• Achieving sustainable health care
    December 09,2012
     

    The following opinion piece is based on a speech made by John Brumsted, M.D., at a community forum held Oct. 24 in South Burlington, where he discussed how Vermont is developing new models for both health care delivery and payment to provide high-quality health care thatís also affordable. Dr. Brumsted is president and chief executive officer of Fletcher Allen Health Care in Burlington.



    Amid the current gloomy national headlines about health care reform, thereís a great story in Vermont about what is right and whatís working. Weíve made great progress on the goals that are shared by all: right care, right time, close to home.

    The federal Patient Protection and Affordable Care Act, and Vermontís complementary law, Act 48, passed by the Legislature and signed by Gov. Peter Shumlin in 2011, established clear goals. And weíre working closely with the newly formed Green Mountain Care Board to align our efforts with theirs.

    Our focus is on the major challenge that remains in health care: bending the cost curve.

    Health care has been a story of advances ó research has led to major clinical achievements, quality of care has improved nationally and particularly in Vermont, with tremendous progress in ensuring access, and new attention is being given to making the patient experience more respectful and convenient.

    Now as we turn to bending the cost curve, weíre making progress on that front via two key strategies: collaboration and integration.

    Collaboration is part of the Vermont DNA.

    Today, thereís no better example of collaboration than a unique effort being led by the regionís two university medical centers. Fletcher Allen and Dartmouth-Hitchcock are partnering with nearly every hospital in Vermont ó along with primary care providers, specialists, community health centers and rural health clinics ó to form OneCare Vermont, a new and more efficient way of caring for Medicare beneficiaries, focusing first on quality because quality care, by its very nature, is the most cost-effective care. OneCare Vermont is whatís known by Medicare as an Accountable Care Organization. There are currently several hundred ACOs under way in the U.S. But ours is unique in that it is the only ACO that covers an entire state, and the only one that is being led by a collaboration of two university medical centers.

    On the integration front, we also have success stories. As Vermontís university medical center, we believe that integrated delivery systems are the model for the future. In alliance with the University of Vermont, we have created an integrated delivery system called Fletcher Allen Partners.

    Our first partner was Central Vermont Medical Center, and early next year, Champlain Valley Physicians Hospital in Plattsburgh and Elizabethtown Community Hospital in northern New York will join us. Four hospitals, more than 1,000 physicians, more than 2,000 nurses and countless other health care professionals ó all brought together to serve patients across the region, in an integrated approach.

    Among our plans and achievements:

    Creating standardized treatment protocols and fully integrating patient records.

    Linking doctors and clinicians across the region via telemedicine for real-time consultation.

    Using our Simulation Laboratory at the UVM College of Medicine and College of Nursing and Health Sciences for training staff at partner hospitals.

    Integrating operations to cut costs. In one year alone, Fletcher Allen and CVMC saved more than $1 million via coordinated purchasing of drugs, orthopedic implants and other medical supplies.

    This kind of integration and coordination makes absolute sense from both a clinical and a business perspective, as we can realize economies of scale and avoid duplication.

    What Iíve described here are just a few examples of how collaboration and integration benefit patients, purchasers of health insurance and payers.

    These efforts are certainly not simple, nor easy. They require everyone involved to make changes, and change is always difficult ó but when we can deliver better health care and rein in costs, we welcome that change.

    As a practicing physician in Vermont for 30 years, what has always kept me going is making an impact, one patient at a time. Now we are doing it collectively, creating a model for the country and, more importantly, charting a new and even better course for medicine and health care for the people and families of Vermont and Northern New York.

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