Health Reform Efforts Add Complication

Lebanon — Accountable care organizations are among many efforts aimed at reforming the U.S. health care system. But the array of disparate projects is threatening to push hospitals into further disarray, said Dartmouth-Hitchcock’s president and CEO, Jim Weinstein.

“The bigger issue is we can’t keep doing these one-off projects,” Weinstein said. “We’ve got all kinds of acronyms for new models. ACO, shared savings, risk contracts. … What’s the next federal project when we really need to move faster in a more coordinated way? We’ve got all kinds of … not connected processes that make it very complicated for systems like ours that want to change faster.”

The health insurance exchanges are just one example. These are the online marketplaces for health insurance that every state is working to have ready by Oct. 1.

Vermont and New Hampshire have taken very different paths toward implementing them. Vermont has developed its own exchange, with distinct plans, rates and rules, while New Hampshire is working with the federal government and has yet to release many details about the types of coverage offered or how the system will work.

On top of that, Vermont is trying to move toward a single-payer insurance system in 2017 and New Hampshire is figuring out how it can expand its Medicaid program, as provided for in the Affordable Care Act.

With feet in both states, Dartmouth-Hitchcock has been struggling to keep on top of what lies ahead, Weinstein said, adding that the “potpourri of changes and no coordination creates chaos and disruption unnecessarily.”

As a result, it has been challenging for hospitals to know where to invest their money at a time of great financial uncertainty.

This is nothing particular to the Twin States, though. Hospitals everywhere are struggling to keep up with federal reforms. Given these circumstances, it is not surprising that many of the Pioneer ACOs chose to leave the program, he said.

“I would really like to see more coordination of these efforts toward creating a sustainable health system,” Weinstein said.

“I don’t know what the federal goal is besides saving money. Our goal is to provide the best care, right time, right place, every time and do it in a non fee-for-service model.”

A spokesman for the Centers for Medicare and Medicaid Services acknowledged the challenges for ACOs in meeting “ambitious” goals.

“We appreciate that accountable care for populations of patients requires significant up front investment for participants as well as changes in clinical practice that take time to implement,” the spokesman said in an email.

“Pioneer ACOs are at the leading edge of improving care for Medicare beneficiaries and we expect those that are remaining in the model to continue to deliver high quality care and lower costs, and to improve on their performance over time.”

Chris Fleisher can be reached at 603-727-3229 or