Cooley Dickinson Hospital is a small community hospital Northampton that has, in recent years, worked in partnership with Dartmouth-Hitchcock Medical Center, then returned to its status as an independent entity, and now is forging a partnership with Massachusetts General Hospital. President and CEO Craig Melin Melin has been the person to steer the institution through these interesting times. Context is important, Melin tells the Valley Advocate; the field of health care is changing dramatically and very quickly. As the state and federal governments begin to implement initiatives to make health care more affordable and effective, Melin says, he believes Cooley Dickinson has positioned itself well ahead of the trend.
Melin says he’s glad to see the system catching up with his hospital, even though hospitals like Cooley Dickinson may lose patients to other hospitals and clinics and will likely require a reduced workforce in the future. While managing a downsizing process might seem less interesting than worrisome to a chief executive, Melin is far from pessimistic.
The key to understanding the future of health care, Melin says, is knowing how a patient goes about gaining access to service under the old and new models, which differ significantly. Melin believes the move from a fee-for-service model to one that focuses on prevention is a positive one—and that when people comprehend the differences between the models, they’ll understand why these changes ultimately benefit hospitals like Cooley Dickinson.
Valley Advocate: Can you explain how the fee-for-service model works and what’s taking its place?
Craig Melin: The fee-for-service model breaks health care services into piece work and often places the burden upon the patient to put those pieces together. It’s cumbersome, inefficient—and not nearly as effective from the vantage point of health.
For hospitals, this model means charges are accrued by people’s use of services. That doesn’t make sense. Financially, that would mean a hospital wants patients to come. To focus on prevention and aim to keep people healthier in the first place is a much better approach for the community. The hospitals need to find ways to help assure better health rather than wait to treat sick people.
VA: How can hospitals do this?
CM: Although practices are changing within the field, much of what’s being implemented in a more widespread manner is not new for Cooley Dickinson Hospital. These kinds of initiatives really are the same as ones our hospital already had in practice—through Population Health. We implemented this shift, even when it cost our hospital more to do so.
We wholeheartedly support movement toward case managers and reprioritization to inform how health care will be delivered. The goal of primary health care will be much more focused upon supporting patients to take ownership of their health. These changes should mean that the need for inpatient care shrinks.
The way most primary care practices were traditionally arranged was all about getting to see the doctor. The doctor must refer patients to specialists and this creates a bottleneck around the doctors. For most people, all that pressure on the doctors translated into very little contact with a primary care doctor—15 minutes, maybe 30, once or twice each year for someone in reasonable health. There isn’t a great deal of information a doctor can elicit or share in that amount of time. If it’s the health care system’s aim to support people in lifestyle improvements so they are healthier, it would be hard to do much toward that goal in a few minutes a couple of times each year.
A case manager works to create better networking on a patient’s behalf—coordination between people able to help with a health care issue, whether acute, such as recovery after a hip replacement, or ongoing, such as respiratory issues or diabetes.
VA: Can you give an example of how this shift may keep more people out of the hospital?
CM: People with chronic issues such as congestive heart failure or asthma or behavioral health issues will receive more helpful treatment. By focusing on office visits and outpatient contact more steadily, you can help people avoid situations that become emergent by managing their health issues better.
Take a step back, though. For an institution like ours, we see our role as going into the community more to support our population’s health. We want to help kids, so we’re going into local schools and working there on issues like nutrition and exercise. We’re doing the same thing for senior citizens: going into senior centers and doing more on-site work at places like Lathrop and Applewood around diet and exercise. The idea is to take on new roles to promote health. We want people to need the hospital less.
As people are healthier, we’re working to find ways for them to use the hospital differently, more effectively. So we’re trying to build on that case management model, especially for issues like cancer care. We’d like to make it easier for patients to obtain care at their own pace rather than have to run around from specialist to specialist. Ideally, you could find those specialists under one roof. That’s the direction we will take with our new Cancer Center.
VA: Will people feel choice is being taken away from them?
CM: When the shift occurred from people’s primary care physicians coming to the hospital to our hospitalists, an adjustment period was required. For so many reasons, the shift turned out to be positive, including something as simple as hospitalists are around all day, so it’s much easier for families to speak with them. And they know how the hospital works and thus can help patients on site very effectively.
VA: How will a reduced need for inpatient services affect staffing?
CM: The way the payment system is changing has meant some reduction in the hospital’s work force. This doesn’t signal trouble. We’re repositioning and our track record, both for patient care and for fiscal stability, remains solid. The changes aren’t seamless, but they are positive. We’ve been educating our staff, department by department, about the changes. What will be more true going forward is this: patients will find more care outside of the hospital in other settings and the hospital will be increasingly a place you go if you are really sick.
VA: What’s the advantage of partnering with a large hospital like MGH?
CM: For a small community hospital like Cooley Dickinson, an important decision is whether to try to partner in some significant way with a larger and more deeply resourced institution or to remain fully independent. Our collaboration with MGH should allow our hospital to retain the advantages of the community hospital while ensuring that patients—and the local community—gain easy access to specialists and services a larger institution possesses.
We join into a huge information technology infrastructure that allows records to move back and forth instantly. This partnership means that our hospital has access to skills and technology we don’t have and can’t have, and that our patients can move between the two institutions with ease. What our hospital can often do, in consort with MGH, is deliver certain services—radiation is a good example—nearer to home for our patients.•