One billion dollars over five years. That is the scale of federal investment heading to New Hampshire through GO-NORTH, a new rural health program whose director laid out an ambitious vision this week for fundamentally reshaping how the Granite State delivers healthcare to its most underserved communities.
Donnalee Lozeau, the program’s director, outlined GO-NORTH’s goals at a meeting of the New Hampshire Public Health Association held at the McAuliffe-Shepard Discovery Center in Concord. Her message was direct: the money alone will not solve the problem if the underlying system remains unchanged.
“It’s not just about spending the money,” Lozeau told attendees, as reported by the New Hampshire Bulletin. The goal, she emphasized, is transformational and long-term change that creates sustainable health access for rural residents who have gone without it for too long.
A System Built for Illness, Not Wellness
At the heart of Lozeau’s presentation was a frank assessment of what the current healthcare system actually does versus what it should do. New Hampshire’s existing approach, like much of the country’s, is fundamentally reactive. People get sick, seek treatment, and the system responds. Prevention, early intervention, and sustained wellness are afterthoughts.
“Our current system is designed to treat illness, not consistently keeping people well or healthy,” Lozeau said.
She described the system as fragmented and volume-based rather than value-based. Providers are incentivized to see more patients and perform more procedures rather than to keep communities healthy over time. For rural New Hampshire, where access to any provider can require long drives and where specialist care is often unavailable locally, this model is especially punishing.
What GO-NORTH Intends to Change
The program’s framework centers on several key shifts. First, moving from reactive care to proactive health management, meaning investments in prevention, screening, and community health infrastructure rather than just hospital beds and emergency departments.
Second, GO-NORTH aims to address the fragmentation that plagues rural healthcare delivery. Patients in rural communities often navigate a maze of disconnected providers, traveling to different towns for primary care, mental health services, and specialty treatment. The program envisions better-coordinated systems that meet patients where they are.
Third, the initiative seeks to transition from volume-based to value-based care models. Under this approach, providers would be measured and compensated based on patient outcomes rather than the number of services rendered. This shift has been discussed in healthcare policy circles for years but has been slow to materialize in rural settings where financial margins are already razor-thin.
The Scale of the Challenge
New Hampshire’s rural health challenges are significant. The state’s northern counties, including Coos, Grafton, and Carroll, have aging populations, limited provider networks, and some of the longest travel times to care in New England. Hospital closures and consolidations in recent years have only deepened the gaps.
Mental health and substance use disorder treatment remain critically undersupplied in rural areas. The opioid crisis hit New Hampshire’s rural communities particularly hard, and while progress has been made, access to medication-assisted treatment and behavioral health services remains uneven.
Workforce shortages compound every other problem. Rural practices struggle to recruit physicians, nurses, and behavioral health professionals who can find better compensation and more resources in urban settings. Without addressing the workforce pipeline, even a billion-dollar investment risks building infrastructure that has no one to staff it.
Making the Money Count
Lozeau’s emphasis on sustainability suggests an awareness that federal funding is temporary by nature. Five years of investment can build something lasting, or it can create programs that collapse the moment the money stops flowing. The distinction often comes down to whether the funding builds capacity, such as training local providers and establishing systems, or merely subsidizes services that depend on continued outside support.
The GO-NORTH program represents one of the largest federal healthcare investments New Hampshire has ever received. How effectively the state deploys those resources will shape rural health access for a generation. For ongoing coverage of healthcare developments across the Granite State, the New Hampshire Review will continue tracking this story.
