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Joanne's Journal - Thursday, January 11, 2018

Joanne's Journal - Thursday, January 11, 2018

Dear Colleagues:

Let’s talk about health insurance.

Even though health insurance is an employer-sponsored benefit for many U.S. citizens, it is something that had been taken for granted for many years because the true costs were not obvious. Many of us remember the era where there was no copay and you never saw a bill. Now that the market is moving to high-deductible plans, we are all much more aware of the out-of-pocket costs and the impact on our pocketbooks and wallets. This is complicated, and we all need to improve our insurance literacy.

I always like to start with some history for background, but if you’re skimming and don’t have time to read it in its entirety, I’ll get right to it. If you have time to read the history lesson, scroll to the bottom of my letter.

Our health insurance plans

Dartmouth-Hitchcock offers employer-sponsored health insurance for eligible employees and their dependents and covers the majority of the total cost. Our affiliates do the same. We are self-insured – which is another way of saying that Dartmouth-Hitchcock collects premiums each paycheck from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims (so do our affiliates).

D-H contracts for insurance claims processing through Harvard Pilgrim. On average, Dartmouth-Hitchcock pays approximately 75 percent of the total cost and the employee pays the remaining portion through a combination of pre-tax/tax-exempt earnings via bi-weekly payroll deductions for the premium and toward the deductible and co-insurance when the employee or his or her dependent see a provider for health services.

Across the nation, the percentage of total compensation devoted to health benefits has been rising since the 1960s. Average premiums, including both the employer and employee portions, were $4,704 for single coverage and $12,680 for family coverage in 2008. In 2017, they were about $6,700 and $18,700 respectively. Employer health care costs (and group insurance premiums) have been increasing the past five years at three to four times the rate of general inflation.

Employees have been sharing in the cost of care as the market moves to high-deductible health plans. High-deductible health plans are increasingly becoming the norm in commercial insurance. The average deductible is now $1,700 for an employee.  Average deductibles for single plans range from a low of $988 in Hawaii to a high of $2,434 in New Hampshire. New Hampshire also has the highest percentage of workers enrolled in high-deductible health plans (69 percent) while Hawaii has the lowest (about 12 percent).

Generally, these plans have lower per paycheck premium cost but a higher cost share at the point of service as the employee would pay toward his/her deductible before the plan would pay. This cost-sharing is very similar to car insurance – if you get into an accident, the deductible is paid first, then the insurance kicks in. With health insurance, a deductible is an amount that must be paid out-of-pocket by an enrollee before some or all services are covered by their health plan. The amount an enrollee pays is part of the fee schedule that is negotiated by a plan administrator. So enrollees are not paying full retail for the services….but instead they are paying a lower negotiated rate.

Per the IRS (Internal Revenue Service) guidelines, a high-deductible plan is defined as one with a minimum annual deductible of $1,300 for an individual and $2,600 for a family. The theory behind this shift is that in order to have people be smart consumers of care, they need to have “skin in the game.”  For years economists have said that the disintermediation (lack of connection) between the consumer and the cost of their health care created a lack of sensitivity to the value of the services. Evidence shows that higher deductibles and other cost sharing reduce the use of health care by exposing enrollees to a larger share of their health care spending and, thereby, encouraging them to be more selective with the services they consume. We do not know yet if this also results in people delaying necessary care….but is something that we will investigate using our own data.

So how do you best navigate our plans?

