North Country Healthcare: Blazing a Trail for Critical Access Hospitals

Serving a population of 30,000, the independent healthcare providers in rural northern New Hampshire faced the typical struggles and financial pressures impacting all critical access hospitals, including the ability to recruit and retain staff, rising healthcare costs, low reimbursements, and inability to leverage more favorable contracts. The reality that healthcare for the region’s population was in jeopardy and unable to grow forced several forward-thinking healthcare leaders to “circle the wagons” and develop a unique approach that would not only ensure quality care be available but provide for sustainable growth of quality services.

The leaders understood the value of creating visibility across the continuum of care for the population, and the concept of developing an affiliation was explored. The goal would be to achieve a non-competitive collaborative process, where together through integration and standardization, the combined economies of scale could ensure the financial sustainability for all of the healthcare organizations. Multiple drivers influenced the potential alliance, but member facilities agreed a singular focus would be needed to ensure long-term success. The vision would be to develop a clinically integrated network for all hospitals and providers in the North Country of New Hampshire to address population health and to improve health indicators for area residents. As explained by Darrell Bodnar, Chief Information Officer for North Country Healthcare, “For the alliance to be effective, all members must truly be committed to the same mission, and that would be the best possible delivery of patient care. Independently each hospital cannot be all things to all people. But as a system, we can help ensure maintaining services in our region. By combining our clinical resources we will develop a clinically integrated network providing coordinated high-quality patient-centered care.”

North Country Healthcare was born when the leaders from the medical facilities in the White Mountains region of New Hampshire agreed to move forward with a non-profit affiliation. It would be comprised of three critical access hospitals (Androscoggin Valley Hospital, Upper Connecticut Valley Hospital, and Weeks Medical Center), and North Country Home Health and Hospice Agency. North Country created partnerships with other local healthcare providers, including two Federally Qualified Health Centers (Coös County Family Health Services and Indian Stream Health Center), and urgent care provider ConvenientMD.

Beyond having a unified mission, the success of the affiliation would require all members to agree and align with a new governance structure, operating structure, standardized care models, and the mindset that they must find common ground. Fortunately, the culture at each facility (and engrained throughout the leadership teams) provided the perfect platform. Organizations and individuals were willing to sacrifice their autonomy for the benefit of the overall strategy and mission of North Country. As the framework for the affiliation developed, governing boards remained in place at the facility levels and a unified board was established at the system level, allowing equal voice among all members. Consolidation occurred at the executive and departmental levels, resulting in the merger of many positions into combined regional roles, including a single CEO, CIO, and the same for various North Country Healthcare system department heads. This allowed for economies of scale and provided a means for the essential unified vison and oversight.

“The mission of North Country Healthcare is to assure consistent, high quality, accessible, and integrated healthcare across the communities served,” said Thomas Mee, Chief Executive Officer for North Country Healthcare. “The passion behind this commitment is evident at every level of North Country Healthcare and leadership has set the goals and blazed the trail with a clear vision and focus. The dedication of staff to deliver the highest quality care is inspiring. I think a consistent feeling is that even though challenging at many levels and sometimes a bit overwhelming, it’s rewarding and fun to do what nobody else has done. I believe everybody at North Country Healthcare feels that quality care and great customer service is everybody’s job regardless of their title or role. It’s great to be part of what we are doing here.”

In 2018 North Country began the search for an electronic health record (EHR) to standardize across member facilities. The formal RFP search and selection process included EHR vendors Athenahealth, eClinicalWorks, Cerner, Allscripts, and MEDITECH. After an extensive evaluation by physicians, clinicians, leadership, and stakeholders from all facilities, North Country elected to implement the MEDITECH Expanse (acute and ambulatory) EHR, due to its advanced functionality and fit for their long-term goals. With Go-LIVE planned for December 2020, North Country partnered with Navin Haffty to provide leadership, assist with the workflow redesign, and complement their teams with certified implementation resources. The process of implementing a single EHR forced discussions to streamline and standardize care and paved the way for the members to become a unified system.

The success of these efforts demonstrates the sense of community that extends beyond the walls of each respective organization. Years into the affiliation, members remain focused on the primary goal and long-term mission to improve patient care. North Country is providing new services and experiencing improvement in their ability to recruit specialized resources to the region. Further, North Country is recognizing benefits and efficiencies in other areas. It has greater purchasing power, consolidated numerous contracts, enhanced services and improved reimbursement rates. This expanded affiliation is now able to lobby on state and federal levels and provides a stronger voice for the community. When Darrel speaks of the success and benefits being recognized, he says, “The glue is hardened to where it’s not coming apart. All facilities remain committed to the mission and success of North Country.”

The approach utilized to affiliate the members of the North Country community can be modeled elsewhere. Although other notable collaborations have been achieved in the critical access community, the North Country environment, structure and accomplishments make it unique. Each member is able to remain independent, yet benefit from the larger affiliation, without losing the autonomy that would result from an acquisition by a major health system. In addition to blazing a trail for other critical access facilities, North Country members have been recognized as industry leaders in other categories, such as its selection by Modern Healthcare as one of the 2020 Best Places to Work in Healthcare, and Androscoggin being named a top 100 critical access facility for 2020 by The Chartis Group.

Navin Haffty is proud to be part of North Country’s success and looks forward to supporting the partnership well into the future as their mission and vision continues to grow and flourish.