Community Benefits Report
Letter from Our President and CEO
As an institution that strives to continually improve health outcomes, that means assessing not only ourselves, but the needs identified by the community we serve. How we respond to community needs is crucial to our success.
With that critical mission in mind, every three years, Cheshire Medical Center conducts a Community Health Needs Assessment by asking patients and community members to identify what it means to be a healthy community and then analyzing the data they provide. Our 2022 assessment yielded several areas of focus. After thorough review by stakeholders — with guidance from the Healthy Monadnock Alliance — we identified four areas of priority: improving healthcare access, behavioral health supports, substance use disorder prevention and supports, and aging population services.
The purpose of this year’s Report is to update the public on the Community Health Needs Assessment Implementation Strategy; the strategies we’re employing to tackle the identified needs, whether opening new clinics, augmenting our staff, enhancing existing programs, or adding new ones. In establishing our priorities, we ask ourselves, “Who is not yet thriving?” and then find ways to enrich their experiences.
Improving healthcare access is being addressed through many initiatives, among them the recent establishment of Cheshire’s Family & Community Care clinic and Family Medicine Residency at our West Campus on Maple Avenue, continued access to telehealth and home health services, and other methods to reach and support patients in rural communities.
Behavioral health support begins with recognizing the
growing need for resources, expanding staffing to specifically address that need, embarking on a health promotions campaign to increase awareness of what’s available, and integrating resources across departments to solidify the continuity of care.
Substance use disorder prevention is closely tied to behavioral health, and we’re always looking for ways to boost education and awareness, offer risk assessments, and decrease the stigma of asking for help in a safe, supportive environment.
Our improvement commitment also calls for a focus on services we offer for the aging population in the Monadnock Region. This includes supporting healthy aging through resources that consider the specific concerns of older adults, and collaborating with community partners to pool our resources for the best outcomes.
In the following pages, you’ll read about the people and programs responsible for implementing our community benefit commitments to best meet the needs of our community. Together, we are working to lead our community to optimal health and wellness through our commitment to “clinical and service excellence, collaboration, and compassion for every patient.”
Joseph L. Perras, MD President and CEO
June 2024
Organizational and Community Context
Cheshire Medical Center is a unified physician-hospital organization and a member of the Dartmouth Health system. The hospital services the Monadnock Region of New Hampshire which includes 22 towns and the City of Keene in Cheshire County and 10 towns in western Hillsborough County.
In line with our mission statement, “To lead our community to optimal health and wellness through our clinical and service excellence, collaboration, and compassion for every patient, every time”, Cheshire Medical Center has a long
history of serving those who live and work in our area through community health improvement activities. Whether they be individual efforts — giving a talk in the community, serving on a local Board of Directors, doing a health-related activity in a local school — or large programs sponsored by the hospital, all efforts make a significant difference in the health status of our community. We also remain committed to serving as the healthcare safety net provider in our area by offering charity care and other financial assistance for members of our community who may be uninsured or are considered low-income.
Priority Health Needs Identified in the Greater Monadnock Region
Community Benefits Summary for Cheshire Medical Center, Fiscal Year 2023
In
Family & Community Care helps improve healthcare access for rural communities
As part of our goal to continually improve the health of the people we care for in the Monadnock Region, Cheshire Medical Center opened a new family medicine practice, Family & Community Care (FCC), at our West Campus location at 62 Maple Avenue in 2023. FCC is the primary care clinic associated with the Family Medicine Residency (FMR).
“It’s a remarkable achievement to start a new residency program with its own clinic — and the purest
“This is an excellent and logical step towards training the next generation of family physicians locally, and it will positively impact our community’s health and the future primary care workforce.”
Karl Dietrich, MD, MPH
Karl Dietrich, MD, MPH, chats with a patient at the new Family & Community Care space on Maple Avenue.
