Dartmouth Health, CMC scrap merger

Conroy Pepe

Joanne Conroy, CEO and president of Dartmouth Health, and Joseph Pepe, then-CEO of GraniteOne Health, in January 2019, when they signed a letter of intent to merge into a combined nonprofit health care system. (Photo by Mark Washburn-Dartmouth Health)

Dartmouth Health and GraniteOne Health, which includes Manchester’s Catholic Medical Center, are abandoning plans to combine forces after the state Attorney General’s Office said the collaboration as proposed would violate the New Hampshire constitution.

The AG released a report Friday objecting to the proposed combination.

In a statement, Attorney General John Formella said the combination would have violated a clause in the state constitution that requires “free and fair competition in the trades and industries.”

“Free, fair and robust competition is critical to providing employers and patients with options for lower cost and high quality health care services,” Formella said in a Friday news release. “Our state has experienced significant consolidation in health care over the past several years, and this transaction seeking to combine two of our top four largest systems is unacceptable without appropriate protections for consumers in place.”

Formella, the son of the late Nancy Formella a former DH leader, cited concerns about the effect of the proposal on health care costs.

“Without remedies in place protecting the public from harm and ensuring the combined system delivers on the promised benefits, the transaction as proposed is not something that I can approve,” he said in the release.

The collapse of the CMC proposal marks the latest setback in DH’s ongoing effort to find a partner in New Hampshire’s more populous southern tier.

“Although we disagree with, and are deeply disappointed by, the result of the regulatory review, we respect the process that led to this decision,” DH CEO Joanne Conroy said in a Friday email to employees.

However, Conroy acknowledged that combining forces with GraniteOne — which officials once described as pivotal to DH’s future — may not have made as much sense today as it did when the parties first began negotiations.

“During the 2-3 years of review by state and federal officials, the dynamics of the healthcare landscape in New Hampshire — and beyond — have continued to change dramatically,” Conroy wrote. “Despite the unforeseen challenges of the pandemic, Dartmouth Health and GraniteOne remained committed and focused on how we would deliver the benefits and promises of the combination for our patients and communities. But it has become clear to us that those benefits and promises that we envisioned several years ago are no longer practical and realistic in the current environment.”

DH, which has an annual operating budget of more than $2 billion, and GraniteOne, which has an annual operating budget of more than $600 million, first announced in January 2019 that they planned to combine forces. The organizations said at the time that they planned to build on the two health systems’ pre-existing clinical collaborations in the areas of obstetrics, pre- and post-natal care, oncology, rheumatology, endocrinology and critical care. They also said they aimed to reduce costs by integrating back-end services and data sharing, and to increase access to specialty services at smaller, more rural hospitals.

Lauren Collins-Cline, a spokeswoman for GraniteOne, said “the parties were not able to agree on all of the terms” in an emailed statement on Friday.

“We reached an impasse late yesterday afternoon and will not receive the regulatory approval we need to move forward,” she said. “This outcome is disappointing for GraniteOne Health and its members — CMC, Huggins Hospital, and Monadnock Community Hospital. It’s also disappointing for the patients and communities of New Hampshire. Based on the public forums we held last fall, it was clear how much the community supports our organizations and recognized the benefits this combination would have provided.”

In addition to 396-bed DHMC, the DH system includes Alice Peck Day Memorial Hospital in Lebanon, Cheshire Medical Center in Keen, Mt. Ascutney Hospital and Health Center in Windsor, Vt.; and New London Hospital. In addition to 330-bed CMC, GraniteOne includes Huggins Hospital in Wolfeboro and Monadnock Community Hospital in Peterborough.

This is not the first time DH has sought a partner in the south. It was in talks to create a formal affiliation with the Manchester-based Elliot Health System, but ended them in 2017. The following year, Elliot combined with Nashua-based Southern New Hampshire Health to create SolutionHealth, combining the 296-bed Elliot Hospital with the 188-bed Southern New Hampshire Medical Center.

In 2010, while Nancy Formella was one of DH’s leaders, the Attorney General’s office rejected an effort by Dartmouth-Hitchcock to acquire Catholic Medical Center.

This article is being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.

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