This is a conversation that occurred on WDEV’s “Open Mike” program on January 11, 2018 about the benefits for patients that will come from a closer  connection between hospitals and home care.  Host Mike Smith interviewed Judy Peterson, president and CEO of the Visiting Nurse Association of Chittenden and Grand Isle Counties and Dr. John Brumsted, president and CEO of the UVM Health Network about the two organizations deciding to create a formal affiliation.

Listen to the interview at the link below or read the transcript that follows.

Learn more about the Visiting Nurse Association.

Mike Smith: Let’s start with this question, Judy. This seems like an unusual sort of an alliance, an affiliation, in that one side deals with people in their homes, the other side is talking about a mission that, you know, you have to go to a facility, for example. Why affiliate? What’s the advantages of affiliating given sort of the two missions here?

Judy Peterson: Well, great question, Mike, and starting with the mission, our missions are just so well-aligned that doing the affiliation kind of formalizes our relationship, but our missions of what we wanted to accomplish, our desire to help people in our communities live better, healthier lives, those both existed, and now it’s work that we can do together. It really is not an unusual kind of affiliation. This has happened, or does happen, around the country, and it’s all in the name of continuity of care, really trying to help give a better experience to the patient and to help people get well quicker, stay well longer, by having the hospital and the home health agency work even more closely together.

I want to say, we’ve had a great relationship with the medical center and with all the other area hospitals for years. We receive the bulk of our referrals from hospitals, so people who’ve had that hospitalization and acute stay are referred to the home health agency afterwards. Through this affiliation, it just gives us a higher level of coordination. We’re sitting at the same tables all the time, we’re in the same meetings, we’re problem-solving together. As someone who’s worked in home care for about 40 years, for me, this is just what I’ve always wanted, what I’ve always believed was going to be the way to improve health.

Mike Smith: So let me ask this question to John. The hospitals, they get their revenue from patients. What you’re saying in this sort of alliance, at least from outward appearance, is, “We don’t want patients.” Is that what we’re talking about, here?

Dr. Brumsted: I don’t view it as characterizing that we don’t want patients, what we really want is what Judy said, we want people to live life as healthy, as well as they can based on their circumstances, and the alliance between the Visiting Nurse Association of Chittenden and Grand Isle County and the University of Vermont Health Network is a natural one. What we’re really striving to do is make sure that where people get their healthcare is based on what’s best for them and their family. As Judy said, we’ve had a great relationship between the Visiting Nurse Association, our doctors in our doctor’s offices like largely primary care, and with our hospitals for quite some time, but even with that great relationship, there are difficulties sometimes in the transition of care from one site to the other. And when there are those difficulties, it’s not good for patients, it’s not good for families, and it also costs more money. What we’re really all about in bring our organizations closer together is to be able to be at the same table, to really understand how we can set up the systems to coordinate care in a real seamless fashion so that we can get people to the right site of care for them.

Mike Smith: But if you’re successful at providing home health care instead of being in hospitalized care, doesn’t that impact the revenue in some way?

Dr. Brumsted: It certainly does, and we’re working very hard to have it impact the revenue in a way that makes healthcare much more affordable. It’s a lot more affordable, and it’s the right thing to do, to have people who are ready to have care in the home have care in the home, and not be in a hospital bed. It probably costs 15 to 20% of what a hospital bed costs to care for somebody as well at home, and oh, by the way, I don’t know about our listeners out there, but if I can get taken care of in my home or my wife or a loved one could be cared for in the home, that’s what I want, and so we’re trying to smooth this out so that this works as best as it possibly can.

Mike Smith: Judy, I want to turn to you. What does an affiliation mean?

Judy Peterson: This affiliation is really a very formal partnership of working together. I want to explain that the VNA continues to maintain its own board of directors. I remain President and CEO of the VNA, but we have reporting relationships to the Network. So the Network has certain powers, for instance, to approve our budget on an annual basis. Should I decide to retire at some time in the future, then my board of directors would choose a new CEO, but it would be approved by the Network. There are those powers that the Network maintains, but also, the VNA board of directors are able to have a seat on the Network board so that there’s always that VNA voice there, also. It really ends up being the best of both worlds.

Mike Smith: What advantage is it for you in the Visiting Nurse Association to do this?

