It’s been a busy and noisy last several weeks in health care. We’ve had federal, state and local elections on top of it all. We cannot ignore the stress we feel, and know our neighbors feel, in this moment. But what we can do is act. We can lean into things that represent progress. As Vermont moves forward with health care transformation, the Vermont Association of Hospitals and Health Systems (VAHHS) remains committed to advancements in areas that we know align with what Vermonters want and deserve: equitable access to high-quality care (especially in rural Vermont), stabilization and strengthening of our health care ecosystem (nursing homes, transportation, mental health, etc.), and affordability (we must continue to find efficiencies and cost-saving where possible).

To get there, we need to align hospital transformation work, public policies and health care regulation. Without this alignment, we will fail.

Making health care affordable is essential for both patients and providers. Every hospital in Vermont is actively working to lower costs, focusing on preventive care, reducing hospital readmissions, sharing or consolidating services where feasible, embracing telemedicine, and adopting value-based care models. These strategies all serve to improve quality while managing costs and ensuring that Vermont's healthcare system remains accessible and efficient. Reducing costs is not solely about operational efficiencies, however. Our health care providers face significant financial pressures that threaten their ability to deliver affordable care. Known challenges, like workforce shortages, federal payment uncertainties and shifting costs within our healthcare ecosystem, have long been cost-drivers. When we talk about health care costs, we need to have a much more comprehensive conversation about the strategies that are really necessary to lower costs, while improving care. The fact is, cutting services at our hospitals will only cost us more in the end.

Improving local access to care requires both a commitment to equitable practice and targeted investments—especially in Vermont’s underserved regions. Ensuring that all Vermonters can access timely care will not only reduce overall costs but also improve health outcomes. As our state looks to grow, not shrink, having essential services like hospitals will make or break our efforts. Understanding and defining the relationship between affordability and access is also key. What may be affordable in one region might present barriers in another. Losing a service line may save money today but harm the health of Vermonters. That is not a price we are likely willing to pay. A nuanced approach to balancing affordability with local access will be essential to achieving meaningful progress for Vermonters

Health care transformation of the magnitude we need is a significant effort that requires collaboration, and Vermont hospitals are eager to lead in the Agency of Human Services’ feasibility assessment work, which can uncover new ways to improve affordability and sustainability. As we move into this next phase, we must continue to recognize the pressures our health care delivery system faces. Transportation, safe housing, mental health and substance use disorder services, long-term care and skilled nursing availability, and home health care all play important roles in the health of our communities—and insufficient access to these services increases the burden on our hospitals, drives up costs, increases inefficiencies and ultimately will lead us to fail in our efforts, no matter how well-meaning and willing to change we are.

A holistic approach to healthcare transformation must always consider these broader realities. Our goal is not just to transform hospitals, but to support a healthier, more resilient health care ecosystem that meets Vermont’s complex and evolving healthcare needs.

Let’s all agree that what we are really talking about in this next feasibility phase is extremely consequential. It will take careful planning, good data, long-term commitment, and the objective above all to “do no harm” while paving the way for a stronger healthcare system.

Together with our state leaders and healthcare colleagues, VAHHS is ready to roll up our sleeves and get to work. This is a pivotal time for healthcare in Vermont, and we look forward to the journey ahead.

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In Vermont, Where Almost Everyone Has Insurance, Many Can't Find or Afford Care