For months, Bruce Hamory, a physician and consultant with the firm Oliver Wyman, has been engaged in a fact-finding process to determine what is and isn’t working in Vermont health care. In a series of public meetings across the state, Hamory has repeatedly highlighted the fragility of the state’s health care institutions and the need for change.

“Vermont’s health system is failing and needs urgent fixes,” he told attendees at a Monday evening virtual meeting. “You experience this daily.”

But despite the dire prognosis, the initiative has yet to release many specific recommendations — offering only a few hints as to the scope of its final proposals, which are scheduled to be released later this month or early September.  

“I’m eager to be part of the solution, but I’m not seeing many solutions presented tonight,” Katherine Williams, who introduced herself as a registered nurse case manager and recent health policy graduate, said at the meeting. “I think we’ve identified and labeled the problems, but I’m not seeing what the solutions are.” 

Patients, providers and advocates across the state regularly encounter those problems. Vermont health care is growing increasingly unaffordable for many residents. Insurance premiums have risen rapidly, putting upward pressure on taxes. Nine out of 14 of the state’s hospitals ended fiscal year 2023 in the red, and their financial outlook is grim. Health care workers are in high demand and short supply, and wait times to see practitioners — including primary care practitioners — can be months long. 

The consultant’s work is part of a years-long “hospital transformation” process, one set in motion by 2022’s Act 167.  

On Monday, Hamory said a specific list of recommendations is forthcoming, likely at the end of August or beginning of September.

“You’re going to get about 150 suggestions-plus with fairly detailed recommendations,” he said. In the meantime, he offered a list of high-level fixes for the state’s care system.

Vermont needs to build more housing, Hamory said, including specialized housing for people with physical or mental health needs. The state should expand health outreach programs in rural parts of the state, and expand hours for urgent care and primary care, Hamory said. 

Transportation to and from medical facilities needs to be “enhanced,” Hamory said, and EMS services should be combined, professionalized and closely linked with hospitals. 

The state should create a statewide monitoring system for hospital beds and improve its information technology across hospitals and other care facilities. 

Hamory also recommended creating “regional referral centers,” where patients could be referred for treatment in specialized areas such as orthopedics, cancer treatment or surgeries.

“The new system will also assist hospitals to repurpose inpatient units so they can provide other services for mental health, memory care, skilled nursing or other needs,” Hamory said, in perhaps the biggest hint that he would propose significant changes. 

But many of those needs have long been familiar to people who interact with the state’s health care system. And many are similar to recommendations that the consultant made two months ago, in mid-June, as a series of public meetings was kicking off. 

They provide few hints as to the outcome of a process that could recommend sweeping changes to Vermont health care facilities.

Michael Del Trecco, the president and CEO of the Vermont Association of Hospitals and Health Systems, said that he was not worried that the final proposals might include cuts to hospitals. 

“I’m not concerned about the recommendations or how hard they might be,” he said. 

Del Trecco said that he could not speculate about those recommendations, but said they would require careful appraisal. 

“I don’t think this is an overnight or a six-month or a year activity,” he said. “I think it’s careful planning, so we make the right decisions while we have these difficult conversations on how we keep care local in the communities.”

Meanwhile, Mike Fisher, Vermont’s chief health care advocate, said in an interview that he hoped the final recommendations would be far-reaching enough to shore up the state’s struggling system.

“I really look forward to seeing Hamory’s official report,” Fisher said. “And I hope it’s enough to address the serious financial challenges we’re in. And I have a real fear that at the end of the day, we’ll only accomplish a fraction of things that are put on the table.”