Officials from Dartmouth-Hitchcock Medical Center and Fletcher Allen Health Care have been holding discussions since January about how they might collaborate on delivering care to sizeable groups of patients in Vermont and New Hampshire, the presidents of the two organizations said Thursday.
Doctors Melinda Estes of Fletcher Allen and Tom Colacchio of Dartmouth-Hitchcock said in a joint telephone interview that the movement toward reform both federally and in Vermont brought them together to discuss how they might act jointly to bring the highest possible quality care to their patients.
This collaborative posture stands in striking contrast to the historical relationship between the two centers, which has been characterized by tough competition for patients, physicians and ties to community hospitals in Vermont.
The current fee-for-service environment effectively forbids collaborative action by two academic medical centers, Colacchio said, but new types of reimbursement systems could allow joint efforts to provide the highest quality, lowest cost care to large groups of patients.
“We share a common view of health care reform and we see academic medical centers as leaders, so it’s a natural outgrowth of the times in which we find ourselves,” Estes said.
The presidents emphasized that the discussions to date, though intensive, are preliminary.
A decision to go to much more detailed planning, which would entail some
significant cost, would be made within the next six to 12 weeks.
They also made it clear that the discussions do not contemplate anything like a merger of assets, nor has there been talk about joint clinical operations. The point would be to enable the two medical centers to share risk in contracts to cover designated groups of patients.
At the same time, however, Doctor Colacchio suggested that the contemplated cooperation might be called a “model of accountable care” which at least sounds like the new federal concept called Accountable Care Organizations. Dartmouth-Hitchcock has already agreed to set up such an organization in collaboration with New Hampshire Blue Cross to cover patients in New Hampshire.
“The concept,” Colacchio told a health trade publication, “is to bring together the hospital, the physician group practice and the major (insurance) carrier all with one goal—to provide high quality, cost effective care to those we serve.”
The Dartmouth initiative in New Hampshire, and most of the putative “accountable care organizations” now showing up on drafting boards across the country, involve just one major provider.
A “model” of such a device that included both Dartmouth-Hitchcock and Fletcher Allen could play an important role in the development of health care reform in the state.
Anya Rader Wallack, the lead designer on Vermont’s health reform team, said collaboration between the two medical centers would be a concern in a fee-for-service reimbursement system, but that in an alternative payment system it could be a boost for reform. “We would definitely be in favor of a joint effort if it led to better integration of care, less duplication, and better
cost containment,” she said.
