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Editorial: Health Care Experiments; Initial Results Are Encouraging

Encouraging progress reports recently arrived regarding two local experiments in changing the way health care is delivered. Both were preliminary and short on detail, but interesting enough to warrant further attention, particularly at a time when so much change seems to be taking place — and so much is needed.

One focuses on the delivery of primary care and is being sponsored by Dartmouth College. Launched in the spring of 2012, Dartmouth Health Connect is now providing care to 1,200 college employees and their families in a format that many reformers believe will improve care and reduce cost — elimination of the fee-for-service payment system. Dartmouth is paying Iora Health, a for-profit Massachusetts company, a set fee for each patient to provide primary care. The “capitated” payment removes any incentive that might otherwise exist for ordering procedures such as diagnostic tests — the company receives no extra payment for them — and thereby emphasizes keeping patients healthy.

That is accomplished by a team approach to the delivery of primary care. Health coaches who coordinate care with other members of the team — including physicians and nurses — are assigned to patients and check in with them when appropriate to make sure they’re following through on whatever treatment or regimen has been prescribed. If exercise and a modified diet has been deemed the best approach to addressing a patient’s high blood pressure, for example, it makes sense to keep on top of whether that person is following through — an effort that might ultimately be less costly than a more passive approach that permits the condition to get worse and might ultimately require aggressive treatment.

Initial results are good, at least judging by some indicators. Enrollment has quadrupled, new staff has been added, an expansion of the clinic space is being planned and patient satisfaction is, Dartmouth officials say, high.

The same year that the college initiated Dartmouth Health Connect, Dartmouth-Hitchcock joined the Mayo Clinic Care Network, making it one of 20 health organizations to do so. Gaining access to the expertise of one of the largest and most prestigious health care providers in the country — the 61,000 staff members and studeents at Mayo treat more than 1 million people from around the world annually — presumably would allow for more efficient use of Mayo’s enormous resources. D-H officials expressed hope that the partnership would allow their physicians to consult with Mayo’s doctors on treatment, training and research and even permit some patients to seek second opinions from the Minnesota-based system.

Although the two institutions have spent much of the initial phase of their relationship laying the groundwork for future collaboration, some tangible benefits already have been registered, D-H officials told staff writer Chris Fleisher. Mayo provided guidance to D-H on using technology to care for far-flung patients who aren’t at the hospital, for example, and allowed Dartmouth to supplement its limited staff of stroke neurologists by making its specialists available for consultations. Ultimately, such collaborations may allow regional medical centers such as D-H to extend their resources and prevent patients from having to travel to seek treatment.

Will the benefits justify whatever D-H is paying Mayo for belonging to the partnership — a sum the medical center has declined to disclose? Will Dartmouth Connect’s emphasis on prevention deliver enough savings on avoided treatment to justify the extra investment in primary care?

It’s much too soon to tell, but considering the overwhelming evidence that the current system delivers far too little for how much Americans pay, we’re intrigued by the initial returns and encouraged by the willingness to experiment.