NMC Commentary

The Importance of Alignment and Partnership in Healthcare’s Transformation

Our message to the Green Mountain Care Board (GMCB) during their visit to Franklin County centered on the need for alignment and partnership during Vermont’s healthcare transformation. NMC and Vermont’s other not-for-profit hospitals are leading the shift from fee-for-service medicine to the capitated population-health-based reimbursement that the State is pursuing. OneCareVT (the Accountable Care Organization – ACO), other healthcare providers, regulators like GMCB, all the payors, the Governor’s administration, and the legislature have crucial roles. NMC is investing in primary care access and prevention and community care management and we need the reimbursement to allow that to continue. This transformation is in motion and we were clear it is time for the alignment and priorities across the system, across all these partners, and across the state. That is the only path to true cost reductions while preserving financial sustainability, access, and quality.

I was very pleased to have the GMCB accept our invitation to hold one of their ‘traveling public meetings’ here in St. Albans. They understand the benefit of going out into the communities, seeing healthcare in action in the local settings, and hearing from community voices about priorities and expectations.

The morning was devoted to three tours based on the All-Payer-Model goals. The GMCB members and staff divided up among those, getting first-hand perspectives of this important work. The primary care access tour visited Northwestern Primary Care, the St. Albans NOTCH office, and Northwestern Pediatrics. The positive impact of the Patient-Centered Medical Home Model and the Blueprint for Health were consistent themes, as was the significant challenge to access posed by the state and national shortage of providers. The tour on addiction and suicide visited the NMC Emergency Department to see the need for the safe patient rooms and other proposed renovations; Northwestern Partners in Hope & Recovery; and the Valley Crossroads site where we hope to integrate services. The chronic disease tour group saw primary prevention in action with our youth at St. Albans City School (the Abbey Group’s healthy school food taste testing was delicious!); visited the construction site at Congress & Main where wellness offerings and a teaching kitchen will be embedded in downtown; and came back to NMC where chronic disease treatment, rehabilitation, health coaching within the primary care office, and prevention through lifestyle change are active.

In the afternoon, we had a standing-room-only crowd for the GMCB’s public meeting. I am grateful for our team who presented on how we are working within the transition to the All Payer Model within the Accountable Community for Health. We showed data on excellent work being done clinically at the hospital and in our practices as well as measurable gains being achieved through prevention efforts. We also showed data on areas still needing improvement and discussed barriers to continue our important work and investment. It prompted a strong, productive conversation. The discussion of insurance plans not being required to reimburse for nutrition counseling, health coaching, or exercise training for individuals with pre-diabetes despite the clear benefit and anticipated savings of doing so created great insight into need to align priorities and incentives across all stakeholders in the healthcare transformation. Hospitals are baring the risk yet all stakeholders need to be held accountable. That is a powerful understanding that we will continue to pursue with GMCB, payors, providers, legislators, and partners.

I am thankful the GMCB invested the time to come to our community. I appreciate all our partners, legislators, and area residents who took part in the GMCB visit. Even with the challenges it presents in the short-term, we are fortunate to have this shared opportunity to transform the healthcare system. By working together to sustainably increase the emphasis on prevention and the focus on wellbeing while maintaining access and quality for those in need of medical treatment. We need to invest in the long-term impact of prevention which is the real answer. It is time we are afforded the means to fund it. Each of us plays a major role in prevention by choosing a healthier lifestyle. Staying healthy needs to become our norm.

— Jill Berry Bowen, RN, NMC’s Chief Executive Officer