Highlights from UVMHN’s Health Care Reform Community Breakfast

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– We have one of the lowest
uninsured rates in the country. We should be proud of that. We’re ranked the healthiest
state in the nation in 2019 by the United Health Foundation. And Vermonters generally have
good access to primary care. But these good things come at a price for Vermont families for
whom the increasing cost of the success is not sustainable. That’s why I see so much
promise in accountable care to address costs by improving
quality and efficiency. – Why does the United States pay so much for healthcare and get so little health? One of the reasons is the
way we pay for healthcare in this country is broken,
and the fee-for-service system where you only get paid if
you do something to someone as a doctor incentivizes
expensive procedures, even when they’re not necessary. It creates a tug of war between
insurers and clinicians, and it actually rewards healthcare systems when their population is sicker. So the idea in health
is to pay differently. And accountable care
organizations are one way for that to execute that vision. In my mind, the most important
thing that they can do is change how care is delivered. They can say, “We’re not
paid now by the heart attack “and the stroke and the heart operation.” We actually have a chance
to do things differently to invest in prevention
and still see the benefits. – Much of this effort builds
on a long history in Vermont of community efforts to coordinate care. Communities have been digging
in and doing that work on the local level for years and years, and saving a lot of healthcare dollars, not in such a coordinated way. – The providers, the hospitals in Vermont really decided to lead the
way and jump into this effort for a pretty simple reason,
which is the opportunity to really do what this panel
I think visually represents, which is to come together
as a community of providers and really deliver patient
care in a more coordinated and thoughtful way that
also keeps people healthy. And ultimately, that saves costs, but really, maybe more importantly, it orients our healthcare system to what I think it should be oriented to, which is helping people live longer, healthier, better lives. – We are now seeing hospitals putting, investing in social workers
in their emergency rooms. We’re seeing them investing
behavioral health specialists and nutritionists in their
primary care practices. We’re seeing hospitals investing in lifestyle medicine specialists,
nutrition specialists. We’re seeing hospitals
enhance their palliative care in their cardiac rehab. We’re seeing them investing in
housing in their communities. This is a transformation that
I’ve seen over five years, and they’re realizing that
if they’re paid differently and that the goal is to basically align with what patients want, which is lower cost, high-quality care, and the incentives are
structured that way, the investments are
gonna be made that way. So seeing those providers
start to make those investments gives me hope for the long run. – Now we have the opportunity
to care for people the way that we think is best, and that makes the most sense
for them and for us as well. And so we’ve been able to
test amazing innovations that let people get treated in their homes for the longitudinal care project. It allows people to be treated in groups so that they can really build
a community around them. And those small tests of change are really what I see as very
promising in this effort. – What we know is that
actually more touch, more patient human
interactions with a nurse, with a community health
worker, over time at home is keeping people out of the
hospital in Chittenden County. And through OneCare, we’re
actually gonna be implementing it all over the state in
many of our agencies. – One thing that we’ve tried is doing a diabetic group visit, and I think hopefully you’ll
hear from one of our patients, Marie, who is part of our diabetic group. – Yeah, I really can’t say
enough about the group. They’ve really changed
the whole picture for me. We bounce ideas off from each other. If somebody’s struggling to do something, one of us may say, “Well, try this.” That’s helpful, and it’s just
we’re all in it together. So it’s helped us all. – All expenditures in
the healthcare system should make the system
better for everyone. That is the idea of aligning
the different payers, that when Medicaid is
paying in a different way, the practice is able to
do things differently and you can get a
diabetes group discussion, and all patients can benefit. So you have a platform
in Vermont for that. It doesn’t guarantee results,
but it gives you a chance that other states do not have to bring the various
resources in healthcare and wind up getting a change that really is good for
both costs and health. – We’re trying to change a system that has been built over many
decades without any plan. And I think true innovation, if you just look at any
examples across any environment, any industry, it doesn’t
happen all at once. – So it’s pretty nice to get an article saying Vermont had the best outcomes with the states that have done this. – It is, I’m not really sure
that many people in Vermont paid attention to it. We saw it, we were very proud of it. We put it out there, but it
has been a bit of a challenge to both work on it and
then tell the story. So it’s great that you’re
here doing this, thank you. – We have a responsibility as
a Vermont healthcare company to be on a path to affordability on behalf of all of those customers. And we absolutely feel
that the all-payer model, the healthcare reforms of Vermont, the integrated system
through OneCare Vermont is that best passed for
the state of Vermont. – Well, you know it was interesting, I remember asking I
think it was Don George at the last time you spoke, and I said, “As an employer, I can’t paint OneCare “because I’m not quite sure as an employer “how I fit into it.”‘ And Don made it very simple. He said, “You may not even
notice the difference, “except you will end up
with healthier employees “being taken care of in
a better environment.” So for me, that was an easy sell. – So, I wanna mention two challenges. One of them, I’ve already kinda talked a little bit about is scale. It’s really important
to get enough patients in an accountable care organization so it can transform care, because otherwise you wind up with the, I couldn’t find the
one foot in two canoes. I don’t know whether that’s a metaphor that really resonates or not, but we use it all the
time outside Vermont. If you have one foot in each canoe, you’re trying to do the old way and the new way at the same time, it can be very hard to
transform clinically. – Thank you so much, Dr. Sharfstein. I do wanna comment on the use of the foot in two canoe metaphor. Those of us that are here
and in the North Country, we’d never do that. (audience laughing) To get yourself in that
situation is not intelligent. (audience laughing) I think more that we’re in the parking lot and we’re heading up the Burrows Trail, we’re heading towards
the top of Camels Hump, and there’s definitely
twists and turns in the road. In the trail, there’s
things that we’ll discover along the way that will
stop and we’ll look at, but we know that there is a summit and that there is path and
that we’re heading up it. And we did have some themes today, marathon, not a sprint,
incredibly complex, unbelievably important for
us to stay on that path, and in my 40 years in Vermont, the way we solve complex problems is that we get the
right people in the room and we hash it out, we keep working on it, until we get it right. And I think we owe a
real round of applause to folks with a lot of
different perspectives on this who spent their time this morning and all of you the same way. We thank you for coming and
being part of this conversation and we’ll keep on that path
and we’ll keep moving forward. So thank the panel and thank you all. (audience clapping)
(upbeat music)

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