at the place and time they want them.
Will there be layoffs?
Both organizations are struggling with industry-wide problems of adequate staffing and workforce development. Rather than eliminating positions, this combination seeks to lower costs through better delivery and coordination of care and more efficient procurement of resources. The combination is also aiming to help meet capacity needs which should result in more jobs, not less. We do not intend for there to be layoffs. We hope that, by working together, we can develop effective ways to address the workforce challenges of health care in NH and better recruit and retain highly-skilled providers.
Are D-H Clinic practices part of this combination? What about GOH members?
As stated in the Combination Agreement, D-HH and GOH intend to include all their members in this combination.
Will all patients be able to continue seeing their current doctors/providers? How will the combination affect patient options for health care?
We share a deep understanding of the importance of preserving relationships between patients and their healthcare professionals. Health care is a personal experience and it is important to us that patients keep the doctors and providers they know and trust. One of the primary goals of this combination is to enhance access and offer more healthcare options, not fewer.
Patients served by D-HH and GOH would benefit from the collective clinical, educational and technological resources of the combined systems. Working together would allow us to stay at the forefront of healthcare technology, information systems, population management, patient care management and quality assurance, all of which drive toward even better outcomes and experiences for patients.
Will CMC and other GraniteOne members retain their non-profit status?
Yes. CMC would continue as a non-profit, Catholic institution while Huggins Hospital and Monadnock Community Hospital would continue as non-profit and secular Critical Access Hospitals.
Similarly, Dartmouth-Hitchcock Medical Center would continue to be the state’s only academic medical center while the other member hospitals in the D-HH system would maintain their current status – a mix of community health organizations, clinics, acute care hospitals, and Critical Access Hospitals.