PowerPoint Presentation

A business of Marsh McLennan

Act 167 (2022) Community

Engagement to Support Hospital

Transformation: Summary of

State-Level Recommendations

19 June 2024

OLIVER WYMAN EXPERTISE

Bruce H. Hamory, MD FACP

Partner & Chief Medical Officer,

Healthcare & Life Sciences

Elizabeth Southerlan

Managing Director,

Healthcare & Life Sciences

• Helps providers, health systems and countries

to redesign their delivery systems to improve

value by improving quality and reducing costs

• Has worked with many groups to improve their

operations, design appropriate physician

compensation and institute new systems of

care and management to improve performance

• Prior to joining Oliver Wyman, he was

Executive Vice President, System Chief Medical

Officer at Geisinger, and was previously

Executive Director of Penn States’ Hershey

Medical Center and COO for the campus

• Has over 50 years of experience in health care

practice, teaching, leadership, and redesign of

systems for improvement

• Has more than 15 years of experience

partnering with healthcare provider systems to

identify and deliver value from expansion

opportunities

• Provides strategic guidance to healthcare

leaders in a range of areas: corporate and

operational strategy, organizational strategic

design, health equity strategy

and operationalization, product and service

line design and launch, M&A strategy and

execution, strategic transformation,

contracting and renegotiation strategy,

and operational performance improvement

• Earned a bachelor’s degree in industrial

engineering from The Pennsylvania State

University and a master’s degree in systems

engineering and management from the

Massachusetts Institute of Technology

Irene Wei

Engagement Manager,

Healthcare & Life Sciences

DAN SHELLENBARGER

Partner,

Healthcare & Life Sciences

Danielle etzel

Senior Consultant,

Healthcare & Life Sciences

PROJECT CONTEXT

Section 2 of Act 167 (2022) requires that the GMCB, in

collaboration with the Director of Health Care Reform in the

Agency of Human Services, “develop and conduct a data-

informed, patient-focused, community-inclusive engagement

process for Vermont’s hospitals to:

- Reduce inefficiencies

- Lower costs

- Improve population health outcomes

- Reduce health inequities

- Increase access to essential services

All while maintaining sufficient capacity for emergency

management

Broad community and provider engagement in and across all

Hospital Service Areas (HSAs) in Vermont.

– a data-informed, patient-focused, community-inclusive

engagement relative to the second stream of work for Act 167

Goals: engage diverse stakeholders and ascertain their

interactions with the health system and perceived needs to

overcome any barriers to equitable access and outcomes

Current plan: conduct interviews and working sessions in 2

phases and codify qualitative and quantitative inputs to inform a

recommendation.

– Phase 1 - August through mid-November 2023

– Phase 2 - March through Sep 2024

– Timing of the phases are subject to change by mutual

agreement

Act 167 objectives Oliver Wyman’s work

SCOPE, GOALS, AND APPROACH: IMPROVING THE VERMONT HEALTHCARE DELIVERY SYSTEM

REQUIRES INPUT FROM ACROSS THE COMMUNITY IT SERVES

Step 1. Finalize engagement

plan and interview scheduling

Identify and schedule interviews with key

stakeholders in the following groups:

• Hospital leaders

• Provider organizations

• Community leaders and members

• Diverse populations

• State of Vermont partners and Legislators

• Health related organizations

Community and provider engagement process

Step 3. Develop solution

options and vet with

community through 2

round

of interviews

• Develop solutions to address current

needs and reach the desired future

state while considering Act 167 goals

– In conjunction with analytics

contractor

• Obtain stakeholder perspective

on the impact of recommendations

on hospital performance and

healthcare delivery

Step 4. Develop and deliver

final report to GMCB

• Document and socialize confirmed

current state understanding, designed

future state, and recommended steps

to achieve future state (including pros

and cons)

• Obtain stakeholder alignment

on recommendations

Step 2. Develop current state

understanding through 1

round of interviews

Obtain community perspective on:

• Hospital Service Area (HSA)

characteristics

• Hospital & healthcare delivery

system performance

• Community needs

• Desired health system future state

Act 167 (of 2022) requires GMCB, in collaboration with the Agency of Human Services, to develop and conduct a data-informed, patient-focused, community-inclusive engagement

process for Vermont’s hospitals to reduce inefficiencies, lower costs, improve population health outcomes, reduce health inequities, and increase access to essential services

