Out of two systems, one

Mark Washburn / Dartmouth-Hitchcock Health

Dartmouth-Hitchcock Health CEO and President Dr. Joanne M. Conroy and GraniteOne Health CEO Dr. Joseph Pepe announce the signing of an agreement Wednesday to combine the two health systems.

Two major health care systems with campuses in Keene and Peterborough announced their intention to become one Thursday, which would bring the only two hospitals in the Monadnock Region under one umbrella.

Dartmouth-Hitchcock Health — a Lebanon-based network of five hospitals, including Cheshire Medical Center in Keene — and GraniteOne Health, which has three hospitals, including Peterborough’s Monadnock Community Hospital, have signed a non-binding letter of intent that details their plans to combine.

The two systems would become Dartmouth-Hitchcock Health GraniteOne, they said in a joint news release Thursday. All of the organizations involved would keep their current names, identities and local leadership, according to the release.

In addition to Keene, Dartmouth-Hitchcock Health has hospitals in Lebanon, New London and Windsor, Vt., as well as 24 clinics in the Twin States. GraniteOne has Catholic Medical Center in Manchester, and the hospitals in Peterborough and Wolfeboro.

“This is really just taking our relationship to the next level,” Joanne M. Conroy, Dartmouth-Hitchcock Health’s CEO, said in an interview Thursday.

Conroy said it’s too early to talk about the changes the proposed union would bring to hospitals within the two systems. But she said collaborations between hospitals such as Monadnock Community Hospital and Cheshire Medical Center are already in place, and new joint programs are likely to evolve naturally as a result of the systems combining.

The process could take 18 months, she said, involving continued negotiation between the two nonprofit systems, as well as input from the public.

The N.H. Attorney General, as well as federal regulators, must approve the union before it is finalized, Conroy said.

Both entities would also need approval from their boards of trustees, and from the bishop of Manchester, according to the release. Catholic Medical Center, which doesn’t perform abortions, would continue to “adhere to its Catholic model of care” even if the two health systems combine, the news release said.

Officials from both systems Thursday touted the benefits that could be realized by joining.

“We have complementary visions for what health care in New Hampshire could be,” Joseph Pepe, CEO of GraniteOne, said in the news release. “Combining systems would allow us to advance that vision, expanding access to primary and specialty care for all New Hampshire residents, including vulnerable patients and communities.”

Conroy said she does not anticipate any workforce reductions as a result of the union, though there could be instances where staff would be retrained to perform a different role as the entities coordinate their clinical services.

“I would say that employees shouldn’t lie awake at night worried about their future,” she said.

At current workforce levels, the proposed system would have more than 13,000 employees. Dartmouth-Hitchcock Health has more than 9,000 workers, whereas GraniteOne Health employs 4,000, according to their websites.

Combining the two systems would give Dartmouth-Hitchcock, already the largest hospital system in the state, access to new markets, such as Peterborough and Wolfeboro, and expand its foothold in Manchester.

It could also give both systems an edge in attracting personnel, even as the region and state struggles to draw and retain health care workers. Conroy said joining Dartmouth-Hitchcock Health and GraniteOne Health could give employees a chance to begin their career at a smaller hospital and then move to larger facilities as their career advances, all within the same system.

GraniteOne Health, for its part, could benefit from lower prices for supplies and medications as part of a larger system, and get better rates for its employee health benefits, Cynthia K. McGuire, president and CEO of Monadnock Community Hospital, said in a news release Thursday.

But whether these savings would translate to lower health care costs for consumers remains to be seen.

A November New York Times analysis showed that the cost of hospital stays increased between 11 and 54 percent in areas where hospitals merged. The Times examined 25 metropolitan areas with the highest rates of consolidations from 2010 to 2013, a period when mergers peaked.

Conroy said Thursday that the drivers of health care costs are complex and not dependent only on hospitals, but also on insurance companies and other factors. She said there are still many other health care providers for patients to choose from in New Hampshire, including smaller hospitals in the North Country and Concord Hospital.

She also said that Dartmouth-Hitchcock has introduced a tool that makes the cost of health care more transparent, so patients know the cost of the services they are seeking in advance.

The American health care landscape is becoming increasingly consolidated as hospitals continue to deal with financial pressures, including Medicare cuts from the federal government and decreasing Medicaid payments from states, with rural hospitals particularly vulnerable, according to a 2018 report in the academic journal Health Affairs.

The proposed merger announced Thursday is the second time Dartmouth-Hitchcock Health has tried to join with Catholic Medical Center. In 2010, then-N.H. Attorney General Michael Delaney opposed a merger between Dartmouth-Hitchcock Health System and what was then called Catholic Medical Center Healthcare because it would have changed the governance and structure of the Catholic hospital.

Catholic Medical Center affiliated with Monadnock Community Hospital and Huggins Hospital in Wolfeboro to form GraniteOne Health in 2017.

Liora Engel-Smith can be reached at 352-1234, extension 1439, or lsmith@keenesentinel.com. Follow her on Twitter @LEngelSmithKS.