John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.
Editor’s Note: The following article has also run as an op-ed in several local papers.
Amidst the current gloomy national headlines about health care reform, there’s a great story in Vermont about what is right and what’s working.
We’ve 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 Vermont’s complementary law, Act 48, passed by the Legislature and signed by Governor Shumlin in 2011, established clear goals. And we’re 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 – 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, we’re making progress on that front via two key strategies: collaboration and integration.
Collaboration is part of the Vermont DNA.
Today, there’s no better example of collaboration than a unique effort being led by the region’s two university medical centers. Fletcher Allen and Dartmouth-Hitchcock are partnering with nearly every hospital in Vermont, along with primary care providers, specialists, community health centers and rural health clinics, 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 what’s known by Medicare as an Accountable Care Organization (ACO). There are currently several hundred ACOs underway 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 Vermont’s 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 – 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 University of Vermont College of Medicine and College of Nursing and Health Sciences for training staff at partner hospitals; and
- 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 I’ve 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 – 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.
John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.
The million dollars saved by bulk purchasing doesn’t begin to touch the excessive costs that workers in VT are paying the ‘health care industry’ for coverage (even with our relatively low usage). FAHC’s budget alone is $1 billion. The average Vermonter earns $40,000. The average family’s insurance premium is $16,000, often with a $5000 deductible – so that’s over $20,000 paid for the most basic level of care.
Most Vermonters are now paying more to suppport the ‘health care industry’ – than they pay for food. Many feel that they are in no way getting their money’s worth.
The excessive costs of premiums are crippling Vermont’s economy and our future: wages are stagnant because of health care costs; parents can’t save for kids’ college tuition; meanwhile, hospital management salaries and ‘incentive awards are well over the half-million-apiece mark, and climbing. Layers of corporate infrastructure, entitled lifestyles, and capital expenditures for revenue-sucking and evidence-poor screenings, procedures, and treatments (PSA, TAVI, mammography, interventive surgical maternity care, NICU, chemo/nuclear/radio/cardio…) not to mention skyrocketing outpatient charges, are all indicators of excess debt driving both overuse AND redistribution of the debt load to patients who can ill afford it.
This is corporate welfare of the worst kind; and that is, alas, Vermont’s health care industry in a nutshell.
Nobody is doing the math from the patients’ point of view. Patient-centered care would first ask: “How much can you reasonably expect to pay for health care?” then reconfigure the system from there. A reasonable estimate would be about half what workers are paying now. “Bending the cost curve” is a step in the right direction; radical change is really what’s necessary.
AND: A third of Americans are now foregoing care because of excessive cost.
http://www.medscape.com/viewarticle/776304?src=nldne
empty rhetoric and hyperbole without substantiation of facts…screening mammography beginning at age 40 has reduced breast cancer mortality by over 25%…that’s a widely accepted, scientifically proven and published fact !
Increased screening has cost more in unnecessary biopsies/treatments than it has actually saved in lives; don’t know what sources you are using but see USPHS screening recommendations based on outcomes (which the suits at FAHC ignore). and – recent report from wild and crazy guy Eric Topol of Scripps Inst:
“We have runaway uses of nuclear scans, CT scans, and PET scanning, and we don’t even warn our patients; we don’t give patients any data on the dangers. In my book, imaging is a really important topic because there’s so much progress in imaging and use of nonionizing radiation like ultrasound or MRI, but we continue to rely heavily on scans. In cardiology, for example, there are more than 10 million nuclear scans being performed each year, mostly CT scans. We know from all the data we have today that 2%-3% of cancers in this country are related to use of medical imaging and ionized radiation.”
It is clearly now more about revenue than patient care, when a 10-minute visit to a FAHC primary now costs $150+, he spends more time looking at the computer than at the patient; despite EHR only looks at presenting problem, not PMH; and listens to lungs and heart THRU THE CLOTHING! This is McHealthcare!
- or really, corporate welfare paid for by the healthiest population base in the country…lol