Ask the Experts: The evolution of healthcare in New Hampshire

As New Hampshire healthcare providers and healthcare facilities slowly move on from the Covid-19 pandemic and navigate the “new normal” of healthcare delivery throughout the state, they continue to improve their delivery systems with the lessons learned.

So, what does post-pandemic healthcare look like in 2022 as New Hampshire’s healthcare providers look to turn the page to a new chapter? Three of the state’s largest healthcare providers weighed in on this important topic.

Our panel:

• Kathryn “Kate” Skouteris, Vice President of the New Hampshire market for Harvard Pilgrim Health Care, a Point32Health company.

• Connie J. Ouellette, a Principal in BerryDunn’s Healthcare and Not-For-Profit Groups and leads the Hospital Practice area.

• Alison Gnerre, a clinical trials nurse at St. Joseph Hospital


Kathryn “Kate” Skouteris, Vice President of the New Hampshire market for Harvard Pilgrim Health Care, a Point32Health company


Q: How is the delivery and access to healthcare improving in New Hampshire?

A: Within all the healthcare advances this year, keeping at-risk populations top of mind will be a primary focus. New Hampshire is regarded as one of the healthiest states in the nation. However, regional disparities exist within the state, specifically the northern most region of the state.

Northern New Hampshire has a total population that is comparably lower than the rest of the State — approximately 19 persons per square mile — and faces greater economic stability, geographic isolation, generational poverty and access to medical, dental and mental health care. These areas often depend on funding from federal agencies for transportation, telecommunication and other development projects. As a nonprofit health plan dedicated to improving the health of New Hampshire communities, innovative community support between Harvard Pilgrim Health Care and providers to address health disparities by increasing health awareness and education and providing easier access to care directly within these rural areas will continue to help to bridge gaps in equity and bring better health to these communities.

Two-plus years of living with the pandemic has also shown the many ways that remote healthcare and virtual doctor visits can be a convenient and efficient means of receiving care. As technology continues to evolve, using it to find ways to improve healthcare access and delivery for all will be just as important. Our state has made strides in expanding access to telehealth for both physical and behavioral healthcare — vital work in helping to support the efforts to bring high-quality care into all our communities across New Hampshire.

Q: How can New Hampshire employers approach an evolving health benefits landscape?

A: Amid the Great Resignation and burnout in the workforce from two years of the pandemic, well-being has been and will continue to be a primary focus in 2022. This year, employers should continue to grow their wellness offerings to address more holistic well-being , and include resources and support that emphasize their employees’ physical, emotional and financial health.

Mental and behavioral health support for employees continue to be top of mind when it comes to health benefits. Enhancing access points to care and services is important as we continue to better understand the impact and relationship between physical and mental health — mental health care is healthcare.

Broadening the range of family-friendly health benefits also makes good business sense for New Hampshire employers, especially in today’s tight labor market. Recent studies have revealed that nearly half of employees cite benefits as an important reason for joining a company — 46 percent would be willing to forgo a bump in share for enhanced health benefits.

The definition of family has also evolved significantly. According to the US Census Bureau’s American Community Survey in 2019, married couples with children under 18 account for just 19 percent of households. These numbers show that nontraditional families, including single parents, LGBTQ+ parents and grandparents raising grandchildren, are redefining what families look like, and employers should be taking note.

We’re hearing more from employers about the growing number of employees that are falling into the “sandwich generation,” which is how the nearly one in five Americans providing care to adult family members are being described. Balancing work and caregiving responsibilities can be overwhelming for individuals, and as a health plan, we’re proactively exploring ways to support those in a caregiving role with both mental health resources and with support in accessing and navigating care options for their loved ones.

We are also stressing the importance of health literacy and understanding of benefits when it comes to our employer accounts — 40 percent of low-wage earners are covered by private health insurance. A recent study by Harvard Pilgrim Health Care’s plan decision support partner MyHealthMath showed that, of this group of workers, 43 percent are likely to have children, and slightly more than half are the sole earners in their families or make major contributions to the family income . Individualized plan decision support — a service offered by Harvard Pilgrim Health Care through MyHealthMath — is a valuable addition to an employee benefits package that employers may want to consider to help deter individuals from “over-insuring” by analyzing the employee’s unique healthcare utilization needs and helping them to choose the most cost-effective health plan for them.

