Q&A with Dartmouth-Hitchcock CEO James Weinstein


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‘Creating a sustainable health system is part of creating a new economy in the region. It will allow small businesses to spend less for health care so they can then spend more money on jobs for more people,’ says Dr. James Weinstein, CEO of the Dartmouth-Hitchcock health system.

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As CEO of the Lebanon-based Dartmouth-Hitchcock system, Dr. James N. Weinstein undoubtedly has a unique perspective on what ails New Hampshire’s, and the nation’s, health care system.

Weinstein oversees a $1.6 billion health care system that includes Dartmouth-Hitchcock medical center, a network of clinics in New Hampshire and Vermont and a partnership with the state’s only medical school, the Geisel School of Medicine, that serves a patient population of 1.5 million.

Under his leadership, Dartmouth-Hitchcock has worked to forge partnerships with other providers throughout the region, all part of his effort to create a “sustainable health system” – a system that offers the best care to patients at a lower cost.

Q. How do you see the state of health care in New Hampshire today?

A. I see the state as an opportunity, in the sense that we need some new models to deliver care in New Hampshire, and I think the models we’re working on with Dartmouth-Hitchcock have local, regional and national implications.

What we need to create in New Hampshire is a sustainable health system, not a healthcare system, and we need to do that with three particular strategies. It would have to be population-based – what do the people of New Hampshire need, not what the health care systems offer. And we need to offer the infrastructure that provides the lowest cost to the most people.

Health care is not a business with a financial model that we should be thinking about in the traditional sense. It’s about real people that have real problems. Whether it’s a Boston hospital or a Salem hospital or a North Country hospital, we need to be thinking about what system we can best integrate to have the best resources and use the best resources.

Q. What do you mean by a population-based system?

A. By population-based, I mean it’s not market-based. We need to be looking at people across communities, not just at specific geographical locations that some would call a market share strategy. Right now, the fee-for-service model is a competitive, market-driven model. I don’t think that creates a sustainable health system for New Hampshire or any state.

What we need is to determine how to aggregate and bring communities together to the benefit of many and the detriment of none. We need to focus on value, not volume, and create a system that makes patients well-informed and only provides them with what they want and need.

Q. Is that what Dartmouth-Hitchcock and other providers are aiming for with your ventures with Harvard Pilgrim Health Care?

A. Those partnerships, Benevera Health and Elevate Health, are good examples of a population-based, value-based strategy that creates a sustainable health system. We are looking at what the population needs, and provide those services at a premium so the cost is lower to the consumer than it is on the market.

They involve bringing together a not-for-profit health plan, like Harvard Pilgrim, and a not-for-profit health care system, like Dartmouth-Hitchcock, to create a high-value, low-cost, sustainable health system – not a health care system.

Q. Is this model being used elsewhere?

A. Others are trying to create it. There are systems that have health plans and they take care of populations in their plans. They are trying to do this with the Blues, Cigna, Medicare and Medicaid. But above all, payer engagement is very important if we are truly going to achieve a population-based health system.

Q. By “payer engagement,” for the most part you mean employers.

A. This is crucial to understand. New Hampshire employers know better than anyone that the health system we have today is unsustainable. The issue in New Hampshire is to allow small businesses to grow and young people to stay in the state and grow more jobs. I think creating a sustainable health system is part of creating a new economy in the region. It will allow small businesses to spend less for health care so they can then spend more money on jobs for more people.

Q. Did the Affordable Care Act have anything to do with making this move toward a sustainable health care system?

A. The ACA was a happy coincidence. We were on this path before the ACA came into being. But I worry about the ACA not being sustainable because if the federal government stops supporting expanded Medicaid enrollment, the model is not sustainable.

The point is, we have to create a sustainable system for New Hampshire, whether the government supports it or not.

Q. It seems like a tall order.

A. In my mind, this isn’t just about health care. What I believe we are doing is creating the next Industrial Revolution that really says, “How does America, and New Hampshire, move into the next several decades with high rates of employment, new jobs and a bright future?”

This is much bigger than just the health care system. We have been winnowing away at the “New Hampshire advantage.” What we need to do is create a future for the state that is vibrant and growing.

Think about it: The cost of health care has long been an economic challenge in New Hampshire, but after we address the health care system, we can then begin to address the education system, and create a stronger economy. I’m talking about housing, I’m talking about education, the economy.

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