Regardless of where you work – at D-H or at an affiliate – understanding the health insurance plans that are offered and what you and your family’s needs are can be challenging. While we often only pay attention to our benefits during Open Enrollment, we should understand all that our benefits offer all year round. I encourage you to take advantage of the resources that are available to you. Below are some of important facts/tips:  

  • The plans cover the same in-network services. These include preventive care, which is generally covered at 100 percent (see a description of those on myBenefits portal), emergency services, inpatient and outpatient care, and prescription drugs. How much you pay for each service will depend on the plan you choose.
  • Lower-wage workers have their premiums subsidized. The employee premiums that are deducted from your paycheck are based on the coverage level and your base salary. We have three tiers so employees that make less than $50,000 per year or $100,000 per year pay less than higher paid employees.
  • Prescription drug coverage is included. How you pay for prescription drugs depends on the plan you choose. Preventive medications are those prescribed to prevent the occurrence of a disease or condition for individuals with risk factors or to prevent the recurrence of a disease or condition for those who have recovered – conditions such as high blood pressure, high cholesterol, diabetes, asthma, osteoporosis and heart attack.

In our ElevateHealth HSA Plan and our Choice Health Plan, drugs on the Preventive Drug List will bypass the deductible and only require you to pay co-insurance. OptumRx manages this program and the list of drugs included in the Preventive Drug Program. (My Lisinopril costs me about 18-22 cents a month under this benefit.)

After two 30-day prescriptions, Optum will contact you to put you on a 90-day delivery by mail option, which is less expensive for you. If you have a hard time paying for your medications, you may be eligible for discounted pricing through the use of coupons. (Go to Google and type in “prescription coupons” and the name of your drug to find if there are any coupons.)

Visit the benefits portal at your location, which has plenty of in-depth information about the health plan options. We hosted information sessions during Open Enrollment in the fall, and will be happy to host more to help you make the best decisions.

I had lunch just today with a group of your colleagues who work in Engineering. They each had their own story as a patient and they were very honest with their feedback. I know that health insurance is complicated…and there is much more that we would like to do to provide coverage and keep employees and their families healthy. We are looking at a number of options to help you take care of your health and your pocket book! The reality is we currently spend close to $100M on health insurance coverage/ health care for our employees. Some of these costs are avoidable (life choices that result in chronic diseases) and some are not (genetic causes of disease and/ or trauma). We need to be thoughtful about controlling the growth in healthcare costs remembering that the investment in the health of our employees is one of the most important investments we can make.

Thank you for your support and feedback (and I anticipate that this post will generate a lot of the latter!)   


And here's a little history lesson on health insurance:

Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Real “sickness” coverage in the U.S. did not start until after 1890. Prior to World War II, most Americans paid for their own medical care, either directly to their chosen provider or through Blue Cross nonprofit health insurance entities, which were created by hospitals to offer individuals guaranteed service in return for a fixed fee. Back then, health insurance was really insurance—providing payment only for major items like hospitalizations that people could not afford to pay for themselves.

In the 1930s, the Roosevelt Administration explored possibilities for creating a national health insurance program, while it was designing the Social Security system. It was abandoned because of fierce opposition from the American Medical Association (AMA). During World War II, the U.S. Congress and President Roosevelt instituted wage and price controls and were determined to maintain them after the war to control inflation. These federally imposed wage and price controls prohibited manufacturers and other employers from raising wages high enough to attract workers.  After the war, the labor market was very tight because of the increased demand for goods and the decreased supply of workers.

Using health care and other fringe benefits to attract the best employees, private sector, white-collar employers nationwide expanded the U.S. health care system. Public sector employers followed suit in an effort to compete. Between 1940 and 1960, the total number of people enrolled in health insurance plans grew seven-fold, from over 20 million lives to close to 150 million.  By 1958, 75 percent of Americans had some form of health coverage.

Still, private insurance (if you did not have employer-sponsored insurance) remained unaffordable or simply unavailable to many, including the poor, the unemployed, and the elderly. Before 1965, only half of senior citizens had health care coverage, and they paid three times as much as younger adults. In 1965, President Johnson signed the Medicare and Medicaid programs into law, creating publicly run insurance for the elderly and the poor. Medicare was later expanded to cover people with disabilities and end-stage renal disease.

Live Well/Work Well Offerings for Employees

Live Well/Work Well type

As we all strive to provide the best care for our community, it is also important to remember to take care of ourselves. Whether through exercise, meditation, healthy eating or just relaxing and having fun with family and friends, Dartmouth-Hitchcock (D-H) encourages employees to find time each day to take care of the most important person—yourself!