As the definition of families continues to evolve, employers that prioritize expanded health benefits to meet diverse family needs will have a tangible advantage as they compete to attract and retain top talent.

These emerging trends will shape both the healthcare industry and health benefits in the year ahead. By taking note, employers and brokers alike can be prepared to support their workforce, and we are prepared to partner with them every step of the way.


Connie J. Ouellette, a Principal in BerryDunn’s Healthcare and Not-For-Profit Groups and leads the Hospital Practice area


Q: What challenges has BerryDunn helped healthcare clients overcome during the pandemic to today?

A: The CARES Act legislation was released early in the pandemic and encompassed an enormous amount of complex funding sources and relief measures to healthcare providers in which to navigate the related requirements and stipulations.

For much of the intensity of the pandemic, we kept well informed of the everchanging regulations, interpretations and guidance in order to be able to advise our clients, and serve as valuable and readily accessible resources to help them make their day-to-day decisions while managing limited resources.

Once the funds were dispersed and relief measures exercised, it became about remaining in compliance with the underlying regulations and conditions. As with most everything during Covid, there were a lot of “first times we’ve all been through this,” and much of the regulations and guidance evolved as time passed, leaving a lot for interpretation and arriving at reasonable approaches. Oftentimes, there seemed to be no logic, which created frustration for both healthcare leadership and advisors.

When we are not talking all things Covid, we look to make our clients’ lives easier, whether by streamlining our requests, helping them meet deadlines, providing staffing resources when appropriate, or being a sounding board or sanity check, particularly at the sustained heightened level of work they have all ended.

Q: How do you communicate new laws and policy changes to clients? How do you approach new strategies for healthcare providers?

A: We know our clients receive a lot of email and that there can be a lot of other noise out there with other parties trying to get messages through. We are very purposeful in communicating with our healthcare clients, keeping our updates brief and focused on what our clients need to know from our world that impacts them, whether we are sharing new information or best practices.

By being brief and focused, with such distributions as our Hospital Insights, we save them time in absorbing the high points or provide them a resource they can refer back to when a need arises. Our goal is to be a valuable resource that filters through all the emails and noise our clients experience during their busy days.

Q: How has your work with your clients been impacted during the pandemic to today?

A: We’ve learned we can audit remotely. Although we are very accustomed to traveling and working in many different spaces, going entirely remote was probably unfathomable when we initially headed to our homes to work.

Like everyone else, we figured it out, and with learning curves and patience we successfully completed engagements, whether audits or consulting projects.

For our healthcare practice, it has been a slow return to working at our clients’ locations as they continue to provide care in safe environments. Similar to the working from home/remote debate, some of our clients love it and others are anxious to see us back in person.


Alison Gnerre, a clinical trials nurse at St. Joseph Hospital


Q: Has St. Joseph Hospital ever conducted clinical trials?

A: Yes! For over two decades, St. Joseph Hospital has been conducting state-of-the-art clinical trials in oncology.

Q: Do clinical trial participants get placebo medications?

A: No, we conduct Phase II and Phase III trials. Phase II addresses the new medication’s efficacy. Phase III trials examine the benefit of the new drug over the current standard of care.

st. Joseph Hospital patients will always receive standard-of-care medications. Patients in the study arm of the trial will receive standard of care plus a study medication.

Q: Who covers the costs associated with a clinical trial?

A: Under the Affordable Care Act, insurers, including Medicare, are prohibited from limiting coverage for a patient participating in a trial. In many studies, the medical costs not paid for by insurance will be covered by the study.

Q: Once a patient signs an informed consent, are they committed to trial participation until the trial ends?

A: no. A patient has the right to leave a clinical trial at any time for any reason. The patient will continue to receive the highest standard of care available.

Q: Are clinical trials a last resort for patients when all other treatments have failed?

A: No, a cancer patient may participate in a clinical trial during any phase of their disease. This includes pre- and post-surgery, treatment, recurrence and survivorship. Patients who have a high risk due to family history are also eligible for trials.

Q: What benefit is there to joining a clinical trial?

A: Cancer treatments are constantly evolving. Patients who join a trial might gain access to a new treatment not available to patients outside the trial. All of our current standard-of-care therapies were once part of clinical trials. Trial participants benefit future cancer patients by helping to find better ways to diagnose, prevent and treat disease.

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