Delivery System and Payment Reform

The Institute for Health Policy and Practice's efforts in the area of Delivery System and Payment Reform drives healthcare systems change to improve healthcare quality and support value-based payment.

For more information, contact Jeanne Ryer at

NH Citizens Health Initiative Annual Symposium

September 29, 2020

The NH Citizens Health Initiative annual Symposium  provided insights on the latest national health policy topics, and attendees discussed how to improve health care systems in New Hampshire. Read more

Projects and Initiatives

NH Citizens Health Initiative logo

The NH Citizens Health Initiative is a multi-stakeholder effort working to develop a healthy population and high-quality, cost-effective and accessible healthcare system for our state.

NH CHI provides leadership, convening, project management, and research support across the Pillar projects including:

  • New Hampshire Accountable Care Project: Transforming Systems through Shared Data and Learning
  • Health Promotion/Disease Prevention
  • Public Health and Clinical Integration Project through Tobacco Mitigation
  • MapNH Health Project

A group of people posing for a photo

The University of New Hampshire Department of Nursing and the Institute for Health Policy and Practice, Citizens Health Initiative received the Advanced Education Nursing Workforce grant through the Health Resources and Services Administration. The grant focuses on two areas: to address behavioral health issues and the opioid crises and limited providers caring for underserved and rural populations.

UNH will work with health care providers throughout New Hampshire to address the behavioral health and opioid crises. The grant will fund nurse practitioner students annually who will be immersed in high need areas of the state to strengthen the integration of primary and behavioral health.

This project provides traineeship/tuition reimbursement funds for longitudinal, immersive clinical training experiences with rural and underserved populations for primary care student nurse practitioners. Preceptors involved in the program will receive continuing education units (CEUs) through educational training on cutting edge topics, including value-based reimbursement, behavioral health, substance use disorder, and telepractice. They will be invited to participate in UNH Project ECHO® sessions, a virtual case-based all-teach, all-learn model. Preceptors can receive funds to attend additional conferences and trainings.


UNH is a Project ECHO Hub participant and has created the Partnership for Academic-Clinical Telepractice (PACT), which is led by the UNH Institute for Health Policy and Practice, NH Citizens Health Initiative. 

Learn More

NH Purchasers Group on Health logo

The NH Purchasers Group on Health is a Coalition of public purchasers working to improve quality and efficient, effective healthcare and share best practices on areas of benefits, wellness, and contracts. Institute for Health Policy and Practice (IHPP) provides facilitation and staffing for NHPGH to advance their goals, apprise them of best practices and market data, and bring in expert resources on a project-specific basis. For more information about the NH Purchasers Group on Health, call (603) 862-1128 or email

The NH Hospital Scorecard is sponsored by the NH Purchasers Group on Health; it highlights the quality and cost of healthcare in our state, and is an effort to get the public and the systems that provide medical care involved in a conversation about what we can collectively do to improve quality and cost.

The Accountable Care Project (ACP) Learning Network leverages a set of analytic reports developed by the Center for Health Analytics. The reports include measures of quality, utilization and cost across systems and regions. The reports are an important source of information for systems undergoing transformation to measure and compare their performance. The ACP analytic reports include two sets of report types:

  • The claims-based reports, driven by the NH Comprehensive Health Information System (NHCHIS) data, have both private access for participating organizations and a "public" access for non-participating health care stakeholders. The full report suite includes data for Commercial, Medicaid and Medicare populations.
  • The Electronic Medical Record (EMR) quality report is based on self-reported data from participating organizations. The aggregated median rates report provides a benchmark for comparison around key quality measures. Access to the EMR reporting tool is limited to participating partners.

The purpose of these reports is to provide data and analysis on which our Accountable Care Project Learning Collaborative can share learning and develop action plans that can be adopted by healthcare innovators in New Hampshire. The Accountable Care Project was formed with funding from the Robert Wood Johnson Foundation.

MapNH Health logo

The dynamic we-based resource, MapNH Health, projects the health and health system needs of New Hampshire in 2020 and 2030, based on current health outcomes and population projections. It is also a catalyst for conversation around the implications of shifting demographics and economics, disease burden, primary care demand, and what we can do in our state to ensure an adequate health future for all our residents.

