This is a population health strategy: A plan years in the making and backed by the local medical center may make Cheshire County, NH, the healthiest community in the nation by 2020.
"Almost without interruption we had the mountain in sight before us,"-- Henry David Thoreau
wrote about 3,165-foot Mt. Monadnock in New Hampshire, a mountain that inspired him, spiritually and physically.
At the base of Mt. Monadnock where the air and water are still clear and cool , thousands of residents, with physician and hospital support, are thinking about different mountain to climb. Their goal is to become the healthiest area in America.
Do you want to talk about population health planning? Cheshire County, NH, is exploring it big time, far beyond the four walls of its lone hospital and physician offices.
The 169-bed Cheshire Medical Center/ Dartmouth Hitchcock Keene, hospital and primary care and multispecialty clinic has sparked an initiative, dubbed Healthy Monadnock, to become the healthiest community in the nation by 2020. Cheshire County has 23 towns and is located in the southwestern corner of the state. According to the census, the county has 76,851 residents within its 729 square miles.
It's no joke. There is a concerted effort to make the Monadnock area the healthiest in the nation. The plan, years in the making, includes government and civic policy changes that officials hope will prompt its community organizations, schools, workplaces and municipalities to make healthy choices about how they eat, how they exercise, and generally take care of themselves.
Thousands of people are involved in keeping track of their own health by measuring their commitment to lose weight and get fit. While schools are revamping their menus to offer reliably nutritious fare, local planners are drawing up sketches for sidewalks and parks to encourage residents to walk and run.
Cheshire Medical Center/Dartmouth Hitchcock Keene, and local physicians are helping people "create an awareness" of their own health, says Art Nichols, the hospital CEO.
"We're not unlike a lot of other communities. We are the only hospital in our county, and we have had this partnership with physicians for 15 years," Nichols says. "When you own the market and are a significant provider, I feel there's a responsibility to that market. We don't want to wait for people to get sick and show up in our offices or emergency room. That's not enough to do our jobs."
"We want to try to help our community be the healthiest it can be, and in fact, we declared we wanted it to be the healthiest community in the country," Nichols adds.
The Healthy Monadnock 2020's activities are overseen and guided by a "healthiest community advisory board," a coalition of 30 people representing schools, private business, healthcare organizations, recreational groups, non-profit agencies, municipal and state governments.
With community 'champions' designated to help residents, the group plans to measure community progress toward achieving goals. Generally, the goals encompass what officials describe as a "broad spectrum and vision of health:"
- Social factors that influence health
- Education and "awareness" of healthy lifestyle behaviors
- Healthy eating
- Active living
- Social support network
The hospital will spend upwards of $200,000 for the program and Nichols says it's worth every penny. "There is no factor more important for health than [the] behaviors of an individual. At least 50% of a person's health is reliant on behavior and that's the whole notion of trying to create the healthiest community. So much happens outside the walls of a hospital, there's only so much a hospital can do."
Physicians have been working closely with healthcare leaders to reduce the amount of time people are spending in the hospital. Under its accountable care initiatives, the hospital has significantly reduced inpatient admissions, Nichols says.
"We got a jump on the whole notion of accountable care, and because of that, our physicians have developed some skills to keep people well and keep them out of the hospital," he says. "We've been about 50% below the national average for Medicare readmissions for some years now," Nichols says.
Economically, "the healthier patient is going to pay off" for the hospital, Nichols says. "This is a nice crossover for a healthier community as we enter the new world of (value-based care)."
Town leaders have written the "principals" of what they envision of a healthy community to be in their master plan. "They have developed streets that include sidewalks and bike lanes that aren't barriers to people [going out and walking]. And there is a lot of emphasis on local foods, and access to fruits and vegetables," Nichols says. "It sounds a little crunchy, but it's really not, it can be done."
For its work, Cheshire Medical Center/Dartmouth-Hitchcock Keene has been awarded the Carolyn Boone Lewis Living The Vision Award from the American Hospital Association reflecting the AHA's "vision of a society of healthy communities where all individuals reach their highest potential for health."
While the community is actively promoting its program, there's a way to go. Less than half of its residents—49%—know about the hospital's goals. "We know if we're going to be successful, we need everyone on board with Healthy Monadnock 2020," the hospital says.
It's a lofty goal, but 2020 is a long way off and Nichols is enthusiastic. In the meantime, the rest of America might consider doing what Cheshire County is actively trying to accomplish.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
