Hanover -- A new primary care practice that will open soon in Hanover is the next step in Dartmouth College's ongoing push to be a national leader in health care reform, and is an example of how the school is putting its research to practical use in its own backyard, Dartmouth officials said this week.

Slated to open February in the former Omer & Bob's space on Allen Street, the practice, called Dartmouth Health Connect, is something of an experiment that turns the conventional way of providing care upside down.

The partnership between the college, Dartmouth-Hitchcock, and a for-profit Massachusetts-based health care company called Iora Health does what many experts working on health care reform have been advocating -- redesigning primary care with the goal of keeping patients healthy and out of hospital emergency rooms, which contribute to the high cost of care.

“This is for us exciting because in addition to just talking about it on an academic level, we're actually doing it on a very practical level,” said Dartmouth spokes-man Justin Anderson. “We can talk all we want about improving health care in the country, but if we can't successfully deliver health care to our employees who live in the Upper Valley, then we’re not going to be successful.”

Dartmouth Health Connect puts into practice many of the ideas, particularly the call for taking a team approach to delivering health care, that have been championed by researchers at The Dartmouth Institute and the newly established Dartmouth Center for Health Care Delivery Science, said Dr. Albert Mulley, the Center's director.

The new practice, which will be open to Dartmouth employees, scraps the old physician-centered model in favor of a health care “team.” The team includes two Dartmouth-Hitchcock physicians, a nurse, practice coordinator and “health coaches,” who will be in touch regularly with patients to make sure they're staying on top of medications and doing the things they need to stay healthy. Iora will manage the practice and, with the exception of the two D-H doctors, hire the employees.

The team will talk with one another, email and phone patients, involve family members and even other outside physicians who are responsible for caring for a patient.

“What's sorely missing in health care is shared teamwork,” Mulley said in a telephone interview from London, where he is a fellow at The King's Fund, a charity designed to improve health care in England. “It's all about coordination. It’s all about being on the same page.”

Another major change will be in how the care is paid for. Health reform advocates have criticized the existing fee-for-service model as being one that promotes treatment of sickness rather than maintaining good health.

With Dartmouth Health Connect, there will be no bills to insurance companies for treatment. Instead, Dartmouth bypasses the third-party insurers and will pay Iora a flat fee for each patient. The hope is that this will give caregivers an incentive to keep patients well rather than seeking more procedures, since it will cost the same either way. It means fewer administrative hassles to deal with billing, and patients won't be charged a co-pay fee for each visit.

Dr. Joel Lazar, who will be one of two physicians at Dartmouth Health Connect, said the model holds great promise for health reform.

“I'm very committed to trying to improve and change the way primary care is delivered,” said Lazar, who is Dartmouth-Hitchcock's family medicine section chief. “While we've made some improvements to the traditional model, I see a real opportunity here to move those innovations to a whole new level.”

President Jim Kim arrived at Dartmouth in 2009 with ambitious goals for advancing Dartmouth's influence in the national health care debate. Last year, he launched The Dartmouth Center to bring together the best thinkers and practitioners from many disciplines to build a new discipline of health care delivery. Also, D-H and The Dartmouth Institute, which has been at the forefront of health research and policy, announced last year they'd be joining a new collaborative of the nation’s top health care institutions, which will pool information to find better ways of offering care.

Though Dartmouth is an early adopter of this redesigned model of primary care, it is not the first place to do so. Similar clinics have been established by Iora in Seattle for Boeing employees and also for casino workers in Atlantic City, N.J. Another clinic will be set up early next year for casino workers in Las Vegas.

Dartmouth's involvement grew out of discussions among several of the school's health researchers, including Mulley, and Iora's founder, Harvard-trained physician Rushika Fernandopulle, whose work was written about by Atul Gawande in an article in the January New Yorker.

Fernandopulle has been a pioneer in health reform, and the New Yorker article went so far as to say that his work had “reinvented the idea of a primary-care clinic in almost every way.”

In an interview this week, Fernandopulle said putting Dartmouth's extensive research into practice seemed like a natural step for the college.

“Dartmouth is moving to be a leader in health care,” Fernandopulle said. “Jim Kim felt that rather than just writing about it and thinking about it, he should be actually putting this into action.”

A linchpin of Fernandopulle's model is the health coach, an idea he got from the promotoras, which are community health workers he'd seen while visiting the Dominican Republic. Coaches work directly with the doctors and nurses to plan patient care, but also have the most direct contact with the patient of anyone on the team.

