Dartmouth Health launches new home-based care initiative. Dartmouth Health is launching a new home-based care initiative branded as Dartmouth Health at Home, partnering with the Geisel School of Medicine at Dartmouth College. The program is supported by a $20 million philanthropic gift and aims to improve outcomes for rural patients by moving services into their homes. It will include home-based primary care and palliative care, along with the Family Caregiver Institute to support family members providing care. Coordinated care teams in the home. Dr. Nathan Goldstein, chair of the Department of Medicine at Dartmouth Health and co-CEO of Dartmouth Health at Home, said the program brings coordinated services to patients' homes rather than requiring patients to travel to facilities. "One of the things that is revolutionary about Dartmouth Health at Home is bringing a range of coordinated services to patients in their homes rather than patients coming to one of our facilities for services," Goldstein said. The program will use interdisciplinary care teams that include physicians, advanced practice providers, social workers, and home health aides. These teams will meet at least weekly to review patient care, and the program will provide home safety assessments and 24/7 phone support. By seeing patients in their homes, clinicians can check on medication adherence, household conditions, and fall hazards, allowing them to diagnose and treat conditions before they become acute. Testing a pilot model before scaling. The Dartmouth Institute for Health Policy & Clinical Practice will study the model to determine how to make home-based services sustainable and financially viable. However, the $20 million gift from alumnus Richard "Dick" Levy is not enough to cover long-term costs. Reimbursement for palliative care is often limited, and Medicare does not fully support interdisciplinary teams. Ensuring sustainability and national expansion. Reimbursement for palliative care in particular is often sparse. Medicare reimburses for physician and licensed independent practitioner services but does not support the full range of interdisciplinary care. While the $20 million gift from Dartmouth alumnus Richard "Dick" Levy is enough to begin the program, it will not sustain the Dartmouth Health at Home program financially over the long term. Family Caregiver Institute. The initiative will provide primary care and palliative services within the home. Guidance for health system leaders. For chief medical officers and other senior leaders at health systems considering adoption of programs like Dartmouth Health at Home, the first step is to select patients for participation intentionally. Leaders should identify the patients who need home-based care services and can benefit from these services. Then, they must ensure that they have the right financial model to make home-based care services sustainable.

Dartmouth Health unveils new home-based care initiative. Dartmouth Health is launching a suite of home-based care services in partnership with Geisel School of Medicine at Dartmouth College. The program is branded as Dartmouth Health at Home. Supported by a $20 million philanthropic gift, Dartmouth Health at Home aims to transform rural healthcare by expanding access to care, improving patient outcomes, and facilitating the safe and effective transition of care from hospitals and ambulatory settings to patients' homes, while supporting patients and their families throughout the process. The program will include home-based primary care and palliative care. "One of the things that is revolutionary about Dartmouth Health at Home is bringing a range of coordinated services to patients in their homes rather than patients coming to one of our facilities for services," said Dr. Nathan Goldstein, chair of the Department of Medicine at Dartmouth Health and co-CEO of Dartmouth Health at Home. Plans for the Dartmouth Health at Home program include providing primary care and palliative care services in the home. The program will also establish the Family Caregiver Institute at Dartmouth Health to provide family caregivers with services, education, support and access to home care aides. Additionally, the program will use the expertise at the medical school's Dartmouth Institute for Health Policy & Clinical Practice to study what works in home-based medical services and how those services can lower costs for health systems, patients, and payers. To boost access to care, the Dartmouth Health at Home program will be designed to provide medical services in the home for patients who struggle to get to medical appointments, Goldstein said. For example, older frail adults often rely on family members to take them to medical appointments, and providing services in the home will avoid the difficulty that family members face in taking time off from work to take a loved one to a doctor's office. The Dartmouth Health at Home program should improve patient outcomes and care quality in several ways, according to Goldstein. By seeing patients in their home on a timely basis, the program's clinicians should be able to diagnose and treat medical conditions before illnesses progress to acute stages. When clinicians visit patients in their homes, they can see whether patients are taking their medications, whether they have food in their refrigerator, whether the home is clean and whether there are fall hazards. Dartmouth Health at Home is expected to reduce cost of care, particularly if clinicians can diagnose and treat medical conditions earlier, which will avoid costly emergency room visits and hospitalizations, Goldstein said. The program should also reduce costs by improving medication management. Shifting care into the home In shifting care from the hospital or ambulatory care setting to the home setting effectively and safely, interdisciplinary care teams are crucial, Goldstein indicated. "With Dartmouth Health at Home, we will have interdisciplinary care teams that include physicians, advanced practice providers, social workers, and home health aides," Goldstein says. "We will not be having a single provider at a single point in time. We will have an entire team of professionals to serve patients and their families." The interdisciplinary care teams will meet at least weekly to review the care of patients in their homes, which should ensure that home-based care services are effective, Goldstein said. To make sure Dartmouth Health at Home patients are safe, the program will offer home safety assessments for patients as well as 24/7 phone support for patients and their families, Goldstein says. Financial stability, national expansion The Dartmouth Institute for Health Policy & Clinical Practice will help to ensure that the Dartmouth Health at Home program is sustainable financially, according to Goldstein. "The institute will examine how we can create home-based services programs, the costs of home-based services programs, how much revenue will be generated, and the expected financial margin," Goldstein said. Reimbursement for palliative care in particular is often sparse. Medicare reimburses for physician and licensed independent practitioner services and does not support the full range of interdisciplinary care. While the $20 million gift from Dartmouth