Ask Jill
01.23.2018

Have You Discussed Prevention and Population Health with our Legislators?

Yes.  Strong access to elected officials at all levels helps ensure opportunities to work together, have local voices heard, and give input on decisions.  Here in northwestern Vermont, we are particularly fortunate to have such strong access our local legislators.  It was a pleasure last week to travel to the Statehouse in Montpelier and have a mid-day conversation with our Representatives and Senators.  They were receptive and engaged and had insightful questions.  This conversation builds on one from before this session and will be the foundation for continued conversations as various pieces of legislation move through the process this year.

My colleagues Chris Hickey (NMC’s Chief Financial Officer), Jonathan Billings (NMC’s VP of Planning, Community Relations & RiseVT), and Jeff Tieman (President of the Vermont Association of Hospitals and Health Systems) and I appreciated the opportunity to highlight the important leadership role Vermont’s hospitals are playing in the transformation of our healthcare system and the work to address the social determinants of health in our communities.  Here in our area, NMC has been a true leader in the shift towards a population-health approach to paying for healthcare where providers are given a set (capitated) amount of funding to care for a defined community, rather than being paid specifically for every visit and treatment.  NMC has also been a leader in the increasing emphasis on prevention to reduce demand for treatment services (which are more costly than preventing the need in the first place).

We discussed how NMC stepped forward as the only non-University of Vermont Medical Center affiliated hospital willing to take on the financial risk and participate in the Medicaid population health pilot with capitated healthcare payments last year.  We found that pilot to be positive and now the pilot has expanded to portions of Medicaid, Medicare, and BC/BS and involves nine Vermont hospitals. A legislator asked if capitated payments and population health are indeed the new sustainable path.  The state’s five year goal is to have 75% of Vermonters in this system within five years.  Our local Unified Community Collaborative brings together key partners from various healthcare and social sectors to improve how we work together to manage population health.  NMC is at the table with Northwestern Counseling, Franklin County Home Health, independent physicians, NOTCH, and many other partners. We believe that if providers commit to changing how care is delivered to improve integrated care coordination and invest in prevention like NMC is doing, that this can be successful. It was exciting to share an example of how NMC is partnering with Champlain Housing Trust and others to take another step forward on the housing front as part of our work on the mental health priority in our community. That work drew praise from a legislator who appreciated the connection between housing and health.  However, to make the shift to population health work, Vermont’s hospitals need the budgetary and regulatory latitude to transform how they deliver care, to invest in helping address social determinants of health (like housing and hunger), and to advance primary prevention through the statewide scale up of the RiseVT movement to embrace healthy lifestyles.  Hospitals must be allowed to invest wisely in the care and resources their communities need.  As the session unfolds, we will be looking to our legislative delegation to help ensure our abilities to advance this critical transformative work is not damaged by additional regulation or micro-management.

Investing in primary prevention through RiseVT and the integrated care management needed to help patients navigate complex and chronic medical conditions are long-term strategies to keep healthy people healthy, reduce demand, and make our health care system more sustainable.  Volunteer community Boards of Directors across the state have positioned their local hospitals to be leaders and key players in these efforts.  Additional layers of regulations on hospitals, decisions to reduce hospital reimbursement further, or actions to limit our ability to invest in community based approaches are counterproductive.  We look forward to working with the Green Mountain Care Board and the Legislature to avoid those paths as hospitals continue to take a leading role in investing and funding Vermont’s journey to a healthier future.

— Jill Berry Bowen, NMC’s Chief Executive Officer