a sustainable health system - Dartmouth

a sustainable health system
IMAGINE A HEALTH SYSTEM
That focuses on health, not just health care.
Where patients, when well informed, receive
only the care they want and need.
Where care is based on value, not volume.
Grounded in population based strategy,
not market share.
That rewards quality, not quantity of
procedures.
Imagine a sustainable health system with
one goal: to improve the lives of the people
and communities we serve, for generations
to come.
At Dartmouth-Hitchcock Health, we are about
more than just health care. We are about keeping
people healthy and out of the hospital. Because
everyone deserves to live life to the fullest.
Creating a Sustainable
Health System
We’ve believed for a long time that health care
should be driven by what’s right for the patient, not
by what’s good for the bottom line. We’re working
regionally, nationally and internationally to make
that a reality.
THE DARTMOUTH-HITCHCOCK HEALTH DIFFERENCE
The roughly 9,000 employees of Dartmouth-Hitchcock Health (D-HH)—
physicians, nurses, caregivers and staff—are working to create a system
of health (not just health care) for the people of our region. In the process, we are leading a transformation in the way care is delivered and expanding our activities beyond the traditional doctor-patient relationship.
A FOCUS ON QUALITY
Our commitment to improve the quality and efficiency of the care we
provide never falters. We are pleased to consistently rank at or near the
best, compared to other academic medical centers, in important areas
like reducing hospital readmissions, lowering the number of emergency
room visits and cutting out unnecessary tests and procedures. Most
importantly, we are engaging people in managing and improving their
health, not just their care.
PARTNERSHIPS FOR BETTER HEALTH
A key piece of our approach to health care is collaboration. We believe in
being partners with our patients and families so they can be involved in
choices about their treatment. We also partner with other health systems
regionally and nationally to constantly improve the care of those we serve.
Through telemedicine, we are reaching out to provide care in emergency rooms and doctors’ offices throughout our region, particularly in
the more remote, rural parts of Vermont and New Hampshire. We also
provide life-saving stroke care through a telemedicine program with our
colleagues at Mayo Clinic, and provide access to low-cost urgent care
through our partnership with CVS MinuteClinic.
From beginning to end, it’s all about our patients. We know that if we
keep our focus on always doing what is right for patients and their families, we won’t go wrong.
REVOLUTIONIZING HEALTH CARE
NEW PAYMENT MODELS
Moving from a system that is built on market share to one based on
value requires developing new models for how care is delivered and
paid for. D-HH has been a leader in this area for years, incorporating
shared decision making and informed patient choice into care, and
improving care with our colleagues at The Dartmouth Institute for
Health Policy and Clinical Practice.
D-HH was one of only 32 health systems nationally to be selected as a
Pioneer Accountable Care Organization (ACO) when the Centers for
Medicare and Medicaid Services (CMS) first introduced the program.
In what is called a “shared risk” model, health systems share in savings
if they improve the health of a defined population, while meeting high
quality standards and lowering costs. If they fail to achieve the benchmarks, they are subject to financial penalties. D-H received $1 million in
its first year as a Pioneer ACO as its share of savings.
D-HH is involved in a number of other shared risk/shared savings
programs, including OneCare Vermont, which is an ACO that includes
all of the state’s hospitals and hundreds of providers.
LOWERING THE COST OF HEALTH INSURANCE
The cost of health care is a major financial burden for Americans and
especially for employers, who provide most of the health insurance for
people under the age of 65. To address this, D-HH, along with Harvard-Pilgrim and Elliot Health Systems, created a new insurance product, ElevateHealth, with premiums that are 10-15 percent below market
price. Functioning as a nonprofit, ElevateHealth seeks to achieve its
goals by delivering coordinated, lower cost care to its enrollees.
COLLABORATING NATIONALLY
In 2010, D-HH, along with Mayo Clinic, Intermountain Healthcare,
Denver Health, and The Dartmouth Institute for Health Policy and
Clinical Practice, founded the High Value Healthcare Collaborative
(HVHC). HVHC now has 18 health system members, providing care to
more than 70 million patients across the U.S. Together the systems are
sharing processes and outcomes to arrive at proven best practices that
improve care and lower costs. With a focus on highly prevalent, costly
conditions including heart failure, diabetes, sepsis and joint replacement, the Collaborative is shortening hospital stays, reducing complications and readmissions, and increasing value and patient satisfaction.
Improving health AND health care
“The care patients want and no less; the care
they need and no more.” That’s a tenet of Dartmouth-Hitchcock Health (D-HH). Through our
Center for Shared Decision-Making, we work with
patients and families to give them good, objective information about their choices. Particularly when there
are multiple treatment options and no one “right”
path, we believe the decision should be the patient’s.
At Dartmouth-Hitchcock Health, we don’t order unnecessary tests or perform procedures that aren’t warranted. We recognize that every medical interaction
has risks and benefits, and we do everything possible
not to expose our patients to risks—or cause them to
incur costs—when it’s not clinically necessary.
