From OneCare Vermont
OneCare Submits Budget to Green Mountain Care Board
OneCare Vermont

This week, OneCare Vermont—our state’s accountable care organization (ACO)—will present our budget to the Green Mountain Care Board, which closely and carefully regulates our work. The budget we are submitting is responsible, and only 1.4% of it funds OneCare’s operations, most of which is used to directly support providers. The remainder of the budget consists of existing Medicare, Medicaid and commercial insurance dollars—not new spending. 

I am still new in my role as CEO but it quickly became clear to me that there is a lot of confusion and misinformation about our work. This may not be surprising given how immensely complex health care is in general. Still, in order for our work to succeed, we need to do a better job educating and inviting people in to learn more. I am a nurse and I carry with me in this new role the very reason I got into heath care – to make a difference in my community.

For background, ACOs were created by the Federal Affordable Care Act. They are groups of health care providers that voluntarily join together to coordinate high quality care for patients while focusing on primary care and disease prevention. Here in Vermont, our ACO—OneCare Vermont—is enabled by the state and federal government through what we call the All-Payer Model, or APM. 

The APM shifts our focus from treating illness and disease once they have occurred to preventing onset in the first place. We call this delivery system reform. We also have to change the way we pay providers (hospitals, physicians and others) so they can focus their time and resources on wellness and prevention. Instead of a payment for every individual office visit, test and procedure, providers receive a single payment to care for their patients. We call this payment reform. 

Together these reform efforts make a real difference for Vermonters. We are working to expand and reimagine primary care. We are working to prevent diabetes and heart disease. We are working to manage chronic conditions alongside patients so that they feel better, live longer and don’t have to visit the emergency room. We are providing new services to people at home and keeping them from ever being admitted to the hospital. We are also helping providers and communities expand care to the areas of food, exercise, transportation and housing because we know access to these fundamentals improves health.

Health care will not serve us better or cost less until we do things differently—which means paying for value instead of volume, wellness instead of illness. That’s the APM. The rest of the country is moving in this direction, but nowhere in the nation is it happening in a more thoughtful and concerted way than here in Vermont. 

As part of our state’s history of innovative health reform, OneCare is fully committed to a transparent and collaborative approach. From a governance standpoint, we are locally-led. The Board and management team include leaders who have spent their entire careers improving health care in Vermont. 

We have a lot more work to do. The model is still in the early stages and, as it grows, we will need to do more to keep our regulators, lawmakers and stakeholders informed. I am committed to transparency and accountability, and we will address question asked by our state regulators, Vermont’s Health Care Advocate, and the public in this process.

I hope this overview of our work has been informative. As the model matures and new Vermonters join OneCare, we will work even harder to share information.

Vicki Loner
CEO, OneCare Vermont
From our Annual Meeting
Crisis Standards of Care

Watch a video of this session.

At our 2019 Annual Meeting, three representatives on the Vermont workgroup that is creating a standards of care plan for possible crises in Vermont reported on their progress and solicited feedback on the current draft. Facilitating the breakout session was Michael Leydon, MPH, Emergency Management Director at UVMHN-Porter Medical Center.

Leydon explained that in a catastrophic crisis, like a pandemic or widespread serious flooding, our health care systems may not be able to maintain the standards of care to which it typically adheres.

He introduced a “newly minted plan”—in draft form—that could help providers make decisions about how to optimize the quality of care and administer finite resources to those most likely to benefit.

“Our overall goal for this initiative is to develop a framework which includes tools and parameters under which we render care and quality benchmarks to guide us in high-consequence decision making with limited information, an incomplete picture of the situation and limited resources,” he said.

He noted that the plan would help providers with consistent and equitable resource allocation among patients. Leyden warned participants that the Crisis Standards of Care Plan was not a substitute for each organization’s emergency preparedness planning. He said that hospitals and health systems can mitigate the effects of a future crisis by planning now.

“Where is your hospital’s command center going to be? What equipment will you need? Who’s going to staff it? Where do you get fuel for your generator?” he asked.

In the News
RRMC among America’s 100 Best Hospitals for Joint Replacement
Vermont Business Magazine

Rutland Regional Medical Center is one of America’s 100 Best Hospitals for Joint Replacement and the only hospital in Vermont to receive this recognition according to a national study by Healthgrades (link is external), the leading online resource for information about physicians and hospitals. Rutland Regional once again was the only hospital in Vermont to receive a Five-Star Rating for Total Hip Replacement and Joint Replacement Excellence Award for the second consecutive year (2019-2020).

Additionally, Rutland Regional was the only hospital in Vermont to receive a Five-Star Rating for Total Knee Replacement for ten consecutive years (2011-2020), and one of three hospitals to receive a Five-Star Rating for Treatment of Chronic Obstructive Pulmonary Disease for three consecutive years (2018-2020). And, for the first time, the hospital received a Five-Star Rating for Treatment of Sepsis (2020). Every year, Healthgrades evaluates hospital performance at nearly 4,500 hospitals nationwide for 32 of the most common inpatient procedures and conditions. These achievements are part of findings released today in the Healthgrades 2020 Report to the Nation.

Vermont’s childhood obesity now highest in New England
VT Digger

Vermont’s childhood obesity rate crept up once again this year, making it the top state in childhood obesity in New England, new research shows.

More than 15% of Vermont’s children age 10 to 17 are obese, according to data from the State of Childhood Obesity, a research project from the Robert Wood Johnson Foundation. That’s compared to less than 12% two years before.

“It’s culture — not just our individual behavior,” said Susan Kamp, director of physical activity and nutrition at the Vermont Department of Health.

While Vermont leads the region, the state comes in below the national average of 15.3%. Mississippi, with a childhood obesity rate of 25.4%, leads the country, followed by West Virginia, Louisiana and Kentucky, which all have rates over 20%. Vermont ranks nationally with the 20th highest rate of childhood obesity. 
Doctors emphasize importance of regular mammograms
WCAX

As part of Breast Cancer Awareness Month, experts are pointing out the fact that 1 in 8 women will get the disease in their lifetime.

Through education and widespread screenings, the death rate from breast cancer has gone down by about 40 percent since the early '90s. The easiest way to detect breast cancer is by feeling your chest. The next best way is through a mammogram. While they can be scary and very uncomfortable, they do save lives.

"Women that get a mammogram, they are much less likely to die of breast cancer if they get a mammogram," said Dr. Sally Herschorn with the University of Vermont Medical Center.

In most cases, Herschorn says breast cancer is beatable and mostly comes down to catching it early. The UVM Medical Center suggests women with no history of breast cancer get screened every year starting at 40 and women with a history will probably start getting screened earlier, after consulting with their doctor.

They say both healthy men and women without a history of cancer should start getting screened every year starting at the age of 40.
'Farmacy' prescribes veggies to families
Addison County Independent

Addison County’s inaugural food-based prescription program, Farmacy, ran for 12 weeks this summer and provided a bounty of incredibly fresh local produce to 45 patients and families. The Farmacy Program, a collaboration of ACORN, the Vermont Department of Health, Bristol’s Mountain Health Center, Middlebury’s UVM Porter Medical Center, Middlebury Natural Foods Coop and three local farmers, kicked off in July and came to a close at the end of September.

Patients suffering from, or at risk of, chronic or nutrition-related illness received prescriptions for free weekly CSA-type boxes of local fruits and vegetables. Weekly boxes included summer favorites such as strawberries, cherry tomatoes and sweet corn, and also introduced patients to items they might not be as familiar with, such as tomatillos, Asian eggplant and baby bok choy.

An education committee comprised of dieticians, nutritionists and educators provided creative recipes along with corresponding tasty samples like cheddar kale scones and chilled ginger carrot soup to encourage patients to try something different once they got home.
Vermont student leaders gather for health summit amid vaping crisis
My Champlain Valley

Student leaders from schools around Vermont will participate in a day-long summit Thursday on youth tobacco and e-cigarette use and prevention.

The OVX (Our Voices Heard) summit on Thursday in Burlington includes a keynote address by Kesha Ram, an environmental health consultant and former state representative. There will also be workshops and other learning opportunities, said the Vermont Department of Health.

The summit is happening amid two public health crises related to vaping: underage use among teenagers and a sometimes fatal lung ailment that has affected more than 1,000 people.

According to the 2017 Vermont Youth Risk Behavior Survey, 12% of young Vermonters aged 12 to 17 reported having used e-cigarettes in the past 30 days and 34% of high school students reported ever having used e-cigarettes.

State psychiatric hospital finally adopts diversity training plan
VT Digger

The Vermont Psychiatric Care Hospital is finally set to educate employees about diversity nearly two years after the state Human Rights Commission found discrimination against workers of color. But not all racial justice advocates are satisfied with the long-awaited remediation plan.

The state Department of Mental Health is hiring ReGeneration Resources of Brattleboro to offer a one-time training to its 200 hospital employees on bullying and harassment, such terms as “implicit bias,” and how to report and respond to problems and “contribute to the creation and maintenance of a healthy, cohesive workplace culture.”

“Our hope is this will help us ensure that we have a positive workforce culture addressing some of the issues that have come up,” state Mental Health Commissioner Sarah Squirrell says.
UVM gets $25K EPA Healthy Communities Grant
Vermont Business Magazine

Today the US Environmental Protection Agency (EPA) announced a $25,000 Healthy Communities Grant award to the University of Vermont in Burlington, Vermont.

Announced during Children's Health Month in October, the grant will help create a new partnership project between the University of Vermont, middle school and high school teachers and students, and community partners to pilot a team-based approach to education, hazard reduction, and educational materials development related to addressing lead in water and soil in Burlington and Winooski.

“EPA is excited to see the partnerships between the University of Vermont, Burlington and Winooski to help build community awareness and capacity around addressing critical lead issues,” said EPA New England Regional Administrator Dennis Deziel. “Enabling communities to reduce lead exposure, especially for children, is a critical issue for EPA across New England and here in Vermont.”

Feeding Chittenden sees 30% increase in demand
WCAX

As the temperatures start to drop, a local food shelf says their need for donations goes up. Feeding Chittenden says they've seen a 30 percent increase in the number of people reaching out for services this past year.

The organization, formerly known as the Chittenden Emergency Food Shelf, says they see 200-300 people per day. Their clients come for a variety of reasons -- to get a warm meal, grocery shop or take part in a culinary class.

Anna McMahon with Feeding Chittenden says recent threats from the federal government to cut services like 3Squares Vermont have made people uneasy.

"I think people are worried. They are not sure how they are going to afford to pay for child care, housing and other expenses. They need programs like Feeding Chittenden to offset that cost," said McMahon.
Mark Your Calendar!
Mondays, October 14-November 18, 8:00 a.m.
The Gables, Mendon, VT

Monday, Oct 28, Monday, Nov 4, & Thursday, November 7, 3:00 p.m.
CVPS C ommunity Health/Education Center, Rutland

Thursday, November 7, 8:00 a.m.
White River Jct. VA Medical Center, White River Jct.