Valley News – Twin States Discuss Health Care Access Issues

WINDSOR — Two events in the Upper Valley this week highlighted the challenges facing rural health care systems in the Twin States, along with a tentative step forward in making that care sustainable.

About 30 people gathered at the Windsor Welcome Center Monday evening for an event hosted by the Green Mountain Care Board and the Vermont Agency of Human Services to gather feedback on the challenges facing the state’s health care systems.

“Vermont is looking at a runway that is 1,500 feet long and ends in a cliff,” consultant and physician Bruce Hamory, of the New York-based firm Oliver Wyman, told the audience.

Lack of transportation, high insurance premiums, and a shortage of healthcare providers are driving patients to the emergency room, and these costs are eating into hospitals’ profit margins.

Emergency room visits cost hospitals more than a primary care provider or urgent care center because of the operating costs and because they have to treat everyone, regardless of ability to pay, and they don’t always get reimbursed, Hamory said. People who don’t have primary care providers and go to the emergency room tend to be sicker by the time they decide to seek care, he said.

In 2023, nine of the state’s 14 hospitals were operating in the red. Some are cutting less profitable services like pediatrics and obstetrics, and there’s a risk that smaller, rural hospitals will close down altogether if they can’t stay solvent, Hamory said.

While the news was dramatic, it was met with determined optimism from lawmakers, health care professionals and administrators in attendance.

“We can’t fix what we can’t see,” said state Rep. Rebecca Holcombe, D-Norwich.

Win Brown, interim CEO of Mount Ascutney Hospital and Health Center, encouraged big thinking, even when solutions are expensive or daunting in scope. “We probably need to think boldly and do some moon shots,” he said in a question-and-answer session after Hamory’s talk.

Nearly half of the nation’s patient records are maintained on Epic Systems software, Brown said. It would cost millions to provide that software to every hospital and clinic in the state, but it would “remove an incredible amount of friction from the system” and is a bold idea worth considering, he said.

Meanwhile, in Canaan, a new partnership has begun between the Mascoma Community Health Center and Laconia, NH-based health care provider HealthFirst. The goal is to provide primary care and some specialty services to people in the Mascoma Valley. The partnership began in November.

It is a model for the kind of community-based care provider that Hamory described as the future of sustainable rural care.

Sen. Jeanne Shaheen, D-N.H., recently secured $189,000 in Congressionally Directed Spending to help the Canaan facility provide under- and uninsured patients with access to health care. Shaheen was on hand Tuesday afternoon to meet with Canaan Center leadership.

While Canaan Health Center has struggled to stay afloat on its own, the partnership will “bring additional resources and the backbone of a larger organization with some administrative overlap, so we don’t have to add new costs,” HealthFirst CEO Ted Bolognani said at the meeting.

HealthFirst has also expanded services at the Canaan location, including behavioral health and resumption of dental care.

“We’ve seen a wild expansion in the need for behavioral health,” Bolognani said. The health center has two mental health providers who work four days a week and offer both in-person visits and telehealth. It also offers school-based services to 100 children in five local districts.

Mike Samson, president of Mascoma Community Health, which owns the building and is responsible for education and patient recruitment for HealthFirst, is excited about the return of dental services to the location after a two-year absence due to staffing shortages.

The practice is financed by loans and private donations and operates independently of HealthFirst. As of August 1, the practice has three dentists and seven treatment rooms.

25% of services will be targeted at low-income patients, such as those insured through Medicaid.

Neither Vermont nor New Hampshire have dental schools, and the Upper Valley is a “desert” for dental care, Thomas Duplinsky, director of Dental Services, said Wednesday.

“There are more dentists in New Haven (Conn.) than in all of New Hampshire,” he said.

In a stroke of luck for the Canaan clinic, Duplinsky, who has taught dentistry at the Yale School of Medicine for the past 30 years, bought a house in Canaan in 2021. Samson recruited him to help with the dental side of the Mascoma Health Center, and Duplinsky recruits residents to work at the center in exchange for student loan forgiveness.

Both meetings this week focused on the thin profit margins that leave rural health care providers struggling to stay afloat.

“We’re not financially stable yet,” Bolognani said. HealthFirst relies on grants, with up to 60 percent of its operating costs coming from patient care revenue. “But we’re going to try to continue to provide health care support to the community.”

Additional community meetings with the Green Mountain Care Board will be held in Randolph on July 24 from 6:00-7:30 p.m. and online across the state on Monday, August 5 from 6:00-7:30 p.m.

Information about the meetings can be found online at the Green Mountain Care website: gmcboard.vermont.gov/Act-167-Community-Meetings.

Christina Dolan can be reached at [email protected] or 603-727-3208.