While other rural health care systems falter, Coos County Family Health-Androscoggin Valley Hospital alliance shores up access to health care
By Kelly Burch-Granite State News Collaborative
Sue Bergquist is 80 and dealing with multiple health issues that have her seeing an oncologist, neurologist and neurosurgeon, along with other providers. That is stressful enough, but Bergquist was also deeply worried about how she’d get from her home in Berlin to all those appointments, which can be up to three hours away.
Earlier this year, one of her providers put her in touch with the Great Northwoods Community Foundation, which was able to help arrange Bergquist’s transport, providing much-needed relief.
“Just knowing I don’t have to deal with the rides — that takes a burden off of me,” Bergquist said.
The Great Northwoods Community Foundation emerged in 2019 through a partnership between Androscoggin Valley Hospital in Berlin and Coos County Family Health, a federally qualified health center with locations in Berlin, Gorham and Colebrook. For more than 20 years, the hospital and the health center have had a collaboration in which they share space and staff.
Recently, in the face of changes to Medicaid, the partnership has provided a sense of financial security to the health center. Leaders at both institutions say the partnership has benefited their organizations and the surrounding communities, shoring up access to health care at a time when rural health care systems are too often faltering.
“The collaboration has been really critical,” said Ken Gordon, CEO of Coos County Family Health. “We’ve been able to achieve some things we wouldn’t be able to on our own.”
Leveraging federal funding structures
To understand the partnership, it’s helpful to have some context about health care funding.
An American flag flies in the wind in front of the Coos County Family Health Service clinic, in Berlin, New Hampshire, on Thursday morning, Sept. 18, 2025. (Photo by Daniel Sarch)
Rural hospitals, like Androscoggin Valley, are often on tenuous financial footing. According to KFF, a nonprofit focused on health care policy, 44% of rural hospitals were operating at a loss in 2023, the most recent year for which data are available. This is one factor that’s contributed to the consolidation of hospitals in New Hampshire and other rural states.
This is true for many reasons, yet perhaps the biggest factor is Medicaid. Medicaid covered 53% of hospital discharges in rural areas in 2023, according to KFF, compared to 45% in urban areas.
Medicaid, a government health insurance program, is notorious for its low reimbursement rates. Most rural hospitals lose money providing care to Medicaid patients, according to the American Medical Association.
Federally qualified health centers (FQHCs) like Coos County Family Health are funded primarily by a federal grant known as a Section 330 grant. The grant allows FQHCs to be paid more than other health providers for treating Medicaid or Medicare patients.
Given the different payment structures, leaders at the hospital and the health center realized back in 2003 that it was more advantageous to have the health center deliver the North County’s primary care, rather than the hospital.
Primary care "was a loss center for the hospital, but a win for [Coos County Family Health’s] structure,” said Kris McCracken, president and CEO of Amoskeag Health, an FQHC in Manchester.
A ‘symbiotic’ relationship
Together, the institutions had “an opportunity to leverage the FQHC funding mechanism,” said Michael Peterson, president and CEO of Androscoggin Valley Hospital.
The hospital stopped delivering primary care, instead shifting staff and patients to the health center. Today, the health center provides primary care to about 13,000 patients in the North Country, Gordon said.
The shift in primary care allowed both institutions to improve their finances, Peterson said, and also cut down on competition between the two organizations in a region that didn't have the population to support two primary care systems.
Cecile Belanger, 58, left, and medical social worker Bridget Laflamme laugh while sitting together in a social determinate office at the Coos County Family Health Service clinic in Berlin, on Thursday morning, Sept. 18, 2025. Belanger says she visits the clinic for primary care other health services due to her narcolepsy, which prevents her from working. Laflamme works with Belanger to get assistance through the Great Northwoods Community Foundation. (Photo by Daniel Sarch)
“The power of collaboration and partnership … is more valuable to the mission of either organization than trying to go head-to-head and compete,” Peterson said. “We had to take the egos out of the situation and realize we need each other."
At the time, the hospital committed to providing the health center a community benefit grant annually for 20 years, in part to cover the cost of starting the primary care program. The grant was initially $1.5 million annually, but decreased over time, Peterson said.
