There’s a metaphorical hurricane bearing down on Vermont’s healthcare system, and we need to prepare now to weather the storm, according to a consultant hired by the Green Mountain Care Board to figure out how to make health care affordable, equitable and sustainable in the state.

“It’s like getting a hurricane warning,” Dr. Bruce Hamory said in an online press briefing. “You can see it coming. You don’t know quite how bad it will be, but you want to get the windows boarded up, get a supply of food or leave town.”

Hamory and his team at Oliver Wyman Life Sciences presented their final report to the GMCB at a public board meeting on Wednesday. The 144-page report includes extensive recommendations on issues ranging from hospital operations to housing and transportation. The Green Mountain Care Board is responsible for overseeing major aspects of the healthcare system in Vermont, including hospital budgets.

Hamory warned that four Vermont hospitals − Gifford Medical Center in Randolph, Springfield Hospital, Grace Cottage Hospital in Townshend and North Country Hospital in Newport − are facing the greatest risk of closure because they don’t have the volume of patients to support their operations, but that all Vermont hospitals are facing severe financial distress.

“Nobody is off the hook here,” Hamory said. “For every hospital, their survival in their current form depends on aggressive control of costs and growing in certain necessary areas.”

Vermonters face challenges getting timely and affordable healthcare

The report lays out the “serious challenges” Vermonters face in obtaining health care:

• Decreasing affordability − Average premiums for silver exchange plans available through Vermont Health Connect are $985 in 2024, a 108% increase in six years.
• Deteriorating sustainability − Nine of the 14 hospitals in the state reported operating losses in 2023 of up to -8.9%. The trend is projected to worsen, with 13 of 14 hospitals expected to report losses by 2028.
• Aging and shrinking population − People over 65 years old are projected to exceed 30% of Vermont’s total population by 2040, exacerbating the strain on the healthcare system because of increasingly complex needs for care. Meanwhile the working population is expected to decline by 13% by 2040, limiting contributions to the commercial healthcare premiums that subsidize the shortfalls hospitals experience in payments from federal programs.
• Lack of healthcare access − Primary and specialty care clinics in Vermont have long wait times, preventing patients from seeing providers for urgent, as well as routine visits in a reasonable timeframe. Also, community-based care, such as primary care and home healthcare, does not fully support Vermonters’ health needs, resulting in increased hospital use.
• Inequity in healthcare − The current system in Vermont fails to adequately support access and affordability needs for low-income populations in rural areas. There’s insufficient affordable housing, a “significant social determinant” to health. Transportation for patients is unreliable and “lacks timeliness,” preventing patients from accessing care. Lastly, “culturally competent” care is not widely practiced to treat patients with unique needs in terms of language, mental health and gender/sexual identity.

Transformation of Vermont’s health system includes regionalized care

The transformation of the health system in Vermont that’s “urgently needed,” according to the report, would be led by the Agency of Human Services, together with the Green Mountain Care Board. The report calls for the state to support the development of infrastructure including a “robust” workforce, greater access to transportation and an affordable housing supply.

The report proposes the development of new regionalized centers of care, to “drive hospital efficiency and shift care outside of the hospital setting.” These “Centers of Excellence” would provide specialized services within the reach of most Vermonters, and would create areas of “sufficient population size” to support the medical professionals and equipment needed.

Decisions concerning the types and locations of Centers of Excellence would be determined by AHS, in combination with the communities and hospitals concerned, Hamory said in an interview with the Burlington Free Press.

Central Vermont Medical Center in Barre, for example, might become a COE for geriatric care, infusion therapy, neurology, psych-adult and radiation therapy. Copley Hospital in Morrisville might become a COE for orthopedics and rheumatology.

Both Brattleboro Memorial Hospital and Rutland Regional Medical Center might become COEs for acute general surgery. The report says additional COE designations for other specialties and other hospitals require further discussion as part of Vermont’s “regionalization plan.”

“Part of the goal is to move care to more convenient and less expensive locations and out of the UVM Medical Center and Dartmouth Medical Center,” Hamory said. “Perhaps one of the benefits of this process will be to give folks some reasonably clear picture of what the future holds that they can use to plan. This is an enormous project.”

Contact Dan D’Ambrosio at 660-1841 or ddambrosio@freepressmedia.com. Follow him on Twitter @DanDambrosioVT.