SHARING VITAL INFORMATION
Another core concept of Dartmouth-Hitchcock
Health is measurement with transparency. Our
patients have a right to know what our results are,
how many procedures we’ve done, what our costs
are and how other patients have fared after similar
treatments. Unlike many health systems, we can
answer these questions.
Research has shown that when patients are given
good information, they make better choices, have
better clinical results and are more satisfied with
their experience. We are committed to partnering
with our patients and families in every step of their
journey to better health.
CARE IN THE COMMUNITY
The newly established Dartmouth-Hitchcock
Health Center for Telehealth will further help drive
down costs and improve patient outcomes through
clinical consultations, educational programming and
administrative conferences offered virtually to any
location, rural or urban, national or international.
Patients benefit from our medical expertise, stateof-the-art technology and the latest treatments
while remaining under the care of their local health
care provider. GROWING COLLABORATIONS
By working together with other health care organizations locally, regionally and nationally, Dartmouth-Hitchcock Health strives to make sure that
care is available for patients in their own communities, where it is most convenient for them. Our clinicians are at work not just in our own facilities, but
in hospitals and clinics across the region. Nationally,
we are working with 18 health systems throughout
the country to improve care quality and reduce costs
for more than 100 million patients. And as a member
of the Mayo Clinic Care Network, our physicians
have the ability to collaborate and share expertise
and resources with one of the nation’s most trusted
and respected health care institutions. Patients and
their families deserve the very best care, individualized to their wants and needs, and delivered in ways
that are most efficient, effective, safe and convenient for them.
For more information about how Dartmouth-Hitchcock Health is creating a sustainable health system,
visit www.dartmouth-hitchcock.org/about_DH.
An Academic Health System­— With a
Focus on
YOU
Dartmouth-Hitchcock Health is an
academic health system, combining
excellence in clinical care with the
research and educational resources of our
partners at Dartmouth College, the Geisel
School of Medicine and the VA Medical
Center in White River Junction, VT.
With Geisel, the Thayer School of
Engineering and the Tuck School of Business,
we conduct research, educate medical
students and train residents and fellows.
At Dartmouth-Hitchcock Health, these
activities are fully integrated; our research
is targeted at finding cures and better
treatments that will improve the lives of
those we serve. Our educational activities
are meant to create a cadre of physicians,
nurses and other caregiving team
members who have a truly patient-focused
philosophy and approach to practice.
Colebrook
About D-HH
St. Albans
Newport
Lancaster
Burlington
Morrisville
St. Johnsbury
Allwell ACO
Elevate Health
Dartmouth-Hitchcock
Health (D-HH) is a nonprofit
One Care Vermont
academic health system that serves a patient population
of 1.2 million in northern New England. Anchored by
D-H Facility
Dartmouth-Hitchcock
Medical Center in Lebanon, NH,
the system includes affiliate hospitals in New London,
NH, and Mount Ascutney in Windsor, VT, as well as 24
Dartmouth-Hitchcock
Clinics
that
New England
Alliance
forprovide ambulatory
Health (NEAH Member (17)
services across New Hampshire and Vermont.
D-HH provides access to more than 1,000 primary care
doctors and specialists in almost every area of medicine.
In partnership with the Audrey and Theodor Geisel
School of Medicine at Dartmouth and the VA Medical
Center in White River Junction, VT, it trains nearly 400
residents and fellows annually, and performs world-class
research.
Barre
Woodsville
Middlebury
Randolph
Rutland
•
The state’s only Level 1 trauma center and regional
air ambulance service
•
Norris Cotton Cancer Center—one of only
41 National Cancer Institute-designated
Comprehensive Cancer Centers in the nation
•
The Children’s Hospital at Dartmouth-Hitchcock
Health, New Hampshire’s only Children’s Hospital
Plymouth
White River Jct.
DHMC
Lebanon
Windsor
Claremont
Springfield
New London
Rochester
Concord
Dover
Manchester
Exeter
Peterborough
D-H Putnam
Bennington
Townshend
Keene
Brattleboro
Association-approved, comprehensive, full-service
children’s hospital
Nashua
Northampton, MA
D-HH BY THE NUMBERS
HOSPITAL ADMISSIONS
APPOINTMENTS
Inpatient/Inpatient Psych
19,044
Observation/Same Day Night Over
5,535
Newborns1,150
Patient Days of Service
Number of Beds
Number of Employees
Outpatient Visits
Total25,729
The original hospital was founded in 1893, evolving to
a health system that includes:
D-H Facility
D-H Affiliate
121,762
425
9,302
1.7 million
New England Alliance for
Health (NEAH Member (18))
One Care Vermont
allwell ACO
ElevateHealth
IMPACT ON
the Economy
With total revenues that exceed $1.3 billion, and one of the
largest workforces in the region, Dartmouth-Hitchcock Health
(D-HH) is a vital contributor to the economy.
Economic impact models show that D-HH has an annual $2.6
billion positive impact on the local and regional economies of
New Hampshire and Vermont.
The employment impact is also substantial—DartmouthHitchcock Health supports a total of 18,000 jobs through direct
employment, as well as through the impact of its purchases
from other businesses and spending by employees and visitors.
