Lebanon — Even as Dartmouth-Hitchcock continues to explore avenues for expanding its reach in New Hampshire and Vermont, its new chief executive is talking about paying close attention to operations at its Lebanon medical center, including the recruitment, training and health benefits of its employees.
In a speech at the annual meeting of the Public Health Council of the Upper Valley earlier this month, Joanne Conroy said she aims to improve the health of D-H’s own 9,000 employees, noting that the organization has more to do to understand its employees’ health and to understand the impact of a high-deductible health insurance plan on their health care choices. She also described efforts to recruit an adequate workforce in a tight labor market.
“We are really a system that focuses on illness rather than health,” Conroy, who took over the Lebanon-based health system in August, said before an audience of about 50 community members and public health advocates at Hypertherm on Nov. 17. “We’re trying to get better at thinking about health.”
The organization appears to be approaching its expansion and health improvement efforts from steadier financial footing than it was a year ago.
The Dartmouth-Hitchcock Obligated Group, including Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, New London Hospital, Cheshire Medical Center and Mt. Ascutney Hospital and Health Center, showed a surplus of $15.7 million, for the first quarter of the year, which ended Sept. 30, according to financials released earlier this month.
Alice Peck Day Memorial Hospital, which also is D-H affiliate, does not report its financials with the others because its debt has not been consolidated.
The surplus for the first quarter of this year far outpaces the surplus of $589,000 — not including restructuring costs — for the first quarter of last year.
These most recent financial results came after the group showed a year-end surplus of $18.7 million on June 30, a figure that includes $17.7 million in restructuring costs that were required following a loss in the fiscal year which ended June 30, 2016.
“It’s a dramatic improvement in terms of where we were before,” Conroy said in an interview following her speech.
She cited an increased effort among scheduling staff to prevent no shows by patients, which can result in gaps in providers’ schedules and a resulting reduction in revenues.
Other factors in D-H’s improved financial results include continued growth in surgical cases and inpatient discharges, D-H Chief Financial Officer Dan Jantzen said via email.
He attributed the improvements “to continued demand for our services as the only academic health system and tertiary referral center in New Hampshire, as well as to the aging population of the region.”
The bulk of the group’s surplus, $18.13 million, came from Dartmouth-Hitchcock Clinic, which outweighed losses at Cheshire and New London.
“We remain encouraged by the overall results for both the DHOG and D-H, and by the fact that our financial performance is exceeding expectations,” Jantzen said in the email.
In terms of growth, Conroy said the organization would like to have responsibility for 2 million people, about 600,000 more than the 1.4 million the system now cares for, in order to level out the financial risks to the health system.
Accountable care organizations such as OneCare Vermont, of which D-H is a member, reward providers for meeting health quality goals and preventing more costly medical care such as emergency room visits.
But, taking on responsibility for people’s health carries a risk. Because some people will still need costly medical care in spite of providers’ efforts to prevent it, health systems need to have enough people participating to offset these costs.
“Once you have smaller populations it becomes a little bit more difficult to accept full risk for that population,” Conroy said.
In a small population of people in the network, one very sick person requiring costly care could undermine the economics of caring for the whole group, Conroy said.
In addition to its affiliates, D-H’s current reach includes outpatient clinics around the state. Conroy emphasized the organization’s presence in southern New Hampshire. She said D-H provides care to about 30 percent of the residents in Manchester, and 25 percent of the residents in Nashua and 20 percent in Concord.
She also pointed to the organization’s growing presence in Vermont, where D-H currently cares for 40 percent of the state’s residents.
“A lot of the hospitals that are talking about joining us are in Vermont, so that number will probably increase,” she said.
In the interview following her speech, Conroy declined to provide details about which hospitals D-H is in talks with right now, but she emphasized the opportunity for growth in southern Vermont, where D-H employs providers through D-H Putnam Practice, in a relationship with Southwestern Vermont Medical Center.
“People actually come from New York and northern Massachusetts to our Putnam practice, so we already kind of have the opportunity to actually grow that,” she said.
As for New Hampshire, Conroy in an October interview with the New HampshireUnion Leader, described plans to expand D-H’s 120,000-square-foot Manchester outpatient facility to offer outpatient surgeries and endoscopy.
D-H officials last week declined to confirm plans for expansion in Manchester.
“We are looking at options to provide care in the most appropriate settings based on quality and cost in Manchester,” D-H’s Chief Administrative Officer Stephen LeBlanc said in an email. “We haven’t made any decisions with regard to options. We are still exploring them.”
Expansions have to be done thoughtfully, Conroy said.
“We have to figure out what makes sense for us,” she said, pointing to factors such as culture and distance. “A lot of other organizations have gotten into trouble by thinking they could manage across a long distance. Sometimes you don’t get the efficiencies that you need to get.”
In addition to eyeing opportunities for growth, Conroy said she is focused on recruitment and retention. Dartmouth-Hitchcock Medical Center currently employs 100 temporary nurses, known as travelers, she said. It’s a number she would like to bring to zero.
Her biggest challenges in recruiting new 20-something nurses are the lack of affordable housing and a nightclub in the center of the Upper Valley.
“They don’t want the sidewalks to roll up at 9 o’clock at night,” said Conroy, who as a Dartmouth College undergraduate in the late 1970s worked as a server at the Dartmouth Outing Club and as a cook at Peter Christian’s Tavern. “I’m not sure we can build a nightclub, but those are the things with community partnerships you start to think about. Affordable housing and close housing and residential housing that’s actually close to shops and restaurants. Those are the type of areas that will attract young staffers.”
To address these challenges, Conroy said D-H is considering beginning to offer transportation stipends to employees who live beyond a certain distance from DHMC. She also pointed to the health system’s workforce training programs for medical assistants, pharmacy technicians and licensed practical nurses as useful tools for matching employees to open positions.
As an employer, Conroy said she hopes to help improve the health of her employees. She noted that the Cleveland Clinic refuses to hire people who smoke cigarettes. As a result, the rates of smoking in the county where Cleveland Clinic is located have dropped, she said.
“You can drive that as a large employer,” she said.
She also said she would like to take a look at how high-deductible health care plans, now the norm in New Hampshire and Vermont, are impacting the way people, including D-H employees, access health care.
“I bet it has a real effect,” she said, noting that people with high deductibles are likely to defer care.
She would also like to do more to incentivize employees to stay fit, ensure they are getting screenings necessary to catch a potentially serious health problem and to understand the challenges that certain groups of employees might face. For example, she noted that night shift workers are more likely to eat fatty foods because of the disruption in their circadian rhythms. Simple changes such as eating apples and wearing polarized sunglasses on the way home might make a difference for them, she said.
“I think the first thing is people knowing how healthy they are,” she said.
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.