Dartmouth-Hitchcock Health CEO: Healthcare costs could be key factor in N.H. primary

Modern Healthcare policy and politics reporter Rachel Cohrs caught up with Dr. Joanne Conroy, CEO and president of Lebanon, N.H.-based Dartmouth-Hitchcock and Dartmouth- Hitchcock Health, about the ways healthcare may play a role in the Granite State’s Feb. 11 presidential primary.

We are one of the states that has the greatest percentage of citizens in high-deductible health plans. I think we’re close to the highest, although that’s pretty fluid, in terms of the highest individual deductible. That changes a lot of the perceptions of the average citizen about healthcare. I’m not a fan of high-deductible plans. I think a lot of employers are starting to be less enthusiastic about them, because they do push a lot of costs on to employees.

Also, we’ve seen the emergence of some of these really high-deductible health plans—people who have $5,000 and $10,000 deductibles.

The issue that is probably concerning for most New Hampshire citizens on high-deductible plans is the cost of prescription drugs, because you’re paying full retail for the cost. Over a year ago I went to fill my husband’s Metformin prescription and it was close to $1,100 for a 90-day supply. That was in January, and I said, “How do my employees afford this?”

We started a campaign to look at how we could support prescription drug costs for our own employees. For our 900 diabetics, we pay for all their diabetic medications and their test strips … we fund your HSA to a greater degree. If you make less than $50,000 a year, we almost fully fund your HSA for you and your family. We realized that with some of the important drugs, there was a big barrier for people being compliant.

A lot of the dialogue about solutions to creating affordable healthcare begins with the premise that we should try to get more people covered. That has to be the goal. Then you’re just talking about what’s the best way to do that. About 29% of the people polled favored the “Current system with a Medicare option for those who choose.” Very close behind it was, “Keep the current system as is.” New Hampshire expanded Medicaid last year and I think that had an impact in terms of covering more people. Then about 21% of people said “Strengthen the Affordable Care Act.” Medicare for All had 18%, and there were about 7% who really had no opinion or something else.

I think it’s really a proxy for, “Let’s try to get coverage for people.”

It’s interesting. D.C. has the lowest percentage of people on high-deductible health plans in the country.

A lot of times your beliefs reflect your personal experience and experience through your friends and family.

And D.C. may be a little bit of a bubble because there are a lot of traditional health plans … where people have a co-pay and the deductible is usually not over $1,000. I think people feel the costs of healthcare very differently.

We are fortunate that we have the Dartmouth Institute for Health Policy and Clinical Practice and we actually have a lot of graduates from the Dartmouth Institute that are members of our medical staff for administrative teams. They think about the big picture of health policy and affordable healthcare.

I’ve always said there are several components of really creating an affordable healthcare system.

The first is sound national health policy. The second is really smart benefit design. The third is aligned incentives. And the fourth is really engaged patients—consumers who are our partners.

I’ve always believed that when you engage families, they make decisions that are the right ones and they’re often the less-expensive ones.