GMCB tasked Oliver Wyman with engaging diverse healthcare stakeholders to ascertain their 1) interactions with the health system and 2) perceived needs to improve equitable

healthcare access and outcomes

Aug-Sept 2023 Sept-Nov 2023 March – July 2024 Aug – Sep 2024

We are here

Patients

Hospitals

HCPsState legislature

/ regulations

Increase

in cost

Reduced

functional

capacity

Delayed care and

compromised care

access & quality

due to long wait /

reduced access

Critical

services/

admissions

being

declined due

to lack of

IP/ER capacity

VERMONT’S HEALTHCARE CHALLENGES ARE INTER-CONNECTED AND MANY STEM FROM

IRREVERSIBLE MACRO TRENDS OUTSIDE OF THE HOSPITAL’S CONTROL

Lack

of long-term

housing

availability

Difficult to

retain HCP

Shortage

of PCPs

Shortage

of mental

health care

professionals

Shortage

of nurses

Reduction

in revenue

Patients

turn up in

ER instead

Crowding

in ER

Lack of staffed

social care facilities

Crowding

in IP

Hire travel

nurses

Difficult to

discharge

certain patients

Low CON

threshold and

long approval

process

Old equipment

are not

replaced in time

Staff

shortage

Cumbersome

licensure

requirements

Difficult to

attract HCP

Inflation and rising labor

and commodity cost

Increased

transportation

needs

Increase in

state-wide

cost

Tight hospital

reimbursement

rate

Aging

population

Shift in payer

mix – reduction

in commercial

insurance

Increase

in healthcare

demand

Long

ambulance

wait

Cost-effective

contracts cannot be

secured due to long

approval process

Reduction

in in-state

dollars to pay

for healthcare

Many go out-

of-state to

seek care

Shrinking

population

Lower

procedure

volumes and

care quality

THE SIMPLE CONCLUSION IS TO ALLEVIATE SYMPTOMS BY INCREASING FUNDING AND

HEALTHCARE PROVISION, BUT IT WOULD NOT BE AFFORDABLE NOR EFFICIENT TO DO SO

Solving for symptoms of healthcare pain points: Because…

But this requires:

❑ Higher taxation

❑ Higher commercial

insurance

❑ Increased co-pays and

deductible

...

Rural nature of Vermont and shrinking population means that,

in many parts of the state, the population size and density do

not support a hospital with full-time full-spectrum of

specialties being sustained

Vermont OOP max, deductibles, and Commercial premiums

are already high and Vermonter cannot afford to see annual

double digit growth in insurance payments. Higher taxation is

also not a viable solution as they will likely drive residents and

businesses out of state

Shrinking population (and proportionally fewer younger

people entering the medical profession). System-wide supply

of medical professionals is unlikely to increase, so increasing

demand will just increase price

And implies:

❑ Lower efficiency due to

lower population density

❑ Lower care quality due to

lack of sufficient volume to

main physician expertise

…

Easy solution

More funding to get more providers to meet access needs

Difficult to get PCP

appointments

Long ambulance waitLong wait in the ER

Long wait to get

elective procedures

Difficult to travel

to care site

…

Diverse populations

and health equity

STRATEGIC IMPERATIVES IN REDESIGNING VERMONT’S HEALTH CARE SYSTEM

Accept the new reality and adapt

Change what we can

Improve access and equity

Act fast before it’s too late and sustain consistent efforts over time

Strategic

imperatives

Ensure financial sustainability to Vermonters, the state and providers

in redesigning Vermont’s

healthcare system

WE NEED A DIFFERENT SOLUTION THAT FULFILS HEALTHCARE NEEDS, BUT SLIGHTLY

DIFFERENTLY FROM HOW HEALTHCARE PROVISION LOOKS TODAY

Fully embedded use of

updated and modern

information technology

Increased use of

community

-based, mobile

and alternative sites of care

Modernized and reformed

EMS

regional referral to

specialized centers

Complete development of

population health with

linked payment

The future healthcare in Vermont will focus on early identification and treatment of illness

and patient being able to obtain care at

the most appropriate level

SUMMARY OF HIGH-LEVEL STATE-WIDE RECOMMENDATIONS

Improve transportation

– For community members to and from acute and urgent appointments and from the ED

– For patients with appropriate means of transport between facilities (EMS and other types of transportation)

Build housing

– For the unhoused and under-housed

– For special group needs

– For people recruited to work in Vermont

Enlarge workforce and improve utilization

Administrative simplification

– Align AHS agencies with HSA boundaries and meet regularly with hospitals and providers

– Fully computerize and integrate AHS services

Improve access to appropriate levels of care in each community

– Reconfigure provider resources to better meet community need and achieve financial stability

HOUSING, PROFESSIONAL EMT, CAPACITY FOR SOCIAL CARE, AND TRANSLATION SERVICES

NEED KEY EARLY ACTION FOCUS TO ENSURE A SOLID FOUNDATION FOR OTHER INITIATIVES

Training

Affordable & Equitable Access to Healthcare

Work

force

Transportation Provider infrastructure

Payment

Productivity

• EMR optimization

• Adequate support staff

Funding

Housing

Licensure

Availability of

appropriate

transportation

• EMS

• Non-emergent

Viability

• Financial

• Operational

Affordability

Professional EMTs

Regionalized EMS

Modernized facility

Coordinated planning between providers and state

agencies

Capacity for home

health, long-term

care, and community-

based MH & SUD

Choice of most

appropriate care site

Transparency of cost

of care

Translation services

Early action priorities

Key area to optimize

Key pillars

Goal

Key components

missing

THE RUNWAY TO CHANGE WILL TAKE AT LEAST 4-5 YEARS TO COMPLETE

Illustrative action timeline, assuming positive decision to change according to current recommendation