Director of Graduate Medical Education and Family Medicine Residency
Development Chris LaRocca, MD; Program Director Karl Dietrich, MD, MPH; and Program Coordinator Christine Symonds gather in Family & Community Care’s reception area on Oct. 9, 2023, opening day.
example of ‘growing your own’ from a workforce development perspective,” says Cheshire President and CEO Joe Perras, MD. “This academic component makes Cheshire more attractive to providers and allows us to train the next generation of primary care doctors. The City of Keene is a great place to live and work. I hope that having an opportunity to care for patients in the region and experience the breadth of the community will help us retain residents as part of our staff for the long term after their training is complete. This residency program is a game-changer for our region.”
The newly renovated patientfocused 25,000-square-foot space is designed to serve as an educational site for future family physicians through Cheshire’s FMR program, which welcomes the first cohort of
six residents this summer. The clinic is fully integrated with Cheshire Medical Center and the larger Dartmouth Health system, using the same electronic medical record system, patient portal, registration process, and billing department.
The full-service family medicine clinic provides primary care and integrated behavioral health services for patients of all ages, including newborn and pediatric patients. The new clinic has onsite laboratory facilities, so necessary lab tests are done at FCC as part of a visit. Expanded outpatient procedures — such as dermatologic, orthopaedic, and gynecological procedures — are also available.
Faculty physicians provide fullspectrum care to their patients at FCC and in the hospital. FCC complements the existing Family
Medicine team at Cheshire’s main campus, which currently serves roughly 45,000 patients.
The FMR leadership and clinical team includes Designated Institutional Official for Graduate Medical Education Cherie Holmes, MD, MSc; Program Director Karl Dietrich, MD, MPH; Director of Graduate Medical Education and Family Medicine Residency Development Chris LaRocca, MD; and Program Coordinator Christine Symonds.
Catherine Schuman, PhD, provides integrated behavioral healthcare for patients who have a primary care provider at FCC. (See page 6 to read other ways Cheshire is supporting behavioral healthcare.)
“We are thrilled to be the newest location for high-quality primary care at Cheshire,” Dietrich says. “This is an excellent and logical step towards training the next generation of family physicians locally, and it will positively impact our community’s health and the future primary care workforce.”
Family & Community Care
is open from 8 am to 5 pm, Monday through Friday, by appointment only.
To establish care at Family & Community Care, or to schedule an appointment, please call 603-354-6900.
To learn more, visit cheshiremed.org/FCC
Meeting patients where they are with behavioral health support options
If a Family Medicine provider at Cheshire Medical Center believes a patient might benefit from a consultation with a behavioral health specialist, the resources are there to support them.
“At our Family & Community Care clinic (FCC), I can be called in to do something called a warm handoff or shared care,” says FCC Director of Behavioral Science Catherine Schuman, PhD. “It’s a gift Cheshire gives the community to help patients get the care they need when they need it — while they’re in the
clinic. We know from this model that patients get better faster.”
Schuman’s role in meeting the mental health needs of the Monadnock Region is one example of the hospital’s priority of supporting community well-being through accessible care. Across Cheshire, programs are either in place or evolving to meet the community’s needs, including — but not limited to — Obstetrics and Gynecology (OB/GYN), Family Medicine, the Emergency Department, and beyond.
“About 80% of patients in need of mental healthcare will visit their primary care provider. Integrated care addresses mental health at a population level by responding to behavioral health needs already present.”
Rose Hitchings, PsyD Integrated Behavioral Health Consultant
While Schuman works specifically with FCC patients, Cheshire also has two embedded behavioral health specialists in the Family Medicine clinic at Court Street — Mary Buckley, LCMHC, and Jack Heddon, LCMHC — who also serve satellite clinics in Walpole and Winchester.
Continuity of care is important for practitioners and patients, as it ensures that needs are addressed while offering an extra layer of support for providers. Rose Hitchings, PsyD, is an integrated behavioral health consultant at Cheshire who works in OB/GYN. Integrated behavioral health, Hitchings says, is a care model that addresses mental health needs within primary care settings.