NH Pediatric Improvment Partnership logo

The NH Pediatric Improvement Partnership (NHPIP) is a multisectoral collaborative of private and public stakeholders dedicated to improving child health through the use of measurement based quality improvement processes in primary care settings in NH. The NHPIP is coordinated by the Institute for Health Policy and Practice at UNH, with Medical Director leadership from the Children’s Hospital at Dartmouth. Examples of project work conducted by the NHPIP include:

  • Developmental Screening QI Learning Collaborative (Cohort 2): assisting NH pediatric and family practice clinicians in implementing developmental screening at the AAP recommended intervals of nine, 18 and 30 months.
  • Pediatric Neurology Telehealth Project: in collaboration with NH Family Voices, NH Special Medical Services, the Children’s Hospital at Dartmouth, and the Dartmouth Center for Telehealth, supporting up to four NH pediatric primary care practices with implementation of tele-consults and telehealth visits for children with epilepsy.
  • Delivery of Oral Preventive Health Services in Primary Care Settings Environmental Scan: assessing where and how to promote the optimal delivery of AAP recommended oral preventive health services in pediatric primary care settings in NH
  • HPV Vaccination QI Learning Collaborative (Cohort 1 & 2): assisting the National Improvement Partnership Network with recruiting NH pediatric and family practice clinics to participate in the HPV immunization quality improvement learning collaborative.

The NH Citizens Health Initiative’s Behavioral Health Integration Learning Collaborative (BHI LC) focuses on the integration of behavioral health in the primary care setting with a focus on depression, anxiety, and substance use disorders as they present in primary care. The BHI LC hosts in-person, webinar and phone conference call for learning content, information and data sharing and peer support; delving into topics such as different BHI models, Payment, HIT Integration and Using Data to Track Outcomes.

Northern New England Practice Transformation Network logo

The Northern New England Practice Transformation Network (NNE-PTN), a partnership between the New Hampshire Citizens Health Initiative at the University of New Hampshire Institute for Health Policy and Practice, Maine Quality Counts, and Vermont Program for Quality in Healthcare, Inc., will receive up to $15 million over four years to provide technical assistance support to help equip clinicians in New Hampshire, Maine and Vermont with tools, information and network support needed to improve quality of care, increase patients’ access to information, and spend healthcare dollars more wisely.

Rural Health Clinic Technical Assistance Network logo

The NH Citizens Health Initiative is pleased to be working with the NH Community Health Institute, under contract with the NH Division of Public Health Services, to develop and support a Technical Assistance Network for NH Rural Health Clinics. The network will equip Rural Health Clinics with the tools and resources necessary to effectively and efficiently serve their rural populations. The NH RHC Technical Assistance Network will provide support for NH RHCs specific technical assistance needs relative to practice management, RHC recertification, financial reporting, billing, data collection and reporting, and quality improvement. The network will also provide support for an RHC Hypertension Learning Collaborative, including clinical quality management reporting and quality improvement practices to improve hypertension clinical processes. Participating Rural Health Clinics will also have access to the Initiative’s Accountable Care Project reporting tools.

Resources and Publications

Quickstart Guide to Teleprecepting: An Interdisciplinary Guide for Conducting Successful Teleprecepting Patient Visits


Quickstart Guide to Teleprecepting: An Interdisciplinary Guide for Conducting Successful Teleprecepting Patient Visits
October 2020
Teleprecepting grants us the opportunity to continue to lead the next generation of providers in caring for patients across the care continuum. Regardless of whether telehealth is being used as an emergency stopgap or will become a tool for ongoing practice, we must not delay in leading the next generation of providers and incorporating students into the care continuum. 
read the report
Planning for Project ECHO in NH


Planning for Project ECHO in New Hampshire 
March 2020
Project Extension for Community Healthcare Outcomes (ECHO)is an evidence-based method using web-based teleconferencing to link specialist teams with community-based sites to help community providers improve their ability to manage complex conditions. It has been proven to improve health care outcomes for vulnerable populations with limited access to care because of socioeconomic factors or geography. The New Hampshire Project ECHO Planning for Implementation and Business Sustainability Project undertook a planning process to inform how to best develop Project ECHO at UNH to serve New Hampshire health and community care providers and ultimately improve access to effective, timely care. Also included is a business and sustainability plan for long-term success of the UNH Project ECHO Hub and an evaluation plan for measuring efficacy.
read the report
10 Steps for Improving Diabetes Care in New Hampshire: A Practical Guide for Clinicians and Community Partners


