Following adjustments and agreed-upon commitments, the New Hampshire Attorney General has said it will back Dartmouth-Hitchcock Health’s (D-HH) proposed merger with Valley Regional Healthcare and Valley Regional Hospital (VRH).

The organizations announced in 2022 that they would come together under Dartmouth Health, the largest health system in the state, but the deal raised concerns with many, including NH Attorney General John Formella who found it would substantially lessen competition in Sullivan County and create a monopoly for inpatient general acute services.

Under a revamped agreement, D-HH has agreed to implement measures to protect consumers, including providing the remaining necessary capital for building a new medical office building at VRH and funding and operating an addiction treatment center there for at least ten years. It will also maintain essential services there for the same amount of time and pay $2 million to the Health Care Consumer Protection Trust Fund, which will be used to help New Hampshire patients.

Formella approved the deal following separate reviews by the Charitable Trusts Unit and Consumer Protection and Antitrust Bureau to evaluate its likely competitive impact. Both found that the transaction substantially complies with the terms of the healthcare charitable trust change-of-control statute.

“These and other commitments will protect competition and ensure patients can access essential healthcare closer to home. We thank the parties for coming to the table to negotiate this resolution, and we look forward to seeing the numerous benefits promised by the parties delivered to New Hampshire consumers,” said Formella in a statement.

D-HH’s flagship facility, Dartmouth Hitchcock Medical Center is located in Lebanon, and it also has two community hospitals, three critical access hospitals, and physician practices across the state. The health system provides more than 80% of inpatient hospital services to Sullivan County residents and owns most of the surrounding hospitals, according to New Hampshire Public Radio (NHPR).

Valley Regional Hospital has been an independent critical access hospital in Claremont since the 1890s but recent financial challenges have pushed it to search for an affiliated partner.

Along with the clinical care commitments made by D-HH, the parties have agreed to prohibitions on certain anticompetitive contracting terms and practices with commercial health insurers, and to protections for physicians and mid-level providers regarding restrictive covenants. They will also not interfere with patient referral patterns and treatment decisions; develop a clinical services growth Plan to bring additional services to the Claremont community; and publish an annual report for the public that demonstrates their compliance with the terms of the final judgment for the deal.

“The two organizations share a strong commitment and a history of collaboration in providing the best care to the people of our state and the region, and believe that regulatory clearance by the attorney general is a testament to the fact that this arrangement promises to improve healthcare delivery for the greater Claremont community and residents in Sullivan County,” said D-HH and VRH in a statement.

Formella has filed the fully negotiated proposed Final Judgment in the Merrimack County Superior Court, which will now evaluate and determine whether or not to approve it.

If passed, the deal is expected to close in July, reported NHPR.

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