“Primary care is the first tier of medical intervention,” Hitchings says. “About 80% of patients in need of mental healthcare will visit their primary care provider. Integrated care addresses mental health at a population level by responding to behavioral health needs already present.”
All care providers are trained to make PHQ-2 inquiries — two basic questions that screen patients for frequency of depressed mood — to determine if further assessment is needed.
If so, the patient might receive a referral to psychiatry, information about available resources, or follow-up from a social worker.
Like Schuman, Hitchings may be called to an exam room to see a patient requiring support evaluation. In OB/GYN and Pediatrics, Cheshire also has doctoral-level psychiatry students, under Hitchings’ charge, who can offer consultation.
“It meets patients and providers where they are,” Hitchings says, “and provides immediate access and support to biopsychosocial needs.”
Overall, the goal is to make sure resources are available no matter where the patient is first seen. Though there is still work to be done to integrate care throughout the hospital system, Schuman appreciates the impact of collaboration in Family Medicine.
“I see positive outcomes with patients daily,” she says. “And I see it with physicians and providers because I can go in, take more time with a patient in distress, and the provider can go on with their schedules. At the end of the day, when we have patients who really just need extra care, we have worked together as a team.”
Working together: Community substance use disorder prevention
The American Hospital Association honored The Doorway at Cheshire Medical Center with the Dick Davidson NOVA Award in the summer of 2022, recognizing the “hospital-led collaborative efforts that improve community health.” The Doorway is a federal grant initiative that offers access points for substance use treatment services in New Hampshire.
“What (Gov. Chris) Sununu wanted was The Doorway to be a one-stop shop,” says Laurie Butz-Meyerrose, who
“Cheshire is very focused on community. This is one more opportunity to reach out and offer a stepping stone to getting treatment.”
Laurie Butz-Meyerrose, MS, LCMHC, MLADC Director of The Doorway
Laurie Butz-Meyerrose, MS, LCMHC, MLADC – Director of The Doorway through May 2024.
directs The Doorway at Cheshire. “He wanted people to be able to call directly and say, ‘I am, or I have a loved one, struggling with addiction. What do I do?’”
The goal at The Doorway is to see patients within 24 hours after they or a family member first reach out for help. Individuals are then screened and evaluated, and depending on what level of care is required, they may enter treatment within 48 hours. In addition, the program offers counseling, medication management, and professional and peer support services to facilitate recovery beyond the acute phase.
Butz-Meyerrose emphasizes the importance of supporting patients beyond their initial treatment, noting the close collaboration that exists between The Doorway, the Medical Center, and other community organizations, to provide comprehensive care for patients. She also acknowledges the link for many patients between behavioral health and substance use disorders.
“The real work doesn’t start until after a person has been in a treatment program,” Butz-Meyerrose says. “We’re fortunate to have really good relationships with many outpatient programs, plus we see them here at The Doorway. The end game is to refer them to community mental health, whether it’s Monadnock Family Services (MFS) or somewhere else, for long-term treatment.”
MFS’ Chief Medical Officer Mindy Asbury, MD, PhD, works closely with The Doorway. Since her arrival in the summer of 2023, Asbury has been working to divert patients from the Cheshire Emergency Department to outpatient resources and emergency response through MFS. She also helped open a specialty clinic at MFS to facilitate the treatment of opioid use disorder.
“We determined that we could create a better integration of services by having these two programs at MFS and The Doorway work side by side,” Asbury says. “We set up a clinic time so individuals receiving Sublocade (buprenorphine)
What if someone I care about needs help?
Whether you are seeking help for yourself or a loved one or are simply looking for information and resources related to drugs or alcohol, The Doorway is the right place.
To contact The Doorway, call 211 anytime or visit 24 Railroad Street in Keene, Monday through Friday, 8 am to 5 pm.
To learn more, visit cheshiremed.org/doorway
injections come when we have our addictions prescriber and nurse available. We have all the systems in place, so we can be more efficient in the way we deliver care in tandem with The Doorway.”