“Our People, Our Well-Being,” is the Dartmouth-Hitchcock Live Well/Work Well (LWWW) program’s theme for 2018, and we are kicking off the year by inviting all staff to participate in the Health & Well-Being Assessment (HWA) being offered now through February 28, 2018. By participating in the assessment, you will help us to customize future opportunities to support well-being. Why is this important? Because it is clear that employee well-being has an effect on employee safety, patient safety and the patient experience.

LWWW is here to help improve and maintain the health and well-being of you and your family by offering a variety of programs and resources on our ManageWell® wellness portal and in person. To access the portal at work, visit Outside D-H, visit You will need your employee ID to log-in—use DH as a prefix (i.e. “DH12345”). Also, your significant other can sign up using your D-H employee ID and your birthdate.

Here are a few of the activities you can participate in:

  • Health & Well-Being Assessment (HWA) is available from January 1 through February 28. Complete the assessment, enter your numbers and you will be linked to a variety of programs and resources. This is also available to your significant other.
  • “Know Your Numbers” is a free health screening for employees and significant others. This is a simple health check to give insight into your current health and help guide you toward well-being. It takes 15 to 20 minutes to complete.
  • Activity challenges:
    • Team Walk-A-Rama will run from January 15 to February 25. Team up with your workmates (minimum 2 people, maximum 10) and track your steps for six weeks to compete with teams across D-H. Registration is now open at!
    • Steps per Week is for individuals or groups to meet a step goal (of 35K or 70K) each week. You can synchronize your Fitbit, Jawbone, Garmin, Microsoft Band or iOS Apple Health app. For group challenges, please contact LWWW to discuss logistics. 
  • Goal setting: Set personal goals online, with an app or with a LWWW coach. There are apps for quitting tobacco, tracking food and activity, or working on mindfulness or meditation skills. Some of our favorites include, My Fitness Pal, Quit Now, My Daily Plate, ManageWell, Calm and Headspace. Not sure where to start? Our coaches are happy to help.
  • Save the Date for the Employee Well-Being Expo on Thurs., April 5, 2018 at DHMC.
  • For more information about these activities please visit Live Well/Work Well.

View our program booklet for January–March. Watch D-H Today and local information boards for current program announcements.

If you have questions, contact LWWW in Lebanon at 603-650-5950 or for the Community Group Practice (CGP) call 603-296-5547 or email Denise Biron at

January 18 Symposium to Explore Opioid Harm Reduction

Despite intensive work by legions of committed groups and individuals, opioid addiction and overdose deaths continue to devastate many New Hampshire families and communities. The Dartmouth-Hitchcock Substance Use and Mental Health Initiative (SUMHI) will host a daylong symposium on "Harm Reduction in an Opioid Era," to explore what more can be done to reduce the ongoing harm.

The symposium will be held Thurs., January 18 from 8:30 am to 4 pm at the Kehas Criminal Justice Training Facility in Concord. A diverse audience of health care workers, law enforcement officers, legislators, educators, prevention and treatment workers and others is anticipated. New Hampshire Governor Chris Sununu is expected to make opening remarks to the group. 

“One of the things we need to recognize is that people who are using drugs—opioids in particular—may not be ready or able to stop using at a given point in time,” notes symposium organizer Dr. Seddon Savage, an advisor to SUMHI and adjunct associate professor at the Geisel School of Medicine at Dartmouth. “Harm reduction is a set of ideas and strategies aimed at supporting human health and dignity, by meeting drug users where they are in the course of their drug use, and working to reduce the negative consequences of use.”  

