Health Care Solutions Must Go Beyond Medicine to Meet Community Needs
In the wake of recent clinic closures, workforce shortages, and rising healthcare costs, a consumer protection advisory commission gathered Claremont residents last month to explore healthcare consumer needs in the region and examine the impacts of a 2024 hospital merger on the community. Held on July 23rd, the meeting was convened and led by the New Hampshire Healthcare Consumer Protection Advisory Commission (HCPAC). Community members and employees and affiliates of Dartmouth Health identified a range of local health needs that go beyond medicine. ”People are making hard decisions [about what they can afford] right now,” one speaker noted - highlighting that competing essential priorities of housing, childcare, transportation, and food security are needs that are prevalent and difficult to meet in the community.
A crowd of around 50 people gathered at the Claremont Savings Bank Community Center, with another dozen people online, and shared feedback and testimonials about healthcare consumer needs in the region.
Community Health Investments Needed Beyond the Hospital
“Health happens outside the four walls of a hospital,” said Matthew Foster, MD, Interim CEO and President of Valley Regional Hospital. That sentiment echoed throughout the night as residents raised concerns that reach far beyond medical office visits: housing, nutrition, mental health, and transportation were all identified as critical social determinants impacting health and well-being.
State Representative Hope Damon shared data from the latest Southwest Community Needs Assessment, which corroborated the concerns shared by many attendees:
82% said housing is a primary concern,
40% said financial assistance for housing was a critical need
Under 40% reported that the cost of food was a barrier to their quality of life and well-being,
32% said there were not enough mental health services,
32% cited insufficient access to childcare,
1,257 households currently receive SNAP benefits in Sullivan County, with 1,189 additional households qualifying for SNAP that are not enrolled.
Greg Norman, Senior Director of Community Health at Dartmouth-Hitchcock, highlighted findings from the region’s tri-annual Community Health Needs Assessment, which consistently shows that basic social needs—such as housing, transportation, childcare, and food—are in direct competition with health care for limited household resources. These overlapping cost pressures make it even harder for residents to access and afford healthcare. The assessment underscores the critical need for stronger partnerships between healthcare providers and social support services.
Access to Primary Care and Community Health Workers Identified As Pressing Rural Needs
Sullivan County is confronting growing health care challenges that mirror the broader struggles of rural communities across New Hampshire. Valley Regional Healthcare (VRH) once operated an urgent care center in Charlestown, which closed in 2020 during the height of the COVID-19 pandemic and never reopened. The region took another hit in 2022 with the closure of the Planned Parenthood clinic in Claremont, ending more than three decades of access to essential public health services. This shutdown created a significant gap in primary and reproductive care, particularly impacting women, LGBTQ+ individuals, young people and low-income residents who relied on the clinic for affordable, consistent care.
A recurring theme throughout the discussion was the lack of access to consistent, community-based primary care, which leaves many rural residents relying on emergency services as their first, and sometimes only, point of contact with the healthcare system.
NH State Senator Sue Prentiss, drawing on her experience as a longtime paramedic at VRH, noted: “For many in rural New Hampshire, Emergency Medical Services and the Emergency Room are the front doors to care because there’s no primary care relationship, or they’re uninsured.” She emphasized that this is not only costly but unsustainable, particularly as services like the local Planned Parenthood, once a key provider of reproductive and preventive care, have closed, leaving even more gaps in access to care.
Transportation to medical and social service appointments was identified as a major challenge for Claremont’s predominantly senior and low-income populations. This is compounded by social isolation, with some noting that many see their health care provider as their only regular source of social contact each week.
Former Claremont Mayor Charlene Lovett reinforced that preventive care isn’t reaching people early enough. “There are real competing priorities in this community,” she said. “We need support for prevention and early screenings. Bring mobile clinics to where people already are.”
Community Health Workers (CHWs) were widely recognized as a vital bridge to primary care, especially for isolated or underserved populations. However, because CHW services are not currently reimbursed by insurers, their reach remains limited. Several speakers urged the Commission to support policy changes that would allow for sustainable funding of CHW programs, recognizing them as essential to expanding access to care and reducing reliance on emergency departments. Others urged that patients have access to more resources to navigate the health system changes and understand what the financial implications are of each service, given that insurance premiums and cost-sharing and deductibles are all on the rise.
Mergers and Partnerships: “We’re Stronger Together”
A key topic of the evening was how the Dartmouth Health–Valley Regional affiliation is playing out for Claremont. Many spoke positively about expanded services, stronger infrastructure, and the promise of long-term sustainability. Recently, Valley Regional Hospital broke ground on a new $20 million Medical Office Building, a project expected to bring expanded primary care, outpatient service, and updated facilities to serve the region. A new substance abuse treatment center is also one of the terms of the merger. Representative Damon stressed the importance of accountability from the Attorney General to ensure that the promises for health care investments made to the Claremont community are on track and ultimately fulfilled.
Executive Councilor Karen Liot Hill, who represents the district, pointed to improvements already underway: the addition of a board-certified OB/GYN, expanded labor and delivery options, and a new facility currently under construction. “The merger appears to be promising,” she said, but also emphasized barriers to access: “In a rural community, public transportation is limited, and getting to the hospital is a challenge.”
Building the Workforce We Need
One of the most urgent themes was the shortage of health care workers. Gary Merchant, a longtime Claremont resident and pharmacist who has worked at both Dartmouth and Valley Regional, noted that while the region trains hundreds of students in healthcare fields through River Valley Community College, many can’t stay and serve the region due to a lack of affordable housing or a reliable transportation system.
Speakers proposed incentives like stipends, tuition support, or housing partnerships to help students stay local. One speaker suggested that Valley Regional’s unused third floor could be renovated to house student nurses, solving both a workforce and a housing issue at once.
Commission members acknowledged that healthcare workforce challenges exist statewide and referenced the important role that Healthforce is playing in the state, building resources and resilience for the healthcare workforce.
What’s Next?
While mergers and affiliations can bring stability and resources, they can also shift the dynamics of access, trust, cost, and care delivery—especially in rural communities. Attorney General John Formella highlighted the importance of holding Dartmouth Health accountable for the legal promises made at the time the transaction was approved. These conditions are intended to maintain focus on local needs. He also identified a key resource of the HCPAC going forward that will be available to help communities like Claremont: the Healthcare Consumer Protection Trust Fund.
This newly established fund is a tool the Commission can use to invest in programs and strategies to benefit healthcare consumers throughout the state, including those in communities in which major health system transactions occur. Through forums like this one, the Commission is better positioned to assess consumer impact and advise how those dollars should be invested, and it has plans to continue these public sessions in communities across New Hampshire.
Whether it’s funding mobile services to enhance primary care, supporting community health workers and patient navigators, addressing social determinants, replicating transportation programs from other towns, or investing in local workforce development, the message from Claremont was clear: Health care solutions must meet people where they are. Real change to improve access and lower costs will require continued public input and accountability, creative partnerships, and sustained investment in the building blocks of health—inside and outside the hospital walls.