For the 9,300 people directly employed by D-HH, these jobs
generate almost $620 million in total employee compensation.
Total direct and indirect compensation is $1.1 billion.
D-HH’s operations also fund $131.2 million in state and local
direct and indirect tax payments, and an additional $177 million
in federal taxes.
IMPACT ON
Research and Education
As New Hampshire’s only academic health system, pursuing new knowledge at the frontiers of medical science
and educating tomorrow’s doctors are integral to D-HH’s
mission to advance health through research, education,
clinical practice and community partnerships.
D-HH will further expand its research presence with the 2015 opening
of the Williamson Translational Research Building—a joint project
between D-HH and the Geisel School of Medicine that will strengthen
the connection between research and clinical practice to improve
patient care.
D-HH contributes to medical and clinical research
through its extensive involvement in clinical trials.
Last year alone, more than 1,500 patients enrolled in
256 clinical trials at D-HH. An impressive 11 percent of
patients at Norris Cotton Cancer Center are enrolled
in clinical trials, compared to a national average among
cancer centers of around 2 percent.
D-HH plays a significant role in the training of health
care professionals. It participates in the training of
medical students from Dartmouth’s Geisel School of
Medicine and nursing program students from ColbySawyer, as well as clinical and non-clinical internships,
and residency education programs. Medical education,
research and patient care also take place through our
partnership with the VA Medical Center in White River
Junction, VT. Our physicians are also among the faculty
at The Dartmouth Institute for Health Policy and
Clinical Practice (TDI) and the Master of Health Care
Delivery Science at Dartmouth (MHCDS).
ENROLLMENT (FISCAL YR. 2013)
ENROLLMENT (FISCAL YR. 2013)
MDs351
Graduate Students in Biomedical Sciences 217
MD-PhDs26
MD-MBAs10
The Dartmouth Institute Health Policy Program 128
Residents and Fellows
385
Students:
Medical Students
Masters and PhD Students
360
340
Faculty:
Clinical and Research Faculty
2,180
Alumni:
Medical School Alumni
Residency Alumni
4,891
2,980
MD student admissions acceptance:
Applicants Per Seat Faculty Members/Student Ratio
Research Funding 2013
59
2.6
$140 million
IMPACT ON
Community Health
As our focus broadens from caring for the ill to improving
the health of our population, we are increasing our activities in the community, building programs and partnerships,
and providing tools and resources to reach people before
they become sick.
D-HH is engaged in a number of outreach endeavors to
meet the needs of its communities—from oral health and
obesity prevention programs to treatment of substance
abuse, support for frail adults and child protection programs. By engaging in key partnerships with communities
in New Hampshire and Vermont, D-HH provides leadership, education, financial support and often time and
energy to help leverage existing resources to bring about
healthy changes. D-HH’s community group practices in
Manchester, Concord and Nashua are engaged in a variety
of community wellness efforts to improve the health and
wellness of our communities. For example, D-HH is piloting
a new water bottle refill project at Concord High School,
which it hopes to expand to other schools. D-HH Concord
and the Concord Regional Visiting Nurses Association are
collaborating to hold a monthly Memory Café event at the
Granite Ledges facility in Concord to enhance education
and support for people suffering from memory impairment.
In addition, D-HH works closely with the Partners for
Community Wellness, a group of more than 300 volunteers from throughout New Hampshire and Vermont to
identify community needs and create strategies to deliver
services in homes, schools, churches and community
centers.
In 2013, D-HH provided more than $267 million in community benefits, including charity and unreimbursed care,
as well as investment in local programs and organizations.
In coming years, we will be increasing our investments in
community programs and resources as a tangible commitment to our goal of improving the lives of the people and
communities we serve, for generations to come.
A network of care serving 2 million
people across New England.
First NIH-backed Center for
Surgical Innovation in the country
to embed a full spectrum of
imaging technology with the goal of
accelerating surgical improvements.
Home of the first-in-the-nation Center
for Shared Decision Making and
internationally known Spine Center.
Founding member of the High Value
Healthcare Collaborative—18 health
systems with 70,000 physicians providing
care to more than 100 million patients.
One of only 41 National Cancer Intitutedesignated Comprehensive Cancer Centers.
New Hampshire’s only Children’s Hospital
Association-approved, comprehensive
full-service children’s hospital.
One of 62 Clinical and Translational
Science institutes established by
the National Institutes of Health
to accelerate discovery through
partnerships and a robust research core.
Named one of the top 25 hospitals out
of 6,000 nationally for environmental
sustainability.
The recipient of a 4-star rating for
quality and patient safety by the
University Health System Consortium
(UHC).
Rated in top 5 percent of hospitals
across the country for efficiency,
measured by low cost and length of
stay by the UHC.
Second only to Mayo Clinic in data
comparing top academic medical
centers (listed in the U.S.News & World
Report Best Hospitals’ list) on safety
and cost.
Ranked as high-performing in 10
specialties by U.S.News & World Report
Best Hospitals’ list.
One Medical Center Drive, Lebanon, NH 03756 | dartmouth-hitchcock.org