Coaches may have medical training, but it isn't necessary. Rather, they are hired for their ability to connect with people, for their engagement skills, and to be able to understand the circumstances that affect a patient's care, Fernandopulle said.

“The real job of the health coach is to get involved with the patient, blocking and tackling, and helping them manage their health the best they can,” he said.

For example, a coach might help patients make sure they are getting the testing they need, schedule an eye exam or make sure they are picking up their medication on time. The presence of a health coach addresses a whole other part of caring for someone that the traditional health care system doesn't provide now, Fernandopulle said.

Much of traditional health care has evolved almost randomly, with new services popping up to meet demand. That has resulted in a health care network that has developed without any blueprint or larger design. What Fernandopulle wants to do in clinics such as Dartmouth Health Connect is to be more deliberate in health care planning, and design a system from the bottom up.

“What we're doing now is explicitly designing the clinical system to meet our goals,” he said.

Lazar, who will split his time between his existing practice and Dartmouth Health Connect, hoped that his experience would help inform the way he provides care in the traditional model.

“I want to bring this new learning back to the model at Dartmouth-Hitchcock,” he said. “There's a great opportunity for cross-talk.”

The exchange of information between traditional practices and Dartmouth Health Connect is an important component of the team model. However, it could be an early challenge for the new practice.

The electronic records systems for each are entirely different -- designed by different companies and for different purposes. The information won't be presented in the same way, and in many cases, physicians won't even be interested in the same data.

“It really doesn't do all the things we need it to do,” Fernandopulle said of the D-H system.

He is working with Dartmouth-Hitchcock to find ways of sharing data between the two networks.

This will be one of the issues that researchers at The Dartmouth Institute and The Dartmouth Center will be watching as the clinic gets going, Mulley said. They will be looking at measures of teamwork and how well everyone is working together to provide care.

The challenge posed by electronic health records offers one opportunity for advocates of reform to watch and learn.

“It's an example of why I think this is so valuable to TDI and TDC,” Mulley said. “We get to watch that experiment.”

It also will be an opportunity to improve health on campus, as well as potentially lower health care costs, Dartmouth officials said.

“We think it will reduce hospitalizations over time as people have access to primary care in an easily accessible location with convenient times and open schedules and improve the health and well-being of our employees,” said Tricia Spellman, assistant vice president for finance at the college.

The amount of money that Dartmouth pays to Iora in patient fees depends on who enrolls, Spellman said. That is, sicker patients and those with chronic conditions will be more expensive than healthy people.

Enrollment is voluntary and the college is hoping to get about 1,200 people to participate. The practice will enroll adult patients -- Dartmouth employees, their adult dependents and Dartmouth retirees who are not yet eligible for Medicare. There is no deadline at this point, Spellman said.

There will be no change in the cost of employee health benefits as a result of Dartmouth Health Connect, Spellman said, regardless of whether someone chooses to participate. Also, Iora will pay the estimated $140,000 renovation cost at 7 Allen St.

There has been strong early interest from employees, Spellman said, though some are taking a wait-and-see attitude.

Earl Sweet, a custodian who is president of the Local 560 SEIU workers union, was openly critical of the college when it made cuts to employee health benefits that were instituted in January.

The lack of a co-pay seemed like an attractive policy, he said, but he doubts it would defray much of what it costs him to receive care. Sweet, who is 66 and a cancer survivor, said he receives most of his tests and treatment at DHMC anyway. He uses a primary care provider, but didn't know enough about Dartmouth Health Connect to say whether he'd be interested in participating.

“I'm sure they're not going to have cancer specialists down there, so I'm going to end up at the hospital anyway,” Sweet said. “I'm not saying this won’t help, but I just don’t know if it will help.”

The larger Hanover community stands to benefit from the arrival of Dartmouth Health Connect as well, said Town Manager Julia Griffin.

The ground-level storefront has been vacant since children's store Kiddo closed a year ago. Having a tenant there would bring foot traffic to an otherwise quiet side street in downtown Hanover. And there's a likelihood that most of it will be foot traffic, as employees can walk to appointments from campus and avoid contributing to car congestion, Griffin said.

Finally, there's also the prestige to the town from hosting an innovative model of health reform, she said.

“This is an innovative approach to providing medical services,” she said. “I think it's a real model for the region.”

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.