Brumsted: A new prescription for Vermonters’ health

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Brumsted: A new prescription for Vermonters’ health

Mon, 01/25/2016 - 3:33pm -- tim

by John Brumsted, MD Together, we are writing a new prescription for the health of Vermonters: Pay health care providers for keeping people healthy instead of just treating them when they are sick. This is a change the University of Vermont Health Network is committed to making.  We recently set a goal of having 80 percent of our revenue tied to the overall health and wellness of our patients by 2018, rather than being paid for every test or procedure we perform or by our hospital admissions. Right now, less than 15 percent of UVM Medical Center’s revenue comes from payment arrangements tied to the quality, not the quantity, of care provided, so this represents a big change.

Dr John Brumsted, CEO of the UVM Medical Center

We unveiled our new 80 percent goal when UVM Health Network presented its budget to the Green Mountain Care Board (GMCB) last summer, and we will be providing periodic, transparent updates to the GMCB as we move toward that goal.

How will this work?  It means we will agree to get paid a fixed dollar amount to take care of our patients.  If we exceed that dollar amount, the difference is on us:  we will need to absorb the loss.  We will also need to meet robust quality standards to ensure that patients are getting the care they need in order to collect our reimbursement.

So what will this reform look like to patients?  Patients and families should feel like they are partners with their providers in making decisions about their care.  They should also see other changes that include:

  • more reminders from their primary care provider about screenings and vaccinations and wellness check-ups;
  • more support from their providers to help them be successful in following treatment plans;
  • more support for managing their chronic illnesses to reduce the need for hospital admissions and trips to the emergency department;
  • a more holistic approach to care by providers who will treat not just one symptom or illness, but the whole person;
  • smoother transitions between the different providers involved in their care; and
  • very importantly, greater focus on non-medical barriers to care that many patients experience, including housing challenges, transportation needs, and food insecurity.

There are many factors outside of a hospital’s control that impact our patients’ health.  Hospitals are just one part of the health care continuum; what happens outside of our walls makes all the difference to health and wellness. 

Hospitals must work together with our home- and community-based health care colleagues to keep people well.  In Chittenden County, that includes all of the good work being done by the Visiting Nurse Association, the Champlain Valley Agency on Aging, the Howard Center, COTS, the Champlain Housing Trust, the Vermont Department of Health, Cathedral Square, United Way and many other social and community service agencies. 

The urgency regarding health care reform is high because the status quo is no longer an option. Health care costs too much, and the renewed focus from our political leaders at both the state and national levels on keeping costs down has been a game changer for all of us.

A clear example of the pressing need for collaboration – and one in which we’ve made progress – is the opiate addiction crisis.  Over the past year, many more Vermonters are accessing treatment for their addiction through clinics at the Howard Center and the UVM Medical Center, or through their primary care providers, thanks to the shared efforts of the City of Burlington, the State of Vermont, the Chittenden County State’s Attorney’s Office, the Howard Center, the Community Health Centers of Burlington, the UVM College of Medicine and the UVM Medical Center.  Together, we are bringing our collective resources to bear on this issue, and together, I am confident that we will meet the need of Vermonters struggling with this difficult disease.  

Not only is this the best way of caring for our patients, but we need to make these kinds of changes if we are to be financially accountable – take risk – for the health of our communities.  The costs of complications from a single case of Hepatitis C or HIV from needle use can cover treatment for dozens of patients accessing suboxone or buprenorphine.  

As we turn the corner into 2016, we are excited to take an aggressive approach to health care reform, and we are also excited to collaborate with our many community partners in new and different ways to meet the mission we all have:  improving the health of the people we serve.  It is simply the right thing to do, and the best way to reform our health care system.

John Brumsted, MD, is president and CEO of the University of Vermont Health Network and CEO of the UVM Medical Center.