This commentary is by Anya Rader Wallack of Burlington, senior vice president for strategic communications for the UVM Health Network.
Intent matters. This is a well-established concept in business, law and personal relations. If we understand what a person or an organization is trying to accomplish, we better understand their individual actions and their accountability for those actions.
I have returned to this concept many times as I have oriented to my new job at the UVM Health Network. I grew up in Vermont, and worked on improving the state’s health care system in the 1990s, the 2000s and 2010s. I have also worked on health reform in other states, and at the federal level. I know from this work that the UVM Network is a rare phenomenon, a rare force for good in a really messed-up American health care system, and that is the major reason I came to work here.
The UVM Health Network is pursuing lots of initiatives, and many outside our organization do not understand why, or how, they fit together. That’s on us. If we do not clearly explain our work and, more importantly, how it will benefit our patients, providers and staff, the community has a right to be leery.
The UVM Health Network came into being a decade ago, and is an affiliation of five community hospitals in Vermont and New York, an academic medical center (the UVM Medical Center), a home health and hospice agency (formerly the VNA of Chittenden and Grand Isle Counties), more than 1,000 physicians and more than 15,000 total employees. The intent, when this not-for-profit network formed, was to build a system of health care providers, facilities and services across northwestern Vermont and northern New York that:
- Preserves access to the health care services people need in their local area and also rapid access to specialists and complex care when it is needed.
- Focuses on keeping people healthy through prevention and primary care and treating their acute needs when they are ill.
- Remains low-cost and high-quality compared with valid national benchmarks.
- Is financially sustainable, so our communities can count on us to reliably care for them.
I want to point out how unusual this is. You would be hard-pressed to find another provider network in the country that is pursuing this path. Many hospitals in the United States continue to focus on preserving market share for treating illness only, and many are for-profit and shareholder-controlled. And most American health care providers continue to get paid, primarily, based on the volume of services they provide, with no accountability for the cost, quality, or coordination of their services.
It’s also true that most rural American hospitals are struggling for their financial survival. In fact, over the last 10 years, 138 rural hospitals have closed across the country — a scary trend to which Vermont is not immune. And other providers, from independent physician practices to home health and hospice agencies, struggle in a system where survival depends largely on getting the highest possible price for your services and selling as many services (doctor visits, surgical procedures, hospital stays) as possible.
We are trying to take a different route — one that places value on prevention, primary care and disease management. And, we are doing this work as a locally led, locally governed, and highly regulated organization.
The corollary to “intent matters” is “execution matters.” The Vermonters and New Yorkers we serve should expect that we not only have the best intentions, but that we execute effectively on those intentions, for the best possible results.
The intentions of the leaders of our system (including me) are good, but we can do better on execution. We are trying to do the right thing in a national health care system that is not aligned to support reform, and often we fail to explain to our various constituencies — patients, policy makers, regulators and our own employees — what we are up to and why. We will do a better job going forward.