Dartmouth Health Spearheads In-home Primary, Palliative Care With $20m Gift

Dartmouth Health and the Geisel School of Medicine at Dartmouth are launching the Dartmouth Health at Home program, supported by a $20 million donation.

The new program will offer in-home primary care and palliative care, among other services. Dartmouth Health plans to grow the program over time, Dr. Nathan Goldstein, chair of Dartmouth Health’s department of medicine and co-CEO of Dartmouth Health at Home, told Home Health Care News in an email.

The Dartmouth Health at Home program will launch in January 2027 as a pilot, serving 10 to 20 patients. The organizations plan to grow the program over the next several years to serve over 1,000 patients and their families annually, according to Goldstein. At full scale, the program will employ approximately 30 clinicians and staff.

“The programs will all start locally, so we can adapt and refine the programs based on the feedback of the patients and caregivers that we serve,” Goldstein said. “Then, over time, we will expand the program across New Hampshire and Vermont, with the ultimate goal of serving all patients who receive care from Dartmouth Health.”

The Dartmouth Health at Home program is intended to revolutionize rural healthcare by expanding care access, improving patient outcomes and supporting patients and their families through a safe and effective shift of care from hospitals and ambulatory care settings to the home setting.

“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 told HHCN’s sister publication, HealthLeaders. 

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 aids.

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 to the home effectively and safely 

In shifting care from the hospital or ambulatory care setting to the home setting effectively and safely, interdisciplinary care teams are crucial, according to Goldstein.

“With Dartmouth Health at Home, we will have interdisciplinary care teams that include physicians, advanced practice providers, social workers and home health aides,” Goldstein said. “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 said.

Achieving financial sustainability and developing national model 

The Dartmouth Institute for Health Policy & Clinical Practice will help to ensure that the Dartmouth Health at Home program is financially sustainable, 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.

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 expects the program 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 said. “We think the programs we are building can be disseminated across the country.”

Advice for CMOs and other senior leaders 

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 will lead 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.”

Christopher Cheney, CMO editor at HealthLeaders, contributed reporting to this story.  

MK Manoylov, senior reporter at Home Health Care News, contributed reporting to this story.

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