10 Steps for Improving Diabetes Care in New Hampshire: A Practical Guide for Clinicians and Community Partners
March 2020
In 10 Steps for Improving Diabetes Care in New Hampshire you will find an easy-to-follow stepwise format of practical, best-practice strategies that are feasible to implement in any primary care setting. These Strategies are applicable to planning for prediabetes, as well.
read the report
Addressing Childhood Adversity and Social Determinants in Pediatric Primary Care: Recommendations for NH


Addressing Childhood Adversity and Social Determinants in Pediatric Primary Care: Recommendations for NH
July 2020 
The Endowment for Health and SPARK NH funded the NH Pediatric Improvement Partnership to develop a set of recommendations to address identifying and responding to Adverse Childhood Experiences and Social Determinants of Health in NH primary care settings caring for children. Methods included conducting a review of literature and Key Informant Interviews. Themes from these were identified and the findings are summarized in this report.
read the report
Attention Deficit Hyperactivity Disorder (ADHD): Survey Report


Attention Deficit Hyperactivity Disorder (ADHD): Survey Report
December 2017
In the spring of 2016, the New Hampshire Pediatric Improvement Partnership conducted an online survey of NH pediatric and family practice clinicians to understand practice patterns, comfort level, and support needs relative to caring for pediatric patients with ADHD. Of the clinicians surveyed, 138 responded yielding a 13% response rate.
read the report
Telehealth and Mobile Health Applied to Behavioral Care: Opportunities for Progress in New Hampshire Report


Telehealth and Mobile Health Applied to Integrated Behavioral Care: Opportunities for Progress in New Hampshire Report
May 2017
This paper is an accompanying document to a webinar delivered on May 16, 2017, for the New Hampshire Citizen's Health Initiative. As integrated behavioral health efforts in New Hampshire gain traction, clinicians, administrators, payers, and policy makers are looking for additional efficiencies in delivering high quality healthcare. Telehealth and mobile health have the opportunity to help achieve this while delivering a robust, empowered patient experience. Combining technology-savvy consumers with New Hampshire's high rate of electronic health record technology adoption, a fairly robust telecommunications infrastructure, and a predominantly rural setting, there is strong foundation for telehealth and mobile health expansion in New Hampshire's integrated health continuum.
read the report
Integrating Behavioral Health& Primary Care in New Hampshire: A Path Forward to Sustainable Practice & Payment Transformation


NH Citizens Health Initiative Whitepaper Integrating Behavioral Health & Primary Care in NH: A Path Forward to Sustainable Practice & Payment Transformation
December 2016
In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative created the NH Behavioral Helath Integration Learning Collaborative, as part of its Accountable Care Learning Network (NHACLN). The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service revenues. As well, follow up work on prior developments of a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings.
read the report
Medical Home Evaluation


Medical Home Evaluation
November 2013
This study explored the specific nature of the Patient-Centered Medical Home models implemented across the nine pilot sites as well as the process of change enacted at these sites. The nine practices participating in the pilot varied with respect to their size, ownership, and history. The pilot sites are located across the state of New Hampshire, and vary in terms of the number of providers and the patient population served.
read the report
NH Public TV Special- NH Health Care: Is There Good News?


NH Public TV Special- NH Health Care: Is There Good News? 
February 2012
A look at what's being done in the Granite State to reduce health care costs while improving care for patients. Focused is the Medical Home Project initiative.
watch the video
NH Patient-Centered Medical Home Pilot Documentaries


NH Patient-Centered Medical Home Pilot Documentaries
February 2011
In 2008, The New Hampshire Citizens Health Initiative, in partnership with groups from all parts of the New Hampshire healthcare system, launched the Multi-Stakeholder Medical Home Pilot. Video series on the nine pilot sites throughout the state that are participating in the 2-3 year study of PCMH.
watch the series