Vermont: An Almost Perfect Pilot for Health Care Reform
There is nothing ordinary or typical about Vermont. Vermont feels like it is populated by people who seem to have a greater than average concern for the environment and for one another. Perhaps the crafts, art, music and interest in extracting as much from life as possible, plus its interesting and empathetic social philosophy that seems so proximate everywhere you turn is because many of the lasting elements of the "peace, love and back to basics" movement of the sixties and seventies came to rest in the beautiful valleys between those Green Mountains and along the eastern shore of Lake Champlain. This blog posting is largely devoted to what is happening in health care in this state with a most remarkable sense of social responsibility.
What also makes Vermont interesting is that it is an almost perfect pilot for much of America where life is centered in small towns with incomplete medical resources. In those environments we must look at the transformation of health care differently. In much of the broad stretch of the country we may end up looking at the future through the lens of regional planning and not the evolution of competitive markets. Vermont’s small cities and towns dotted across a landscape of farms and mountains defines the problems of a new health care in terms of geography and a small, defined population. Many states or parts of states have a similar distribution of population and geography.
The solutions derived from the evolution of a system of care and optimally designed for the megalopolises on the two coasts or the large cities of the heartland may not work in places like rural Pennsylvania, Kentucky, much of Iowa, New Mexico, and the list goes on and on. As a conceptual consideration, it is a huge advantage that the large majority of the residents of Vermont get tertiary care in only two academic medical centers, the University of Vermont and Dartmouth Hitchcock which are both a part of OneCare, the largest ACO and would be the major hospital resources in the new single ACO. (Despite the fact that Dartmouth Hitchcock is over the Connecticut River in New Hampshire, forty percent of its patients are from neighboring Vermont and it is a founding member of OneCare, the largest ACO into which the two smaller ACOs will possibly move.) No location in the state has a multiplicity of providers, which makes market competition between providers on quality, price and service impossible. The total population of the state is 630,000, a fact that adds to the plausibility of treating the delivery of care in the state as one enterprise.