PETERBOROUGH — Two major health care systems with facilities in Keene and Peterborough are making progress toward becoming one.

The systems, Dartmouth-Hitchcock Health and GraniteOne Health, announced in January that they intend to join, in a move that would bring the only two hospitals in the Monadnock Region under the same umbrella.

Dartmouth-Hitchcock is a Lebanon-based network of five hospitals, including Cheshire Medical Center in Keene. GraniteOne Health formed in 2017 and comprises three hospitals: Monadnock Community Hospital in Peterborough, Catholic Medical Center in Manchester and Huggins Hospital in Wolfeboro.

At least 60 people attended a listening session about the merger at the Monadnock Center for History and Culture in Peterborough Thursday night, where officials from both systems, as well as from Monadnock Community Hospital, gave an overview of the proposal.

Representatives from the three entities emphasized their well-established relationships with one another.

Dartmouth-Hitchcock Health already provides oncology and gastroenterology services at Monadnock Community Hospital, said the Peterborough hospital’s President and CEO Cynthia McGuire, while GraniteOne Health provides cardiology, vascular surgery, rheumatology, neurology and teleneurology services there.

Hospitals within the two systems have long been collaborators in other ways as well, according to Dr. Joseph Pepe, GraniteOne Health’s CEO.

“So we’re not strangers to each other, and I think that’s very important, because when it comes to joining together two systems, many organizations start off behind the eight ball because they really don’t know each other,” Pepe said. “Well, we’ve known each other for over 15 years.”

Officials framed a merger as a way to bolster rural health care, as well as provide more advancement opportunities for their employees and pool resources to better address state needs for mental health care, opioid addiction and veterans services.

“Hospitals see coming together as a strategy for longer-term success, sharing resources to make things better for their community. Rural hospitals in this situation are particularly vulnerable, and many struggle to maintain a positive bottom line,” McGuire said. “Our size kind of gets in our way.”

Though she said Monadnock Community Hospital is doing well financially, the facility is not currently able to offer some in-demand services.

“What I hear most often from all of you in our community is, ‘We want more access to specialty services.’ Three rise to the top of my mind: pulmonology, endocrinology and dermatology,” McGuire said. “... By being part of a larger health system, we can pool those resources to create access to those services.”

Dr. Joanne M. Conroy, president and CEO of Dartmouth-Hitchcock Health, said the potential economic benefits of a merger extend beyond the hospital campuses to the communities where they’re located.

“We have to think about affordable housing for those employees, we have to think about transportation for those employees, and it all comes from creating great community partnerships. This is not something that hospitals or health systems can do alone. We do it with our communities,” Conroy said. “But we are anchor institutions in all of our communities.”

By offering higher-quality care more efficiently, the systems also hope to reduce costs, Pepe said.

“As you say, we’re trying to keep care local, and when we do, it’s less expensive than having people travel to Boston,” Pepe said. “Not only is that inconvenient, but it’s much more expensive than having something done at Monadnock.”

But when separate medical centers become one, patient bills don’t always reflect the savings.

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.

As the floor was opened to questions Thursday, a few attendees asked how Catholic Medical Center would be affected by the merger, raising concerns about compromising the center’s mission. One man questioned whether revenue from the hospital would benefit other facilities that perform procedures at odds with Catholic values, such as abortions.

Pepe responded that the structure of the proposed new system would maintain the bishop of Manchester’s “final say” in order to preserve the institution’s Catholic mission. He further explained that though the new system would have a “consolidated bottom line,” the hospitals’ budgets and monies would be separate, with Catholic Medical Center’s finances overseen by its board of trustees.

“We’re going to look at the experts, both financial and religious, and we’re going to say, ‘Let’s make sure this doesn’t happen,’ “ he said.

Bob Edwards, chairman of the Antrim board of selectmen, inquired about Monadnock Community Hospital’s satellite location in the town, and the process for determining the longevity of that office should the merger go through.

“One of the things that we all discuss when it comes to long-range planning is public transportation, and we don’t have that,” Edwards said. “So that satellite office in Antrim is very important to our town, and Monadnock Hospital has invested considerable funding into that site to make it a state-of-the-art location.”

Conroy reiterated that each member in the system would retain its own board, and said that officials are in the process of determining which decisions would fall under the system-wide board and which would fall to the institutional boards. In this case, it would be up to Monadnock Community Hospital to evaluate the Antrim site, she said.

“The individual institution is really the primary decider whether or not a facility, a service is going to be expanded or whether or not it’s going to be reduced,” she said.

The systems hope to submit their final agreement to state and federal regulators next month, Pepe said, and plan to hold public forums to gather comments for the official record sometime in the fall. The merger would also need approval from both entities’ boards of trustees, as well as the bishop of Manchester.

They hope to finalize the merger in July of 2020.

Meg McIntyre can be reached at 352-1234,

extension 1404, or Follow her on Twitter at @MMcIntyreKS.