CANAAN — Over the past seven years, the Mascoma Community Health Center has relied on donations to help support its operations.

About $2.7 million from individuals, charities and foundations has gone to help balance the difference between the revenue the clinic was able to bring in and the expenses it incurred delivering services including primary and dental care at the corner of Roberts Road and Route 4 in Canaan.

“That has made all the difference in the world for the patients who have been served here,” said Mike Samson.

Samson, who previously served as the Mascoma health center’s volunteer finance director, has been interim executive director since March.

That reliance on philanthropy to help cover operational costs, which now total about $1.8 million annually, will be reduced beginning Nov. 1, when HealthFirst, a federally qualified health center with clinics in Laconia and Franklin, N.H., takes over operations at the Canaan clinic.

The deal, which includes HealthFirst leasing the building from Mascoma Community Healthcare, hiring Mascoma’s staff and providing the care, received a final stamp of approval Sept. 29 from the Health Resources & Service Administration.

More than two years in the making, the arrangement also has required approval from the New Hampshire Department of Health and Human Services, governor and Executive Council, the Attorney General’s Charitable Trusts Unit, the New Hampshire Judicial Branch Probate Division and the U.S. Department of Agriculture.

“It was a big hurdle that we finally got over recently,” said Ted Bolognani, HealthFirst’s CFO, who will be executive director of what will be called HealthFirst Canaan. “We had a lot of them on this road.”

Bolognani, who has been with HealthFirst for 12 years, said it’s a “good feeling that we now have a date definite to begin our services.”

News of the partnership with HealthFirst was welcome to Alice Ely, executive director of the Public Health Council of the Upper Valley.

“The folks there have worked so hard to build this place,” Ely said of the Canaan health center. “Sometimes with their own sweat equity. It was ambitious.”

She’s also familiar with HealthFirst.

“I would say that that is a stable, committed to community kind of organization,” she said. “I think that it is a good partner for the Mascoma region.”

She also emphasized that the partnership is a sign of strength, not of weakness, for the Mascoma center. The board knew that the center needed to become a federally qualified health center to be sustainable. This was the best way to achieve that.

“I think the board needs to be really applauded for sticking with something that was hard,” she said.

For HealthFirst, the deal marks an expansion by a third.

Samson, Canaan’s former town administrator, said the deal offers two categories of benefits: Additional services and added revenue.

The clinic currently employs a nurse practitioner and a part-time physician, who provide primary care. The plan is for them to become employed by HealthFirst and then HealthFirst aims to recruit additional primary care providers.

“Recruitment always takes time,” Bolognani said.

Immediately, however, the clinic will be adding behavioral health care four days a week, Monday, Tuesday, Thursday and Friday.

“From day one they’ll be up and running,” Bolognani said.

Samson said that piece has already begun.

HealthFirst also will be bringing a nutritionist who will be available to help provide education for patients with diabetes or obesity or those who are simply trying to lose weight.

By the beginning of 2024, HealthFirst plans to begin providing medication-assisted treatment for substance-use disorders in Canaan. That service is integrated with the primary care practice and patients are followed by HealthFirst’s community resource social workers.

HealthFirst also offers other “enabling services,” which Mascoma couldn’t afford on its own, Bolognani said.

Those services include patient advocates who help patients enroll in insurance. There’s also a quality team, which provides care management to help make sure patients don’t miss prescriptions or follow-up appointments and that they follow through on referrals. HealthFirst has agreements in place with Dartmouth Hitchcock Medical Center and Alice Peck Day Memorial Hospital to ensure that patients are able to be referred to specialists at those Lebanon hospitals.

In addition to expanding services, joining a federally qualified health center also has financial benefits. As part of HealthFirst, the clinic will enjoy enhanced payments from Medicare and Medicaid, which Samson said he expects will yield about $500,000 annually. The clinic also will now qualify for the 340b program, which offers access to discounted medications. There also is a block grant associated with being an FQHC, which Samson said he expects also will yield about $500,000 annually.

“When we’ve been able to have a positive bottom line in the two locations that we’ve run,” Bolognani said, noting that he expects to see similar results in the Canaan location.

The Canaan clinic also relaunched dental services this week for the first time since July 2022. The reopening is gradual, starting with just a couple of days a week and adding more as more staff come on board. In the first two days the dental clinic was open it saw 16 patients, Samson said.

The clinic is “fully booked now for the next month,” he said. It continues to register about nine patients each day.

It will “take us a few months to get back up to where we were,” he said. The “goal is to double the size of the practice we had.”

Before closing in July 2022, the clinic had about 1,500 dental patients. It currently has about 2,500 medical patients, a number HealthFirst plans to grow.

To sign up for dental care, Samson said patients should call the clinic at 603-523-4343. For dental services, the clinic is currently accepting Anthem/Blue Cross, Delta Dental, Medicaid, Cigna and private pay. It’s planning to add more insurers, he said.

Samson also noted that the health center is continuing to fundraise for operations through this month and to purchase new equipment for the dental practice.

“The financial piece doesn’t transfer over until November,” he said, noting the clinic has been “struggling severely since June.”

To prepare for the handoff next month, the Mascoma staff are learning to use HealthFirst’s electronic record. HealthFirst staff were onsite this week to meet some of the Mascoma employees.

“For all practical purposes we’re on the ground already,” Bolognani said.

The Public Health Council will hold a walk-in, free flu shot clinic for people 10 and older at the Mascoma health center, 18 Roberts Road, Canaan, on Friday, Oct. 27 from 4 p.m. to 7 p.m.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.