2024 2025 2026 2027 2028

Improve VITL clinical data access

Improve rural internet coverage

Embed upgraded EMR system in each provider office’s workflow

Enhance local training programs and increase workforce pathways

Hospital actions

Revise licensure for MH professionals, pharmacists, APRN

DHMC and UVM to codify clinic notes

State-facilitated regionalization discussions

IT infrastructure

Hospital-specific

transformation plan

Conduct transformation (e.g. EMR integration,

workforce re-allocation, embed referral SOP etc)

Funding alignment

Activity

Conduct EMS transformationAlign 2026 budget plan to coordinated services

Service re-alignment

Enhance non-clinic non-hospital care provisionRealign healthcare services

to HSA boundaries

Devise AHS service-coordination plan

Reimbursement re-design

Implement primary care

incentive change for FY27

Devise and test primary care /

hospital incentive alignment model

Housing

We are here

Build low income and group housing

Licensure & training

State agency actions

Devise action plan

Approve increased care capacity and funding

for Mental Health, Long-term Care and Telehealth

Legislative actions

Obtain federal waiver (if any)

Change plan

Report

publication

Decision to

transform

Approve zoning/environmental regulation change

and funding for EMS transformation

Illustrative

12
© Oliver Wyman
✓ Improved master patient index
✓ 5-year strategic plan
❑ ‘Unified data space’ data 
aggregator
❑ Provider single sign-on
❑ Co-develop use case with providers
❑ Provider ‘self-help’ data analysis 
tool
❑ Collaborate with payers to obtain 
pharmacy data
❑ Modernize integrating enrolment 
eligibility (legislative effort, 5-year 
runway)
✓ Joined social work compact 
(effective upon passing)
✓ Joined counselling and PSYPACT 
(effective 1 July upon approval)
✓ Allowed bachelor-level mental 
health professionals to obtain 
license in VT
✓ In 2020, approved short-term 
prescription extension by 
pharmacist (until consultation, up 
to 5 days, one time only)
❑ Act 117 to review MH licensure in 
VT to streamline and further 
remove barriers to licensure (study 
due Dec’24)
✓ Age Strong Vermont Plan (link)
✓ SNF bed board (from March’24)
✓ 3 Adult Services Division complex 
care nurses to help with care 
coordination
✓ Nursing facility retrospective rate 
adjustments
✓ Rate review for residential care, 
assisted living, home health, and 
adult day (link) 
✓ Root cause analysis for hospital 
case managers to address complex 
discharges
❑ Further expedite new application 
process for long-term care 
Medicaid eligibility process
❑ Reduce minimum occupancy 
threshold on nursing homes (link)
❑ Seek to bring iCare to Vermont
MANY INITIATIVES ARE UNDERWAY TO TACKLE THE SYSTEM-WIDE CHALLENGES 
Medical data 
infrastructure
improvement
Licensure 
streamlining
Mental health / 
substance use 
support
Elderly care 
support
Select initiatives only, non-exhaustive
✓ Mobile crisis response (since 
Jan’24, link)
✓ New psychiatric residential 
treatment facilities (youth, 
forensic)
✓ Centralized dispatch from 988
✓ 6 new delivery system projects, 
funded by $100k by OneCare (link)
✓ $1 million, one-year CCBH 
Planning Grant (extended to 
March’25) (link)
✓ DMH Vision 2030 on MH 
integration across the healthcare 
setting (link)
❑ DMH global referral checklist
❑ Seek alternative to hospital-based 
administration of court ordered 
medication
Key: ✓ Completed  ❑ Ongoing

HOWEVER, DEEPER STRUCTURAL CHANGES NEED TO BE ACTIONED NOW TO AVOID

DEVASTATING FINANCIAL DIPS

Deeper structural

reform

Momentum of current efforts needs to

be scaled up to deliver structural reforms

in addition to patch solutions

Support local

change

Local health organizations will need

support in transitioning to new

operational models

Expedited

action

Vermont must act now with urgency to

complete structural changes in the next

5 years. Hospital systems and the state

will see deep financial deficits if no

structural reform is achieved by then

NEXT STEP: GMCB BOARD MEETING ON HEALTH SYSTEM RECOMMENDATIONS AND

COMMUNITY MEETINGS IN JULY

GMCB Board meeting on

health system

recommendations

Monday, 8 July 2024

10:00am – 12:00pm

14 in-person community

meetings

9 July 2024 – 1 Aug 2024

See GMCB website for details

1. https://gmcboard.vermont.gov/Act-167-Community-Meetings

Virtual community

meeting (state-wide)

5 Aug 2024

6:00pm - 7:30pm