The symposium aims to bring together people with diverse perspectives and professional experience to hear presentations on life-saving strategies and to engage in purposeful discussion to advance appropriate harm reduction strategies in New Hampshire. Topics of discussion will include naloxone distribution, needle and syringe service programs, supervised injection programs, expanded access to pharmacologic treatment of opioid use disorders, as well as strategies to engage opioid users in conversations aimed at safer use and treatment options. See the full agenda for the symposium here

The symposium is open to the public, and advance registration is required at

In addition to the Dartmouth-Hitchcock SUMHI, co-sponsors and partners include the New England Institute on Addiction Studies, N.H. Harm Reduction Coalition, the C. Everett Koop Institute at Dartmouth, the N.H. Police Standards and Training Council, and the N.H. Training Institute on Addictive Disorders

Patients Who Use Opioids May Be More Satisfied But Not Healthier

Brian Sites, MD

Brian Sites, MD

Patients with common musculoskeletal conditions who use opioids may be more satisfied but have poorer health when compared to patients who do not use opioids.

That is one of the conclusions of a new study by researchers at Dartmouth-Hitchcock and the University of Michigan. The team’s primary interest was to determine if patient’s perception of their care was associated with the number of opioid prescriptions they received from their health care providers.

“Patient satisfaction is an important driver of health care reimbursement mechanisms,” said Dr. Brian Sites, Dartmouth-Hitchcock anesthesiologist and the lead author of the study, which was published in the January/February 2018 Annals of Family Medicine. “We found, using population-based data, that patients suffering from chronic musculoskeletal disorders (such as arthritis) rate their satisfaction with care higher when they receive more opioid prescriptions. This higher satisfaction exists despite the fact that these patients have poorer physical and mental health compared to their counterparts who do NOT take opioids.” 

As clinician compensation is increasingly linked to patient satisfaction, and as the United States struggles with an epidemic in opioid use, the authors suggest it is imperative to determine whether improved satisfaction with care is associated with demonstrable health benefits, Sites and his co-authors report.

Read full story here.

Upcoming Town Hall Meetings

All Dartmouth-Hitchcock employees and volunteers are invited to attend the first Town Hall meeting of the New Year with Dr. Joanne Conroy, CEO and President of D-H, on Monday, January 22, from 12 noon to 1 pm, in Auditorium H on the Lebanon campus, or via videoconferencing (see details below). Dr. Conroy will discuss our organizational direction, employee engagement and will answer questions from staff. Questions can be submitted in advance or during the Town Hall by sending them to

Dr. Joanne Conroy speaks at the Town Hall held on September 13, 2017

Town Hall Meeting Details

Monday, January 22, 12 noon to 1 pm
Aud. H, in the Williamson Translational Research Building
Aud. F will be an overflow room

Live Broadcast:

VTel is set up at these locations:

Community Group Practice Locations

  • Bedford Farms, Building 5 – Bedford Room
  • Bedford Farms, Building 4 – Franklin Room
  • Cancer Center – 4th Floor Conference Room
  • NDP – 2nd Floor Conference Room
  • Hitchcock Way – Founders Room
  • ENT – Conference Room
  • Washington Place – 2nd Floor Conference Room
  • Bedford Clinic – Conference Room
  • Southwood Drive – Conference Rooms A & B
  • Hudson – Conference Room
  • Merrimack – Conference Room
  • Milford – Conference Room

Details for D-H Affiliates will be sent by their local leadership.

Future Town Hall Meetings and Facebook Live Sessions with Dr. Conroy

Town Hall Meetings Hosted at D-H Manchester

  • April 6, 12 noon – 1 pm
  • October 31, 12 non – 1 pm

Town Hall Meetings Hosted at DHMC

  • June 19, 12 noon to 1 pm
  • December 19, 12 noon to 1 pm

Facebook Live Sessions

  • January 29, 12 noon to 1 pm: Dr. Conroy and Carol Majewski, director of the Office of Patient Experience, D-H
  • April 3, 12 noon to 1 pm
  • July 9, 12 noon to 1 pm
  • October 2, 12 noon to 1 pm
  • December 5, 12 noon to 1 pm