Between 2019 and 2022, The Doorway saw an increase of 380% in average monthly appointments, a strong metric of the growing needs of the local population. Both Butz-Meyerrose and Asbury stress efforts to continue streamlining the process of treatment through multiple pathways between The Doorway and MFS. Integration of services, Asbury says, is essential to the goal of reducing barriers to care.
“Cheshire is very focused on community,” ButzMeyerrose says. “This is one more opportunity to reach out and offer a stepping stone to getting treatment. If you need a higher level of care, the Medical Center is here, but in the meantime, The Doorway can support you as another arm in that community partnership.”
Case Management team helps put patients first — especially for aging population
Jaime King, MSW, refers to the work of care managers who coordinate integrated care for hospitalized patients at Cheshire Medical Center as a behind-thescenes effort. They are part of an interdisciplinary team of medical staff involved in each case.
“We are an integral part of a patient’s hospital stay,” says King, who manages the Inpatient Care Management team, “because we help navigate each patient’s complex needs and connect them to resources that will best support them.”
In addition to King — who works closely with Senior Director of Acute Care and Care Management Tiffany Boyd, MHA, RN, ACM-RN — the Care Management team includes nurse case managers and social workers devoted to meeting patients, consulting with families, and coordinating efforts to ensure a plan is in place that best addresses the needs of the patient and their caregivers. They work collaboratively with members
of the patient’s care team across multiple hospital departments to ensure a coordinated and successful strategy.
Cheshire offers integrated services to all patients; however, the team approach is vital for older adult patients and their families to help them navigate challenges by connecting them with the right resources based on their specific needs amidst an extensive network of options.
The Care Management team, Boyd says, ensures access to appropriate healthcare services for the aging population by coordinating comprehensive personalized care plans that address medical, emotional, and social needs. Beginning with an introduction to a bedside nurse, Care Management connects individuals with local medical providers and social services, ensuring continuity of care and reducing barriers to treatment.
“By offering education and resources to patients and caregivers, they promote the development and maintenance of healthy habits.”
Tiffany Boyd, MHA, RN, ACM-RN Senior Director of Acute Care Services & Care Coordination
“By offering education and resources to patients and caregivers,” Boyd says, “they promote the development and maintenance of healthy habits.”
Advocacy is the goal when it comes to meeting patients’ precise needs. King shares a recent example of an older adult who required a prolonged inpatient experience. His care manager listened to his concerns, including the anxiety of remaining away from his wife, and advocated for him to get acute inpatient rehabilitation at Cheshire
“Success comes when the patient doesn’t have to worry about the next steps because we are helping with the follow-up to make sure they have the best outcome.”
Jaime King, MSW Manager of Inpatient Care Management
rather than at a nursing home.
“She was calling his wife and helping her follow up with the insurance, following up with his provider, establishing what care he might need after release,” King says. “I credit the whole system at Cheshire for putting patients’ needs first.”
Help does not stop after a patient leaves Cheshire. The Care Management team coordinates all referrals and discharge information after a hospital stay. This might include helping patients transition to a higher level of care in assisted living or a nursing home, setting them up with equipment and supplies ordered by a healthcare provider, or connecting them with other services.
“Success comes when the patient doesn’t have to worry about the next steps because we are helping with the follow-up to make sure they have the best outcome,” King says.
580 Court Street, Keene, NH 03431
Examples of Community Benefits from the Center for Population Health
Cheshire’s Center for Population Health provides support to all 33 municipalities in southwestern NH to advance the health and well-being of the region. Some of this work includes supporting schools, worksites, faith-based partners, coalitions, and others to support population health improvement based on community health needs and other specific community requests.
This map highlights the reach of some of our longstanding signature offerings. These valued resources are provided to our community at no cost as a community benefit offered through Cheshire Medical Center, allowing for a more equitable distribution of resources throughout the region.
* Indicates area with highest opportunity for positive impact on health according to social and demographic data sources
were delivered to area homes across the Monadnock Region