Health care spending is high and rising in New Hampshire, and the state should consider holding both providers and insurers accountable for improving quality and containing costs, consultants hired by the insurance department said Friday.

The department hired Compass Health Analytics and University of Massachusetts Medical School researchers as part of a larger project to explore health care payment reform. According to their report, New Hampshire ranks in the top 10 states in health care spending per capita, in part because there is little competition among hospitals or insurance companies.

"Every single stakeholder we talked to expressed concern about the rising cost of health care in New Hampshire," said Katharine London of the medical school's Center for Health Law and Economics. "People were looking to the state to develop one unified vision for how New Hampshire should move forward to promote better health in New Hampshire, to improve quality of care and to contain costs."

At a forum Friday, London and the other consultants outlined several solutions, including having the state set health care cost and quality benchmarks, publicly identifying those who fail to meet them and developing incentives and consequences for performance.

For example, the state could set a target for growth in total statewide health expenditures per capita, tied to an economic indicator such as growth in state domestic product - goods and services produced in New Hampshire. Consequences, like publicizing failures or imposing fines, could get more severe over time.

The consultants also recommended the state promote arrangements that encourage providers to focus on efficiency and outcomes rather than volume.

Under the accountable care organization model, an organization - often a hospital or a physicians' group - coordinates health care for its entire community across the health care system, rather than just when a patient shows up at a facility. The focus is then on the patient's overall health and this preventative care may avoid costly hospital stays.

New Hampshire already has several accountable care organizations, but the consultants suggested the state develop a single, model contract that could be used by multiple providers and insurers. One insurance company executive in the audience said she was skeptical that a model contract would be the best approach. Beth Roberts of Harvard Pilgrim said the natural evolution toward accountable care organizations should be allowed to play out.

"Frankly, we were the underdog for many years and we developed these mechanisms to compete with the larger carrier and it worked out fine," she said.