alumnus Richard "Dick" Levy, is enough to begin the program, it will not sustain the Dartmouth Health at Home program financially over the long term. "One of the goals is to make sure the home-based services that we offer will be attractive to private and government payers," Goldstein says. Dartmouth Health at Home expects that their model will eventually be adopted in rural areas across the country. "When we look at the intersection of rural health and home care, we think that Dartmouth Health and the Geisel School of Medicine at Dartmouth can be national leaders," Goldstein says. "We think the programs we are building can be disseminated across the country." Advice for CMOs For CMOs and other senior leaders at health systems considering adoption of programs like Dartmouth Health at Home, the first step is to select patients for participation intentionally, according to Goldstein. "You should identify the patients who need home-based care services and can benefit from these services, then ensure that you have the right financial model to make home-based care services sustainable," Goldstein said. Another starting point is piloting home-based services before scaling them. For Dartmouth Health at Home, one pilot features a physician who is going to be leading the primary care at home service. "Patients who have difficulty seeing this physician in her office will be enrolled in the primary care at home program," Goldstein said. "The pilot will test the needs of patients and the operational needs of the program, then the program will be scaled based on what we learn." Healthleaders Media CMO Editor Christopher Cheney contributed to this report. Companies featured in this article: Jim Parker, senior editor of Hospice News and Palliative Care News, is a subculture of one. Swashbuckling feats of high adventure bring a joyful tear to his salty eye. A Chicago-based journalist who has covered health care and public policy since 2000, his personal interests include fire performance, the culinary arts, literature and general geekery.

Opinion: A question of dignity, accountability and community at Dartmouth Health. By Esperanza Martinez October 3, 2026 The recent announcement by Dartmouth Health regarding the elimination of employee positions and the cancelation of hundreds of vacant positions has left many people in the Upper Valley asking difficult questions. The issue is not simply whether a large healthcare organization facing financial difficulties has the right to reduce its workforce. Sometimes difficult financial decisions may be necessary. The deeper concern is how those decisions are made and - most importantly - how the people affected are treated. When employees are suddenly told that their positions have been eliminated, with little or no warning, the impact goes far beyond a number on a spreadsheet. These are people with families, mortgages or rents to pay, responsibilities, and years of service to an institution they believed was part of their community. There is a human being behind every position that is eliminated. This raises a very important question: Could this process have been handled with greater transparency, communication, compassion and respect for the people whose lives were being affected? Dartmouth Health is not simply another corporation. Its history is deeply connected to the Upper Valley. Mary Hitchcock Memorial Hospital began in Hanover in 1893. In 1991, the hospital moved to its current Lebanon campus, and over the years Dartmouth Health has continued to grow, bringing together hospitals, clinics, and healthcare organizations throughout New Hampshire and Vermont. That expansion has provided important medical services to communities that depend on them. The growth of Dartmouth Health has also transformed it into one of the largest and most influential healthcare systems in the region. But with growth comes responsibility. Dartmouth Health has recently reported a significant financial deficit. The organization has explained that increasing operating costs - including labor, medications, supplies, and other expenses - have contributed to the situation. Those numbers deserve serious consideration. But so does another question: Has the rapid growth and expansion of the system created financial and operational pressures that now require employees and local communities to bear the consequences? If an organization expands because it expects that greater size, integration, and patient volume will strengthen its financial position, the community deserves to understand what happened when the financial reality did not develop as expected. This is especially important in the Upper Valley, where Valley News already face serious challenges involving housing, the cost of rent, wages and the ability to retain essential workers. Many people who work in healthcare and other critical services struggle to find affordable housing close to their jobs. When people lose employment suddenly, the consequences can affect entire families and communities. That is why the manner in which these reductions were carried out matters. Did management consider the individual employees and the contributions those employees had made over many years? On what information did they make their decisions? What criteria were used and how were individual positions and departments evaluated? Were the employees who were affected given an opportunity to explain the importance of their work? Were alternative solutions considered? Were the long-term consequences for patients, employees and the community fully examined? These are not unreasonable questions. They are questions of accountability and transparency. A hospital is ultimately made up of people. Doctors, nurses, technicians, therapists, administrative staff, environmental-services workers, food-service workers, maintenance employees, researchers and many others are the people who make healthcare possible. Patients do not experience a hospital as a financial statement. They experience it through the people who care for them. Dartmouth Health has been an important part of this community for more than a century. With that position comes a responsibility that extends beyond financial sustainability. It includes responsibility to the employees who have dedicated years of their lives to the institution, to the patients who depend upon it, and to the communities that have supported its growth. Financial sustainability is important. But so are transparency, accountability, communication, compassion, and human dignity. I am speaking out because I believe Dartmouth Health belongs to the community it serves - not only as an institution, but as a neighbor and a major employer. The people affected by these decisions deserve more than a notification. They deserve to be treated with dignity and respect. And the community deserves an honest conversation about how Dartmouth Health reached this point and where it intends to go from here. The question should not simply be: "How do we reduce costs?" Valley News should also be asking: "How do we build a healthcare system that is financially sustainable without losing sight of the people and communities it was created to serve?" That is a conversation that deserves to happen openly, respectfully and honestly. Esperanza Martinez lives in Lebanon.