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Five groups of hospitals and other health care facilities are embarking on a five-year project aimed at keeping patients healthier while reducing health care costs.
The five sites will become "accountable care organizations" in a project that attempts to tackle what many consider to be a big problem in the current system: having accountability spread across hospitals, doctors' offices, insurance carriers and employers with no one group responsible for the overall management of care.
Under the accountable care organization model, one organization - often a hospital or physicians' group - coordinates health care for its entire community across the health care system, rather than just when the patient shows up at a given facility. The focus is on a patient's overall health, and preventive care is emphasized as a way to avoid costly hospital stays.
President Barack Obama's national health care overhaul legislation calls for launching several experimental accountable care organizations in the hopes that if the tests work in the states, lessons could be rapidly adopted through Medicare. New Hampshire is hoping to get its project up and running early so it can apply for federal funding once it becomes available next year.
"We want to be able to have some ability to define this and not wait until someone comes up with a definition. We really want to get in and get working on it now," said Heather Staples of the New Hampshire Citizens Health Initiative, which put out a call for proposals earlier this year and announced the participants Thursday.
The five participants include Cheshire Medical Center and Dartmouth-Hitchock Keene; Exeter Health Resources; Southern New Hampshire Health System in Nashua; the Central New Hampshire Health Partnership in Plymouth and a North Country initiative that includes two hospitals, a community health center and a hospice facility.
"We must be smarter about how we use our health care dollars," Gov. John Lynch said at a news conference.
The details will take time to work out, but Staples said the project will force participating health care providers to focus on the overall health of a population in a way they didn't before.
"They're not just thinking about the patient just when they come in, they're thinking about patients before they ever need to come in," she said. "They're making sure they know who the asthmatics are in the population, who the diabetic patients are. They're making sure they are doing all the right preventive services."
Under the accountable care organization model, patients might get more reminders about appointments. Employees other than physicians may spend more time counseling patients so they don't end up in the hospital. That doesn't happen much now because insurers don't reimburse providers for such activity, Staples said.
"It's a different role," Staples said. "Right now, we pay for care when someone shows up. We don't pay for care when they don't ever come in. What we want is for people to be managed in a thoughtful way outside of when they come into the emergency room."
Edward Shanshala, CEO of Ammonoosuc Community Health Services in Littleton, said his organization already has started taking that approach. For example, it has been working on making sure when someone shows up at the emergency room, providers have access to information about what medications their primary care doctors have prescribed.
"We were already somewhere along that journey without calling it that," he said. "This is an opportunity for us to continue what we've been doing - collaborating - in a more formal approach."
Steve Ahnen, president of the New Hampshire Hospital Association, said the project will require all health care facilities - from primary care, to acute care, to rehabilitative and long-term care, to work together to manage a patient's condition over time. He said such an approach is ripe for success in New Hampshire, a state with a history of collaboration in the health care industry, but said no one should expect immediate results.
"I think we need to be careful that we don't promise more than we can deliver in the short run. I think we can have an impact on providing better, more coordinated care to our patients, we can overtime reduce the cost of care, but I think we need to be cautious," he said.