This commentary is by Margaret Gadon of Strafford. She is a retired physician who has worked in public health in health care policy, academia and clinical care. She is co-chair of the Strafford community nurse program.

What are we going to do about the rising costs of health care in Vermont? In just six years, rates for individual small-group plan health insurance premiums have increased up to 80% with a doubling of the cost of policies under the state health exchange. A recent study directed by the Green Mountain Care Board identified a key element of cost containment; shifting resources from high-cost hospitals to community-based and local primary care, where the social barriers to good health and health care can be addressed. Through this many hospitalizations and costly emergency room visits can be avoided.

Vermont’s Blueprint for Health, with its statewide system of community-based care, was created in 2003 to achieve this. It is a great start. It has improved health care quality and decreased health care costs but it needs to be more robust to save big dollars. This can be achieved with the widespread use of trusted health care coordinators/navigators who know the community and its resources, and link to both Blueprint and the traditional health care system. Will this work? A national demonstration project has in fact demonstrated the cost-effectiveness of these workers through a reduction in repeat hospitalizations and length of stay.

So what are we waiting for? The Green Mountain Care Board, which oversees the distribution of health care resources in Vermont, has focused only on the traditional health care system. To oversee the costs of care comprehensively, it needs to incorporate community care into its vision. With the upcoming changes in health care funding in Vermont, The time is now to develop a system of these care coordinators throughout the state. 

Vermont is a small state with a small population. This may make it one of the costliest to provide health care, but it also gives it the opportunity to take the lead in offering a truly comprehensive and community driven  health care system that makes its  health care affordable. 

You can make a difference by writing your legislators and asking them to support H.140. 

This bill directs the Department of Health to administer a grant program for the purpose of establishing community nurse or community care coordinator programs in Vermont communities. The goal of establishing a statewide network of municipal non- clinical healthcare workers is to improve health outcomes and to prevent avoidable care and over utilization of institutional care, as recommended in the report completed by the Green Mountain Care Board’s consultant in November.