Health Care

Community health care can save money, advocates say

Ellen Tyrell, a participant in the Support and Services at Home, or SASH, program, attends a news conference Wednesday. Photo by Erin Mansfield/VTDigger

Community health leaders say they have figured out how to save money on treating Vermonters with long-term needs.

A half-dozen organizations that make up the Support and Services at Home, or SASH, program gathered at the Statehouse on Wednesday with representatives of Sen. Bernie Sanders, I-Vt., and Sen. Patrick Leahy, D-Vt.

The groups announced that they slowed the growth of federal Medicare spending on long-term care for senior citizens and people with disabilities by about $1,500 per person between 2011 and 2014.

The U.S. Department of Health and Human Services announced the results in a January report. The report said about 3,500 people participated in SASH during the time period, and savings were highest for the roughly 50 percent who had been in the program the longest.

As a group, the people who participated in SASH for the longest also had lower growth in health care costs for emergency room visits, outpatient hospital visits, primary care visits and specialist doctor visits, the report says. The report found smaller savings for patients in the program for a short period of time.

“The real greatness in my mind is about the quality of life improvements, and that is absolutely priceless,” said Kim Fitzgerald, the chief executive officer of Cathedral Square, the South Burlington-based nonprofit organization that set up the SASH program.

Sixty-five social service organizations, including ones handling affordable housing, mental health, primary care, elder care and disability services, are part of SASH. The number of people enrolled has increased to about 4,500, according to Cathedral Square, and 69 percent of them use Medicare. An additional 19 percent have a combination of Medicare and Medicaid.

Camille George
Camille George, deputy commissioner of the Department of Disabilities, Aging and Independent Living, speaks at Wednesday’s news conference. Photo by Erin Mansfield/VTDigger

The SASH program is integrated into Vermont’s Blueprint for Health — a health reform program that encourages patients to establish “medical homes” so a primary care doctor can coordinate the patient’s care with any specialists the person sees.

The cornerstone of the SASH program allows people to “age in place.” That means senior citizens and people with disabilities can receive health care and social services in their home and avoid being placed in nursing homes, which are some of the most expensive medical facilities.

Camille George, the deputy commissioner of the Department of Disabilities, Aging and Independent Living, said the SASH program “puts each person in the driver’s seat” and allows them to remain “happy, safe and at home, on their terms.”

George said the coordinated care program has reduced the rate of participants falling down and getting hurt, increased age-appropriate vaccinations for participants, increased how many people have their high blood pressure under control, and increased how many people have signed advance directives regarding their care.

From right, John Michael Hall, executive director of the Champlain Valley Agency on Aging; Katherine Ash, an aide to Sen. Patrick Leahy; and Eileen Peliter, executive director of Downstreet Housing and Community Development. Photo by Erin Mansfield/VTDigger

John Michael Hall, executive director of the Champlain Agency on Aging, called the SASH program “precedent-setting” because Vermont is the only state to use it, and the federal government’s report shows that it’s working.

Hall said he began working in home health care 37 years ago, when social service organizations would often get involved in senior citizens’ health care after they were experiencing severe issues like dementia.

He said that led to “overreliance on hospitals, our continued habit of chasing disease when it’s at its most expensive instead of preventing it.” And he said governments should be “keeping people healthy, instead of being content to pay for them when they are very sick.”

Correction: A photo caption incorrectly identified Eileen Peltier as Molly Dugan. 


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Erin Mansfield

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  • timothy price

    Staying healthy is a personal responsibility. There is everything a person needs to learn available to them for free on the web. Understanding how your body works and how to keep in tip-top shape is an ongoing study. The individual needs to do it for him or herself. The monopoly of the “AMA disease-care” industry is largely a racket. “keep people dependent, give them bad dietary advice and poor food, no exercise, and a media that focuses on terrible news, and voila… you have a sick society spending far more than they can afford on “sickness”. It is especially galling that “health insurance” is provide to state and town employees as it make the AMA the “state religion” and forces financial support for ineffective practices. I would dump the whole medical establishment in favor of a free-market approach to healthcare.

  • rosemarie jackowski

    Is this information correct?
    SASH will not act as a patient advocate, and accompany the patient when he/she goes to the ER, or is admitted to the hospital.
    SASH does not offer any services to folks who are in their own home.
    SASH will not help a patient gain access to dental care.
    SASH will not transport a patient to a medical appointment.

    • Zachary Hughes

      I was critical of SASH at first but I have seen results. It is a start. and frankly its much better then I could have ever hoped. At my building the residents are very happy with the service. Before SASH came along the folks in the building were often alone and to me were not very active. Now that has changed!

  • Patient-centered medical homes focus a lot of their analytic resources on operational process improvements. Check more at: