Forward Thinking Led to Development of NH Health System

Healthcare organizations often have their greatest successes when they act before they’re forced to act. We see it every day, and a recent client engagement perfectly illustrated this point.

First a bit of backstory: In the state of New Hampshire, there has been a big push towards population health since the passage of the Affordable Care Act, and Dartmouth-Hitchcock Medical Center has assumed a leading role. Stroudwater was engaged by four Critical Access Hospitals in northern New Hampshire and Dartmouth-Hitchcock Medical Center to help them evaluate their strategy options to better serve the region for the future.

With a changing payment system, the basic challenge facing these hospitals was to build infrastructure critical to financial success in a new payment environment. They were each financially secure at the time and had enviable balance sheets, but they realized that delaying action would jeopardize their financial stability.

Stroudwater worked with the hospitals and Dartmouth-Hitchcock Medical Center and concluded that by working together, the four hospitals could achieve greater scale and reduce operating costs, leverage their historical investments in primary care in their communities, and create a clinically integrated network that could not only contract with Dartmouth-Hitchcock Medical Center to fill out its ACO network, but also with other payers.

Stroudwater laid the groundwork for the hospitals to develop a structure for streamlined operations and greater access to care for patients in a rural region of New Hampshire. The ultimate result was the creation of North Country Healthcare, a new system that was officially born in January 2016. With their commitment to accountable care and forward thinking, these hospitals created an organization where they were able to maintain control over their futures. The results are already paying dividends for the organizations and the people in the communities they serve.


Don Horstkotte is a Principal at Stroudwater.