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D-H Board Chairman Makes the Rounds

Robert Oden is Dartmouth-Hitckcock’s new chairman of the board. (Valley News - James M. Patterson)

Robert Oden is Dartmouth-Hitckcock’s new chairman of the board. (Valley News - James M. Patterson) Purchase photo reprints »

Lebanon — In December, weeks before he would take over as chairman of Dartmouth-Hitchcock’s board of trustees, Robert Oden drove north to St. Johnsbury, Vt.

The former religion professor and college president wanted to visit Northeast Vermont Regional Hospital and talk with people there. His intentions were twofold: To learn about what this small 25-bed hospital in the Northeast Kingdom was doing to improve care for patients, and also to send a message.

“I went there not just to learn things, but I went to send that signal,” he said in an interview on Tuesday. “If we move forward, it’s going to be as partners, not as we’re taking over or anything like that.”

As chairman, the 66-year-old Oden will help guide the other 20 Dartmouth-Hitchcock trustees as they make decisions about the institution’s finances, strategic priorities and many of the other long-term questions facing the Twin States’s largest health care network. A major focus for Dartmouth-Hitchcock lately has been how it will work with other physician practices and hospitals to improve care while lowering costs.

Oden, a Hanover resident, has no formal background in health care, but has been putting himself through a kind of self-guided course to learn about the pressures shaping hospitals and what reforms might promote a more sustainable way of providing care. Part of his education has involved visiting the places with which Dartmouth-Hitchcock would like to partner. Since he was elected chairman last June, Oden has visited with officials at Northeast Vermont Regional, New London Hospital and the Mayo Clinic in Minnesota. He intends to visit many more.

Dartmouth-Hitchcock has made overtures in recent years to strengthen ties with other health care providers in the Twin States and across the nation. But the intent is not to seize control, Oden said. Dartmouth researchers, including the hospital CEO James Weinstein, have said partnerships and collaborations among hospitals will be key to figure out the best ways to lower the cost of care while improving the quality .

The relationships Dartmouth-Hitchcock has formed are many and varied, from simply sharing ideas with other institutions to pursuing outright corporate affiliations. Dartmouth-Hitchcock is one of 17 health care institutions, including Mayo and Cleveland Clinic, that are collaborating to share best practices with each other in the High Value Health Care Collaborative. The hospital manages a similar collaborative group in New England called the New England Alliance for Health.

And this year, Dartmouth-Hitchcock joined with Fletcher Allen Health Care in Burlington to form an accountable care organization, or ACO, a concept developed at Dartmouth in which doctors and hospitals coordinate with each other to find more efficient ways of treating patients and lowering costs. If successful, then providers involved in ACOs get to share in the savings with Medicare. The ACO with Fletcher Allen, called OneCare Vermont, involves all but one Vermont hospital, as well as dozens of physician practices that treat 42,000 Medicare beneficiaries in Vermont.

Northeast Vermont Regional Hospital is among the hospitals that joined OneCare. With just 25 beds and 530 employees, Northeast is a fraction of the size of Dartmouth-Hitchcock, which employs about 8,400 people and is licensed for 396 beds in its Lebanon hospital. The two institutions historically have had a good relationship, said Paul Bengtson, Northeast’s CEO. But it’s not every day that Dartmouth-Hitchcock’s board chairman comes calling, Bengtson said, and so Oden’s visit in December was a welcome surprise.

“My first reaction was a very pleasant reaction,” Bengtson said. “This gentleman seems to be very interested in our community, and we’d be more than happy to share our ideas with him.”

Oden spent several hours talking with Northeast officials about workforce issues, finances, how health care is delivered to patients and a variety of other topics, Bengtson said. Although Dartmouth-Hitchcock trustees have visited there before, none have been quite as “spontaneous” as Oden, Bengtson said.

The two hospitals operate independent of each other, though they will likely be working more closely through the OneCare ACO. Bengtson said he believes Oden is genuine about Dartmouth-Hitchcock’s desire to partner with, rather than dominate smaller health care providers.

“We’re not sitting here thinking that Dartmouth is going to dominate that (ACO) network,” Bengtson said. “We don’t have any suspicions that there’s anything negative going on here.”

