Fred Kniffin: Healthcare changes for a healthier county

During my two years as the President of UVM Health Network/Porter Medical Center, I have learned a great deal about our organization, our role in this community and about the people who depend on us for care. Here are some of my key take away lessons:
Porter is a valued community asset. We belong to our community. We exist to serve our community.
I feel a strong ongoing responsibility, and a sincere desire, to communicate openly and transparently with our community, to keep you all — our stakeholders — informed about the status and direction of this important, cherished institution. I am writing today to update you about our progress in the important and transformational work of healthcare reform here at the local level.
Porter is actually several years into a complex journey intended to create significant positive change in how we all experience healthcare. The goal of this journey is to achieve what is called the “triple aim:” high quality care, great patient experience, at an affordable price.
Our strategy for attaining this lofty goal is to leave behind the traditional “fee for service” payment model and move to a new “population health” or “value based care” model. Let me explain.
Since the beginning of time, healthcare has been paid for under the fee for service system. Under this system, the patient gets sick or injured, receives healthcare services, and pays a fee to the provider. It may be the patient paying the fee out of pocket, or it could be their insurance company paying the fee, but care is paid for one episode of sickness at a time.
I have had the opportunity in the last few years to hear a number of healthcare experts speak about healthcare in America, and to a one, fee for service is recognized as one of the fundamental flaws of our healthcare system.
On a day-to-day basis the individual providers I have worked with for 30 years do the right things for the patients in front of them regardless of how they get paid. But at a higher level, at a system level, when each episode of care creates a charge, the healthcare system benefits from higher volume of services provided. There is no financial incentive or reward for the system to: coordinate or integrate care; provide just the right amount of care; intervene as early as possible; and keep the patient healthy. If a patient falls through the cracks or gets sicker over time, the patient loses while the system wins by generating more revenue. The healthcare system and the patients are fundamentally misaligned.
This is our current system, and it needs to change. Here in Vermont (and in Addison County), it is changing. Imagine a world where the interests of our local healthcare system aligned perfectly with the interests of the community we serve. Imagine a system of reimbursement that rewards Porter for working with you to attain the best health possible. This is where we are heading. Porter is receiving a broadening amount of our revenue in fixed payments, creating ever-increasing incentives to: focus on the health of our community; invest in wellness; and align our organizational goals with the goal of our patients to be healthy.
We have been talking, planning, and strategizing about this sort of change for several years. We are now at lift off. Through our involvement with OneCare Vermont, an Accountable Care Organization created by the UVM Health Network and Dartmouth, we are investing in change that will not solely focus on sickness — instead it will seek to improve the health of our community.
Here are some examples. We are hiring nurses to work with our sickest and most complex patients, those most in need of coordination of care (approximately 5 percent of our patients account for 50 percent of our costs). We are working fast and furious to implement the EPIC electronic health record, a huge project that will integrate our health records locally within the Porter system and across the UVM Health Network.
We are joining Rise Vermont, a community-based wellness program that has enjoyed great success in Northern Vermont and will be the statewide platform for practice of wellness. We are revisiting programs like smoking cessation and cardiac rehab, not moneymakers in a traditional fee for service world, but big winners when our goal is to keep people healthy. We are investing in palliative care, helping our sickest patients avoid unnecessary tests and treatments and enjoy the best possible quality of life.
We are early in this massive transition. In 2017 we received roughly 3 percent of our $100 million of revenue as fixed payments. By 2019 we anticipate that 20 percent of our revenue will come to us as fixed payments; with the goal that in five years’ time, 80 percent of our revenue will be in fixed payments. This payment transition has provided financial stability where we are more comfortable funding programs that take us further down the road to positive change.
It is worth noting that when we joined the UVM Health Network this is the sort of fundamental change we were seeking. We recognized that the future of same old, same old status quo fee for service was bleak.
The scope, depth, and support we have gained by being part of the Network has allowed Porter to move forward with meaningful reform much more aggressively than the average community hospital. In fact, of the eight small “critical access” community hospitals in Vermont, Porter is leading the charge and reaping the benefits of reform. One year into our affiliation the synergy between Porter, UVM Health Network, and OneCare Vermont is both palpable and powerful.
Reforming our healthcare system is a daunting task. Locally Porter represents nearly $100 million in revenue and total revenue for the UVM Health Network is $2.4 billion.
Systems of this size do not turn on a dime, but if you or your loved ones have suffered a serious illness and have had to navigate our current fragmented healthcare system, you know there is room for improvement and you know how important this work is. Progress will be incremental, improvement will be gradual. At UVM Health Network/Porter Medical Center, we remain cautiously optimistic that this exciting new approach to healthcare reform, this alignment of our organizational goals with the goals of our patients, will drive us to accomplish our mission of improving the health of our community.
This week’s Community Forum is by Dr. Fred Kniffin, President/CEO of UVM Health Network/Porter Medical Center.

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