Healthcare System of the Future

A drive down Park Street in Malone shows signs of The University of Vermont Health Network’s (UVMHN) latest partnership. Alice Hyde Medical Center, Franklin County’s premier healthcare center for over 100 years, is the fifth hospital to join the growing network that now includes University of Vermont Medical Center, Alice Hyde, Central Vermont Medical Center, CVPH, and Elizabethtown Community Hospital. In a deliberate regional strategic plan to offer high-quality, low-cost health care to residents throughout northern New York and Vermont, UVMHN continues to expand its affiliations and spread its community health focused mission.

Observant patients at Alice Hyde Medical Center in Malone will notice the change first in the signage throughout the sprawling campus. Modern, detached one-story medical office buildings at Alice Hyde frame older brick buildings that blend into the historic architecture of the surrounding neighborhood, and all are clearly marked with the green and white UVMHN signs indicating the formal partnership.

Inside, perhaps less evident, integrated clinical services offer patients higher level, more complex care.

Douglas DiVello, president and CEO of Alice Hyde Medical Center, pointed out that strong relationships, easy, open dialogue, coordinated care, and enhanced technological connections between administrative, professional, and medical staff at the network’s five medical centers ensure industry-proven best standards of practice. “It’s all about building relation- ships and working together collaboratively every single day of every single year—making sure we’re doing everything possible to raise the bar for quality,” he said. “That’s something that every patient who comes to Alice Hyde will benefit from, whether they are aware of it or not.”

DiVello has been in the healthcare management business for more than 30 years. When he came to Alice Hyde in 2012, he was aware of the clinical affiliation Alice Hyde had forged with Fletcher Allen over the years, and he saw it as a positive position to build upon. After just a few years in the North Country, he realized that changes in the healthcare environment, particularly with the Affordable Care Act, were creating pressure for healthcare organizations to work together, to find ways of improving the health of their communities and to lower the cost of health care. He said, “It became evident to me that having a more formalized relationship with an integrated delivery system like the University of Vermont Health Network made a lot of sense.”

Since then, he’s guided the hospital into this partnership while maintaining his original mission of elevating the region’s health status and keeping Alice Hyde a main driver of Malone’s economy. Malone is a town not unlike many rural spots in the North Country and throughout America that have seen better days. Typically, where towns and villages suffer, so does the health and well-being of its residents. Through routine community health needs assessments, Alice Hyde Medical Center has targeted mental health and chronic disease management as the greatest areas of need for its patients. DiVello stated, “It’s very important for us to have a formal process to assess what the healthcare needs of our community really are so that we know we are focusing and working on the right things.”

Chronic diseases like diabetes require management and, above all, prevention; and mental health issues are—for the first time in many clinical settings—being addressed through a more community-wide, holistic approach by integrating behavioral health into primary care offices. “We’re working on specific problems with other community behavioral health organizations like Citizen Advocates to identify as early in a patient’s care process as possible how to connect them with well-trained and experienced mental health providers,” noted DiVello.

This approach seems obvious and is long overdue, but it’s not out of sheer neglect that it is just now being widely implemented as a community health tool. DiVello explained the complexities in getting to this point, including a significant shortage of providers, inadequate reimbursement for services, and infrastructure that hasn’t kept pace with the need. It all boils down to, he said, “federal regulation and lobbying on the part of healthcare organizations to press for better payment for services.”

Being part of a larger network of hospitals gives Alice Hyde and other rural medical centers the leverage they need to provide for patients. Be it lobbying, purchasing and negotiating power, access to capital resources, or enhanced technology, these integrated delivery systems add real, measurable value to each individual hospital. The potential savings realized through group purchasing of medication, supplies, instrumentation, and other types of contract-related services, said DiVello, “enables us to put that money back into the day to day operations. As stewards of our financial resources, we’re most concerned about making sure we are protecting every dollar we spend and using every dollar to get the most benefit out of taking care of patients. That’s really our vision as a community health organization.”

Alice Hyde has been part of UVMHN since May 2016, and has already capitalized on the affiliation in major ways, with more to come. Three levels of cardiac care are offered at three different locations within the integrated delivery system. The program brings medical cardiologists to Malone three or four times a week. If cardiologists determine that those patients need interventional cardiology, they’re sent to Plattsburgh for care. If they need cardiac surgery, they’re sent to Burlington. A seamless process is in the works to bring regional transportation services to patients based on acuity and need.

Laboratory management formally integrates the operation of the laboratories at Alice Hyde, CVPH, Elizabethtown Community Hospital and UVM into one integrated laboratory and pathology department. The four separate campuses work together to ensure that all lab testing performed across the entire network is done in the most cost effective and efficient way. Simultaneously, it has improved access to test results for providers who rely on that information.

DiVello explained, “The biggest thing that’s influencing regional strategic planning and integration is being driven by the Affordable Care Act, which is creating incentives for healthcare organizations to work together to take care of large populations of patients in a coordinated fashion.” He said the future vision for this evolution may result in a different way health care is paid for, particularly by the federal government.

It’s a tumultuous and unsure time for just about every program that is legislated and funded by the federal government, but DiVello sees it as a rare opportunity to be among the architects who will create the healthcare systems of our future. The entire nation is focused on healthcare reform, and we can tell from the conversations and debates coming out of Washington that the transformations to come in this rapidly changing industry are anything but settled.

DiVello concluded, “As we transition from episodic reimbursement for various procedures, there’s a real possibility that we may evolve into a reimbursement environment in which we are paid a flat fee to take care of a specific covered life within the area of the integrated delivery system. If that evolution happens and we find ourselves being paid differently than we are today, it’s really going to be to our advantage to cast the largest net we can across the largest portion of the region possible so that we can take advantage of the economies of scale necessary to make that type of reimbursement structure work for our organization and our network.”