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  • Staff photo by Bob Hammerstrom

    Governor John Lynch, center, talks with David Cawley, left, and Southern New Hampshire Medical Center President and CEO, Tom Wilhelmsen Thursday, July 22, 2010, prior to a meeting on health care.
  • Staff photo by Bob Hammerstrom

    Governor John Lynch and Tom Wilhelmsen, hospital president and CEO, view a database patient board in a waiting room, during a tour of Southern New Hampshire Medical Center Thursday, July 22, 2010.
  • Staff photo by Bob Hammerstrom

    Governor John Lynch, hospital staff and local politicians meet at Southern New Hampshire Medical Center Thursday, July 22, 2010, to discuss health care.
  • Staff photo by Bob Hammerstrom

    Governor John Lynch, center, talks with David Cawley, left, and Southern New Hampshire Medical Center President and CEO, Tom Wilhelmsen Thursday, July 22, 2010, prior to a meeting on health care.
  • Staff photo by Bob Hammerstrom

    Governor John Lynch and Tom Wilhelmsen, hospital president and CEO, view a database patient board in a waiting room, during a tour of Southern New Hampshire Medical Center Thursday, July 22, 2010.
  • Staff photo by Bob Hammerstrom

    Governor John Lynch, center, talks with David Cawley, left, and Southern New Hampshire Medical Center President and CEO, Tom Wilhelmsen Thursday, July 22, 2010, prior to a meeting on health care.
Friday, July 23, 2010

Pilot program could change model of health care for SNHMC

NASHUA – Dr. John Gorman envisions the day when doctors go back to doing house calls under a new pilot program at Southern New Hampshire Medical Center.

The program was created by the state to lower the cost of health care in New Hampshire, and SNHMC is one of five hospitals that has agreed to try it for the next five years. The methods of lowering costs could dramatically alter the way doctors are accustomed to working.

“My view is that physicians will be nervous about this,” said Gorman, a rheumatologist, who sat down Thursday with hospital leaders and Gov. John Lynch to discuss the program. “How could they not be?

“People are used to a certain way.”

The Accountable Care Health Organization Pilot Project gives health care providers a direct role in controlling costs and holds them accountable for the quality of patient care. It encourages doctors to better manage their time and to work with specialists to avoid unnecessary tests and doctor’s visits that drive up the cost of care.

The term “accountable care organization” is all the buzz nationwide. It’s the model of health care that’s being promoted through the new health care reform law. The goal is to move away from the traditional fee-for-service model that rewards doctors and hospitals for driving up medical bills, and to encourage more patient-focused health care.

Specifically, accountable care involves:

Establishing an upfront total cost for treating a patient’s condition, rather than billing separately for each test, procedure or service. For example, a hospital may decide it should spend $100,000 to treat John Doe’s heart disease.

Monitoring a patient’s health care even after he or she has left the hospital, where house calls could come into play. It also includes partnering with home health care groups and nursing homes to coordinate a unified plan for each patient’s care.

Primary care doctors taking an active role as a patient’s “care manager.” This includes more and better communication with specialists to reduce the likelihood of unnecessary or duplicate office visits, tests or procedures.

Physicians teaching group classes on how to manage health care, rather than explaining best practices to each patient individually during office visits.

Few would disagree that something needs to be done about the cost of health care in New Hampshire. The state’s average family health insurance premium – $12,686 in 2006, the most recent year for comparison – was one of the highest in the country.

“Here in New Hampshire, we are fortunate that the quality of our care is very high,” Lynch said. “But we also have some of the highest costs.”

Surveys have shown over and over again, he added, that higher costs do not translate to a higher quality of health care.

Dr. Elliot Fisher, of Dartmouth Medical School, has spent years studying just that. As part of the Dartmouth Atlas Project, his team has discovered that despite wide variations in the cost of care throughout the country, the regions that spend more don’t always have better outcomes for their patients.

Southern New Hampshire Medical Center will spend the next five years crafting a strategy on how best to lower the spike in health care spending while also improving the patient experience. If successful, the program would make the hospital competitive in getting a piece of incentive grants in the federal Obama health care reform law to reward providers that “bend the cost curve.”

Other selected providers in New Hampshire are the Central New Hampshire Health Partnership, based in Plymouth and Bristol; Exeter Health Resources; Cheshire Medical Center and Dartmouth Medical Clinic in Keene; and a North Country initiative of hospitals and home health groups.

Dr. Stephanie Wolf-Rosenblum, chief medical officer at Southern New Hampshire, said the hospital has already spent the last few years trying to improve the quality of care while making the best use of its resources. The pilot program is just one more step in that continuum, she said.

Dr. Stewart Fulton, assistant vice president of medical affairs, acknowledged that it’s human nature to be uneasy about change, but he said the hospital already has a culture that promotes constant change that will make it easier to adjust to the pilot program.

“It’s intimidating but it’s exciting at the same time,” he said. “Change is always a little uncomfortable.”

Gorman, the rheumatologist, said doctors will have to be able to get their patients on board with the program in order to make it a success.

“Patient education is going to be a huge factor in getting patients to buy in to this program,” he said.

Ashley Smith can be reached at 594-6446 or asmith@nashuatelegraph.com.