Today, with that agreement expired, the relationship between the health center and the hospital is “symbiotic,” Peterson said.
“Each of us depend on the other for the good of delivering on our mission,” he said.
The organizations rent space from each other: The health center rents office space in the hospital to deliver primary care and express care, and the hospital rents lab space in a clinic that the health center owns. The hospital provides space at no charge for the health center to run a dental clinic in Colebrook.
“We wouldn’t have a dental clinic there if it weren’t for that,” Gordon said.
The organizations also share staff, which is especially beneficial to the health center, Gordon said. Community health centers often can’t compete with the pay that hospitals can offer. Without the partnership, the health center “probably wouldn’t have gotten these candidates,” Gordon said, including a recent hire who is working as a hospitalist and primary care provider.
This year, the partnership has provided another benefit to the health center. Since the center serves the entire community, it has a higher proportion of patients with private insurance than many other FQHCs. That could provide some insulation against federal changes in Medicaid funding.
“We’re less reliant on Medicaid than other FQHCs who predominantly serve people with Medicaid,” Gordon said. “It’s advantageous.”
Hiccup in the relationship becomes an opportunity
Physician assistant Maryanne Christiansen with patient Kimberly Mulroney, 61,at the Coos County Family Health Service clinic in Berlin, New Hampshire, on Thursday morning, Sept. 18, 2025. Mulroney has been a longtime patient with the health clinic, and comes in regularly for primary care appointments. (Photo by Daniel Sarch)
The partnership hasn’t always been without challenges, however. Over time, the grant provided by the hospital became a sticking point. Neither Peterson nor Gordon was leading their organizations during the initial negotiations, but they were tasked with renegotiating the terms of the grant in about 2016.
At that point, “the FQHC was financially solvent, and the hospital margins were getting thinner and thinner,” Peterson said. That change made it difficult for the two sides to agree on a grant amount. Negotiations stalled with a $90,000 difference in what the hospital was willing to provide and what the health center would accept.
That’s when Gordon and Peterson met up at a local diner. They realized that each organization was impacted by uncompensated care — care delivered to people who couldn’t pay. One way to ease that burden would be through addressing social determinants of health — factors such as transportation and access to nutritious food that contribute to poor health outcomes before someone even sets foot in the hospital or clinic.
The two formed an idea, which they later brought to their respective boards: They would agree to a smaller grant between the hospital and FQHC, and each organization would contribute seed money to form an organization to address social determinants of health. That was the start of the Great Northwoods Community Foundation — the same organization that’s helping Sue Bergquist secure rides to her appointments.
The foundation began operation in 2019, and has helped with everything from getting air conditioners to people with breathing challenges to building wheelchair ramps, Peterson said.
“That’s one of the most proud accomplishments I can point to over the 10 years we’ve been working together,” he said. “That was significant, to turn a challenge into an opportunity.”
Benefiting the community
Peterson says the relationship between Coos County Family Health and Androscoggin Hospital is unique in New Hampshire.
“Typically FQHCs and hospitals have traditionally butted heads,” he said. “They’ve been at odds.”
Team coordinator Shannon Young speaks with a patient over the phone at the Coos County Family Health Service clinic in Berlin on Thursday morning, Sept. 18, 2025. (Photo by Daniel Sarch)
And yet, the relationship also shows the way that collaboration can lead to two health care organizations having a bigger community impact than either could have on their own.
Community members see that when they’re getting dental cleanings in Colebrook, being cared for by staff who were attracted to the dual roles available with the hospital and clinic, or taking advantage of the Great Northwoods Community Foundation.
“I don’t know what I’d do without this program,” Bergquist said. “I really don’t.”
She’s just one example of the significance of the partnership, Gordon said: “There are lots of examples of how the collaboration has benefited the community.”
This story is part of Critical Condition: What hospital consolidation means for care, access, and your community, a special series co-produced by partners in the Granite State News Collaborative. These stories are being shared by media outlets across New Hampshire. We want to hear from you! Take our short survey at https://tinyurl.com/3au39uct about your healthcare experiences. For more information, visit collaborativenh.org.