A question that remains, however, is how these partnerships and collaborations will affect leadership.

“When relationships become closer, that is going to be a key question,” Oden said.

In OneCare, much of the power lies with Dartmouth-Hitchcock and Fletcher Allen. Officials from both organizations hold key positions in the parent entity that manages OneCare, including the chief executive officer, chief medical officer and executive medical director. The two hospitals together also hold six of the 11 spots on OneCare’s board of managers. A Medicare beneficiary holds one position on the board, leaving four seats to be filled by the other providers.

There are other ways in which the leadership at smaller hospitals is becoming intertwined with Dartmouth-Hitchcock. Three Upper Valley hospitals — Mt. Ascutney Hospital and Health Center in Windsor, Valley Regional Hospital in Claremont and New London Hospital — have “management service agreements” with Dartmouth-Hitchcock, in which the CEOs of the smaller hospitals are technically employees of Dartmouth-Hitchcock who are then leased back to the smaller institution. However, the CEO still reports to the individual hospital board.

Hospital officials say these arrangements offer small institutions access to a much larger pool of resources and also tend to improve communication between the organizations.

New London has had a management services agreement with Dartmouth-Hitchcock for 10 years. Bruce King worked for Dartmouth-Hitchcock 15 years before he became New London’s CEO in 2003.

The relationship has worked well, King said, so well in fact that New London’s board wants to strengthen its ties with Dartmouth-Hitchcock. Last month, New London joined Dartmouth-Hitchcock’s “Pioneer ACO,” the accountable care organization Dartmouth-Hitchcock established in New Hampshire last year.

These moves are aimed at preparing for a future when smaller hospitals could play a very different role than they do today, King said.

“The days of standalone hospitals not thinking about a regional delivery system are limited,” King said in a recent interview. “I don’t think every community is going to be sitting there not thinking about how it works with its regional partners. We think this is a good opportunity to strengthen what is already a strong relationship.”

The two hospitals are working on an affiliation agreement that would bring them even closer together through their governing boards. If approved, Dartmouth-Hitchcock would have seats on New London’s board, although the two institutions would remain financially independent of each other, King said. There will be no merger of assets, but it will allow them to share more resources and eliminate some redundant costs, he said.

The affiliation agreement could be finalized by the two hospital boards within the next week but it still needs approval from the New Hampshire Attorney General’s Office. There will be two public hearings to discuss the arrangement, King said. He hopes to have it approved by July 1.

Oden’s visit to New London was a welcome one, King said, adding that the new chairman asked thoughtful questions and seemed curious to know more about how New London serves its community.

How these relationships between Dartmouth-Hitchcock and smaller hospitals evolve over the next five or 10 years is anybody’s guess, said Oden. So much about health care reform is still being figured out, with the state-based insurance exchanges, ACOs, Vermont’s push toward single payer, and the emergence of technology for providing remote care.

“A lot of the questions about health care is who knows?” said Oden, who is joined on the D-H board by, among others, former state Sen. Matt Dunne of Hartland, Barbara Couch of Hypertherm, former U.S. Sen. Judd Gregg, and Bill Helman, a venture capitalist who led the search committee for a new Dartmouth College president.

In the meantime, Oden, who after teaching at Dartmouth went on to serve as president of Kenyon and Carleton colleges, will continue to visit other hospitals to learn how they are answering some of these questions. He wants to visit Virginia Mason Hospital in Seattle, as well as Washington University in St. Louis.

But Oden believes that the greatest advances in health reform could be happening here in the Upper Valley with Dartmouth-Hitchcock and Dartmouth College. The future of medicine is not just in hospitals or medical schools, he said. It will involve engineering and business expertise, two areas where Dartmouth’s Thayer School of Engineering and Tuck School of Business will be helpful. Plus, there is a new master’s program of health care delivery science at Dartmouth, and research coming out of The Dartmouth Institute for Health Care Policy & Clinical Practice. All those resources are concentrated here, he said.

“The combination of Dartmouth-Hitchcock, its leadership, its physicians, its health care providers, the board and the greater Dartmouth (community),” he said, “I think there’s a good chance, in five or 10 years, people are going to say the health care center that figured this out... was Dartmouth-Hitchcock.”

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