Editor’s note: This commentary is by Roger Allbee, a former secretary of the Vermont Agency of Agriculture and Markets. He has also served as CEO of Grace Cottage Family Healthcare and Hospital in Townshend, a critical access hospital.
During the time an ACO or accountable care organization was being discussed in Vermont and just after it was formed, I was the CEO of a small critical access hospital in Southern Vermont. Although I was not formally trained in health care, I understood from listening to the discussions that took place at the time that changing the cost curve of health care in Vermont would be a formidable and ambitious undertaking. It would require a much greater emphasis on primary and preventative care, a way to reduce end of life costs, and actions to address critical health issues in the population.
Some of these issues have come forth recently with family and friends. A friend was diagnosed with late stage pancreatic cancer. The patient understood his diagnosis, and his wish was to do nothing further, but he was convinced to undergo major surgery that did not improve his condition. While I am not a doctor, in these difficult situations, the cost as well as the patient’s quality of life remaining must be brought into question. These are, of course, difficult choices, but I do remember during the discussion of the ACO, many recognized that to “bend the cost curve” it would be necessary to deal more actively with end of life patients and family decisions. There also have been examples of duplication of services when a patient moves from one health care facility to another.
Relative to reducing the cost curve for critical patient health conditions, when I was the CEO of the critical access hospital, a friend who had worked with the AARP Foundation and Kroger Foods, put me and others in contact with Community Servings Food Heals program in Massachusetts. This program, which home delivers medically tailored meals to several thousand clients with critical conditions, has demonstrated through peer-reviewed studies that these meals are a low-cost, high-value service for severely ill patients, and they ultimately reduce health care costs. A rigorous study, funded by the Robert Wood Johnson Foundation’s Evidence for Action program, utilized Massachusetts’ insurance claims database and found that participation in a medically tailored meals program was associated with fewer hospital admissions and nursing home admissions, and less overall medical spending. The results of the study were published in April 2019 issue of the journal JAMA-Internal Affairs.
Some in the health care community in Vermont, and others of us with a background in agriculture and food systems, are working on developing a Community Servings pilot approach in Vermont. We have been in contact with the ACO and have discussed the approach with leaders at Community Servings in Massachusetts. Vermont has gained a reputation for its food systems and thus has the ability, many of us believe, to achieve success as they have done in Massachusetts in reducing hospital admissions and nursing home admissions and overall medical admissions with a Community Servings type approach.
