by Mark Crow For decades, Vermonters have debated how to fix our healthcare system. We've discussed, among other things, single-payer healthcare, all-payer healthcare, accountable care organizations, workforce shortages, hospital sustainability, primary care access, and the ever-rising cost of care. Along the way, we've launched pilot programs, created commissions, commissioned studies, and developed new models of care.
Now, Vermont has a unique opportunity to put many of those ideas into practice. Through the federal Rural Health Transformation Program, the state is expected to receive nearly $1 billion over five years to strengthen healthcare access, support providers, expand the workforce, and improve health outcomes. Combined with some important healthcare legislation passed this year, Vermont has an opportunity unlike any it has had in decades to reshape how healthcare is delivered.
State leaders deserve the credit for securing this opportunity and for the extensive work already underway. The planning is thoughtful, the goals are certainly worthy, the commitment is evident, and the need is undeniable. But, implementation is where transformation can become challenging. Not because Vermont lacks good ideas and not because dedicated people aren't doing the work. But, because meaningful transformation inevitably requires difficult choices.
Should every service be available in every community, or should some highly specialized care be regionalized to improve quality and long-term sustainability? How do we improve access while facing persistent workforce shortages? How do we strengthen primary care without further straining financially challenged hospitals? How do we improve quality while making healthcare more affordable?
These aren't simply policy questions. They are questions about values and priorities. Every answer involves tradeoffs. That reality makes public trust essential.
Transformation of this magnitude will ask Vermonters to embrace far-reaching change. Some services may be delivered differently. Resources may be invested in new ways. Care may become more coordinated, more regional, or more technology enabled. Those changes are far more likely to succeed if Vermonters understand not only what is changing, but, maybe more importantly, why the changes are necessary and how success will ultimately be judged.
To be clear, Vermont is already putting in place a comprehensive evaluation framework to measure and report on the impact of these investments over time. But, really, the challenge is not just simply measuring progress. It’s defining success.
Before legislators, regulators, providers, patients, employers, and taxpayers can determine whether this effort is succeeding, we should share a common understanding of what success actually looks like. In other words, the real test of rural healthcare transformation will not be the number of grants awarded, programs launched, organizations funded, or reports produced. Rather, it will be whether the experience of receiving healthcare in Vermont actually improves.
One way to reinforce that shared understanding would be to identify a small set of public "north star" measures that reflect the outcomes Vermont is ultimately trying to achieve. Not the dozens of metrics or hundreds of performance indicators that undoubtedly will be provided, but a handful of outcomes that ordinary Vermonters can easily understand.
Those measures might include timely access to appropriate care, improved quality and patient outcomes, a stronger healthcare workforce, financially sustainable providers and care systems, and healthcare that is more affordable for patients, employers, and taxpayers.
Reasonable people, of course, may disagree about the criteria used to define those measures, but that seems surmountable. The more important point is that Vermont's transformation effort should have a clear, public definition of success that transcends individual projects, grants, or legislative initiatives. Not only would doing so strengthen transparency and accountability, but it would also help policymakers and healthcare leaders evaluate their thinking and decisions against shared goals rather than individual interests. And, ultimately, it would help build and sustain public trust and support. People are far more willing to accept challenging tradeoffs when they understand the destination, the principles guiding the journey, and how everyone will know whether we've arrived.
The Rural Health Transformation Program is not simply another grant program, a collection of projects, or a series of reports. It is an opportunity to build a healthcare system that better balances access, quality, affordability, workforce realities, and long-term sustainability. Five years from now, the question won't be what Vermont did. It will be what Vermont achieved. Did we end up with a healthcare system that provides the right care, at the right time, in the right place in a way that is more accessible, affordable, sustainable, and effective than the system we have today?
Mark Crow lives in Shelburne and is president of Tenth Crow Creative, a Vermont-based brand strategy and marketing agency that helps rural and community healthcare organizations strengthen their brands and better engage their communities. Through partnering with these organizations for over a decade, he has developed a particular interest in healthcare policy and rural healthcare transformation.
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