This commentary is by Mark Crow, president of Tenth Crow Creative, a strategy and communications agency serving healthcare organizations. He lives in Shelburne and writes about healthcare transformation and systems change.
Vermont has an unprecedented opportunity to reshape its healthcare system. Through the federal Rural Health Transformation Program and other recent and proposed state reforms, we have the chance to build a system that is more sustainable and better able to meet the needs of future generations.
But funding, planning and policy are only part of the challenge. The hardest part of healthcare transformation will be making difficult decisions together.
Vermont’s healthcare system is under increasing strain. Healthcare providers face mounting financial pressures amid workforce shortages, an aging population, declining birth rates and growing demand for behavioral health services. These are not isolated challenges. They are interconnected forces reshaping healthcare delivery across our state.
The encouraging news is that Vermont still has choices. But opportunities have a shelf life. Every year that meaningful change is delayed, the options available to hospitals, communities and policymakers become more limited. If we wait until another hospital is forced to eliminate a service or becomes financially unsustainable, the focus won’t be on designing a stronger healthcare system. It will be about managing another crisis.
The decisions ahead won’t simply determine where and how healthcare is delivered. They will help define what access to and the cost of healthcare look like in Vermont for the next generation. That means we need to begin talking more openly about the compromises required to preserve healthcare for the long term.
That may be an especially difficult conversation in Vermont. Our identity is rooted in local communities. We value local institutions and decisions made close to home. But preserving healthcare for future generations may require us to rethink what local access means in a changing world.
Healthcare transformation increasingly requires us to think beyond individual communities and consider what best serves an entire region. That isn’t simply an operational challenge. It’s a structural and cultural one.
The recent closure of the birthing center at Copley Hospital and the pending closure at Brattleboro Memorial Hospital illustrate this tension. No community wants to lose services that families have relied upon for generations. Yet these closures also reflect broader national realities. Rural hospital administrators across the country reported that approximately 200 births per year were needed for both the financial viability and clinical sustainability of an obstetrical program. Births at Brattleboro Memorial Hospital declined to 230 in 2024, while births at Copley Hospital fell to fewer than 200 in recent years.
Those realities do not make the loss of local services any less painful. But they remind us that hoping things remain the same is not a strategy.
Sustaining healthcare in Vermont will require rethinking how and where some services are delivered. That may mean greater collaboration among hospitals, stronger regional networks for specialized services, and increased investment in primary care, emergency care, telehealth, preventive care, chronic disease management and community-based services. None of these approaches is a predetermined solution at this point, but all deserve thoughtful public discussion before changing circumstances leave us with fewer options.
One lesson I’ve learned from working alongside healthcare organizations is that successful transformation depends as much on public understanding as it does on good policy. Communication isn’t simply about explaining difficult decisions after they’ve been made. It’s about helping people understand the challenges and participate in shaping the future before those decisions become unavoidable.
Many of these discussions are already underway among healthcare providers, state agencies, legislators, employers and others. Those efforts deserve recognition. But meaningful transformation also requires engaging the people healthcare exists to serve.
The greatest need may not be for another report, commission or study. It may be for a coalition of leaders willing to convene an ongoing public conversation before major proposals are developed. Those conversations should help establish the principles that guide difficult decisions by balancing local access, quality, sustainability, workforce realities and the overall health of Vermont’s healthcare system.
Such conversations are unlikely to produce unanimous agreement, but they don’t need to. Their purpose is to build public understanding, trust and a shared framework for making difficult decisions before changing circumstances make those decisions for us.
Handled well, they can strengthen, not weaken, public trust. People are far more likely to support difficult decisions when they understand the challenges, the alternatives, the guiding principles and the long-term vision those decisions are intended to achieve.
As Vermont redesigns its healthcare system, I believe it is also time to rethink how we define success — not hospital by hospital, but community by community and region by region. Ultimately, the future of Vermont healthcare will be determined not only by the difficult decisions we make, but by the way we make them.
