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Another View -- James N. Weinstein: NH can switch from a health care system to a health system

Imagine a health system that focuses on health, not just health care. Imagine a system where care is based on value, not volume; on the health of our population; on new payment models that reward quality, not quantity of procedures; and on care that patients want and need, delivered affordably, conveniently and close to home.

In all the talk about Obamacare, Medicaid managed care, Medicaid expansion, the Medicaid enhancement tax, and whether New Hampshire will participate in the health exchange, there has not been much conversation about how, as a state, New Hampshire is going to improve the health and health care of its residents.

We need to ask: What should an ideal health care system look like? Does it provide the highest-quality services at costs that do not bankrupt our businesses and those individuals who are spending an ever-increasing portion of their income on health care? And how do we ensure that all citizens in our state receive the care they need, without putting inordinate financial burdens on the very health systems we are asking to respond?

New Hampshire must focus on creating a “sustainable HEALTH system.” Not a health CARE system, but a system that works to keep people healthy and out of the hospital, a system where the needs of the patient and family come first. Their convenience and wishes should direct the care they receive; not what’s most convenient for providers.

You may ask, “Don’t health care providers make money by getting people into the hospital?” Yes, in the current system they do. But this is not compatible with the right way to practice and provide care. A system of doing more to make more is not good for patients, and it simply drives health care costs — which are already too high — even higher.

Health care in the U.S. is inexorably changing. In a state as fiercely independent as New Hampshire, doesn’t it make sense for us to take control of our own destiny and build something that works for us? Shouldn’t we be a model for our country, not a follower? The answer is yes.

But individual health care organizations cannot do this work alone. Happily, they are not. Many providers are building on decades of relationships while creating new partnerships across the state, to ensure that residents get the highest quality care, regardless of their location. New Hampshire providers are also reaching out to business owners and others to explore ways to work together to get costs down while increasing employee health and satisfaction.

We are testing new payment models that reward quality and value for patients and their families, rather than paying for each procedure we do. We are partnering in communities with volunteers and service agencies to work hand in hand in aligning our resources to truly reach all the people who need us. In a sustainable health system, innovation and adaptability to change are key. One innovative model involves expanding the use of telemedicine. Why should you have to drive an hour for an appointment or exam that can just as easily be done safely and efficiently from your own home? And there’s more to come: apps and home-based devices that monitor your health and allow you to share information with your physician in real time, smart pill bottles that automatically reorder your prescription when it’s needed.

Innovative approaches such as these, combined with unique partnerships and relationships, will directly improve the way care is delivered in New Hampshire and move us toward creating a truly sustainable health system for all our citizens.

These will be relationships based on quality, not dollars earned. Relationships based on trust and respect toward a future we, our patients and their families can count on. NH has the resources and the people; what we need is a plan and the courage to enact it.

Providers are excited about this work and the prospects of creating something that benefits all. New Hampshire can become a model for the nation. Our employers, their employees and all our patients should be unified in the belief that we can make a real difference for health and wellness for all the people of our state.

James N. Weinstein is CEO and president of Dartmouth-Hitchcock Health System.


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