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CMC and DH Affiliation Q&A

Why is a closer affiliation being pursued?
Cheshire Medical Center faces numerous challenges today including: slow population growth, declining inpatient and surgical volumes, changes in federal and state laws and payment rules such as the Medicaid Enhancement Tax, and the need to transition to new payment models that will reward our focus on population health. Our goal is to ensure a sustainable and robust health system to continue to meet the needs of our community and see this closer relationship as a way to continue expanding the good work that has been done in our community for the past 121 years.
Several strategic options for creating a sustainable health system were studied, including consideration of many potential organizations with which to affiliate. After a comprehensive study, we concluded that a closer affiliation with Dartmouth-Hitchcock was a natural step. The affiliation agreement is the culmination of nearly 2 years of planning and analysis, which has been substantially researched and carefully considered.

Why Dartmouth-Hitchcock?
Cheshire Medical Center (Cheshire) and Dartmouth-Hitchcock (D-H) have been affiliated since 1998 by means of a very successful Joint Operating Agreement involving Dartmouth-Hitchcock Keene. We share a common commitment to creating a sustainable health system by improving population health, focusing on value-based care and by creating new payment models for the benefit of the citizens of New Hampshire and Vermont.

Who has created and approves the affiliation agreement?
The Boards of Trustees and senior leadership representatives of Cheshire and Dartmouth-Hitchcock/Dartmouth-Hitchcock Health have worked collaboratively to analyze and negotiate the opportunities and issues involved in creating a more integrated health/health care delivery system which could better address the population health needs of the Monadnock and Northern New England Service Areas’ populations. 

What does the affiliation agreement represent?
Cheshire will further align its governance, clinical, financial and administrative activities with Dartmouth-Hitchcock. Cheshire Medical Center and the Cheshire Health Foundation will retain their status as separate legal organizations that have their own board of trustees, management and employees.

What are the main elements of the affiliation?

  • Increased Quality of Care

Cheshire and D-H will integrate clinical services and quality improvement efforts by appropriately aligning and promoting collaboration and coordinating care, best practices, expertise, and the allocation of resources. 

  • Increased Efficiencies

To facilitate this clinical integration, Cheshire and D-H will link their governance structures, coordinate their financial approaches, and further align administrative functions to the extent efficiencies can be achieved.

  • Improved Access to Care

Cheshire and D-H share the vision of enhancing Cheshire’s role clinically as a regional resource for southwestern New Hampshire and southeastern Vermont, freeing up beds for the level 1 trauma center and tertiary care patients at Dartmouth-Hitchcock Medical Center in Lebanon. By working together more closely, Cheshire and DHH will make it easier for patients to access healthcare across a broad array of services—including specialized care and research—on a scale that neither organization can achieve on its own.

  • Improved Population Health

The Dartmouth-Hitchcock system’s vision of a sustainable health system includes Cheshire participating as a center for population health strategy and practice, and serving as a population health laboratory -- all in recognition of our focus on population health and our work with our community on the Healthy Monadnock 2020 initiative.

  • Reduced Health Care Costs

Cheshire and DHH will collaborate to reduce costs by better organizing how care is delivered. For example, both organizations will work to create improved models for delivering care and managing chronic diseases. This will help make healthcare more affordable for government payers, commercial insurers, employers, and patients.

  • Continued Local Support

All charitable gifts donated to Cheshire Health Foundation in support of Cheshire Medical Center/Dartmouth-Hitchcock Keene patients and initiatives will remain locally to benefit our community.

Will Cheshire Medical Center change its name?
No, Cheshire Medical Center and the Cheshire Health Foundation will retain their respective corporate identities. Our patients will continue to know us as “Cheshire Medical Center/Dartmouth-Hitchcock Keene.” 

Will this change the hospital’s non-profit status?
No. Cheshire Medical Center is a non-profit, community-owned organization and will continue as such. CMC’s Cheshire Health Foundation will continue to accept donations from donors to continue our philanthropic mission and support local patient care needs and to implement innovative care programs to meet the changing needs of our population’s health in the Monadnock region.

Will clinical programs and services be consolidated or expanded?
Both organizations offer outstanding clinical services. After the final affiliation agreement is completed, the management team and members of the medical staff will continue to explore ways to develop better clinical coordination, share best practices in evidence-based medicine, and improve efficiencies in the delivery of healthcare.

How will this affiliation affect the medical staff?
Physicians and associate providers are currently employees of DHK so the affiliation will not change the medical staff status, relationship or privileges with Cheshire.

What will happen to the Cheshire employees as a result of this affiliation?
We do not anticipate any immediate or significant changes in our operations or staffing as a result of the affiliation agreement. Is too early in the process to know how this will affect employees and which services and functions, if any, may be consolidated or expanded. In terms of employee benefits, we expect Cheshire employees to retain their current benefits. We are well positioned as a highly productive and efficient organization and continue to benchmark and modify staffing models to meet the needs of our patient volume. The vision for CMC/DHK is to fill a regional need within the D-H system, and we feel the affiliation will help with ensuring the sustainability of a robust health system in Cheshire County. Throughout the affiliation process we have been committed to transparency and informing staff as soon as we have information to share and we will continue to keep employees informed as the affiliation moves forward.

What is the timeline of the affiliation discussions? 
Currently, we are estimating approximately 8 weeks after approval by both boards for the due diligence process to be completed and to generate the documents necessary for the Change of Control filing to the state Attorney General's office. The Attorney General’s office then has, by statute, four months to consider our filing. In the absence of needing to file at the federal level, a reasonable estimate for completing the entire affiliation process is fall 2014.