Judy Peterson: Well, there’s the advantage of really promoting our mission, really enabling us to do those better transitions of care, better care coordination, the kinds of things we’ve already talked about, but then there’s also some other very tangible benefits for us. There are many services, shared services, from the Network and from the Medical Center that VNA is now going to be able to take advantage of. That’s everything from staff training to some purchasing. We already, just the other day, my CFO came up to me and said, “You know that big, expensive copier that we needed to buy? We’re getting a 40% discount because of our relationship to the Network.”

You know, we use lots and lots of medical supplies. At the VNA, we have about 630 employees, we do thousands of visits all over Chittenden and Grand Isle Counties, so we use lots of medical supplies, like, you know, gloves and dressing supplies, those kinds of things. That’s going to also be an advantage for us, to do some of that purchasing through the Medical Center.

One of the really big advantages, also, is eventually, we hope we’ll be on the same medical record system. And it’s not just that we get to look at the doctor’s record or they get to look at ours, it’s a shared medical record. We’ll both be documenting in the same place, and that’s really going to help with care coordination, also.

Mike Smith: John, I’ve heard a lot from listeners concerned about this consolidation that’s happening, mostly the fear that there’ll maybe, one day, be only one provider, the UVM Heath Network, out there, and a monopoly in anything isn’t good. How do you put that fear to rest as you start affiliating with VNA and other organizations that are out there?

Dr. Brumsted: It’s a good question, Mike, and we understand that culturally in Vermont and in northern New York, there’s a tendency to be skeptical and sometimes even fearful of large organizations. What we’re doing is bringing organizations together that share a mission to improve the health of the communities that we serve. In a rural environment, it’s really important for us to be able to come together, to share services, to coordinate care, because it’s all about delivering healthcare in a way that’s of very high quality and at the same time, be as efficient as we can be. So it’s not creating a monopoly. It’s creating a family of healthcare providers that share a common mission, and in that coming together, finding value in things that we’ve already talked about. Ultimately, that makes healthcare more affordable, which is important for all of us to strive for.

Mike Smith: Judy, you talked about changes in governance. Are there other changes in billing and how you are paid?

Judy Peterson: No. the VNA bills for whatever services we can. We have a budget of about 34 million, and probably 40% of that is Medicare dollars. That’s of course the insurance for people who are over 65 or who have permanent disabilities. Another 40% is Medicaid revenues, and then that last part is, we bill some commercial insurances and we also do some fee for service where people pay out of pocket. That’s usually for private duty services.

What changes is that there are some advantages to us of being part of the affiliation. I talked about the, you know, purchasing power, but also the Network is supporting some of our programs specifically, and one of those is the Vermont Respite House in Colchester, the new building.

Mike Smith: The new one.

Judy Peterson: Yes. That is so valuable to our community, and really to all of Vermont. It is the only in-patient hospice facility in Vermont, and the network recognizes the value of that, so they’ve said, “Let us help you cover some of the losses from that program.”

Mike Smith: John, did you want to chime in on that?

Dr. Brumsted: I do, because it’s such a great example. The last thing we want is for somebody to be in a hospital bed towards the end of life if they and their family really would like to be at the Respite House. That’s the best thing for that patient and that family, it’s the right thing to do. Let’s look at that from a business case: it also makes unbelievable sense for the Network and for the people paying for healthcare. It’s a lot less expensive to be in the Respite House as opposed to being in a hospital bed. So through this affiliation, through our support of the Respite House, we’re doing the right thing for patients and their family, and we’re doing the right thing for the business side of healthcare, as well. Again, it ties right into keeping things as efficient as we possibly can.

Mike Smith: One of the things that I was wondering, Judy, is this: why UVM? I’m going to ask John the same thing. Why UVM Health Network, and then I’m going to ask John why VNA of Chittenden County?

Judy Peterson: Right. Well, some of it, of course, is location. We’re in the same county, we’re working together, we share many of the same patients, and also, the UVM Health Network is unique in northwestern Vermont, really, and all of Vermont, to be able to have this kind of a system where it’s a range of providers, hospitals, physicians, and now home health agencies, so community health services, all being able to work together, so it really was an opportunity.

I want to say, this began like two years ago when John and I … I’d heard him speaking at a meeting, and afterwards, I went up to him to say, you know, “I just want to make sure that you recognize that as we’re sitting here in this meeting room, there are about 400 VNA employees in the homes of people in our county,” and he said, “Oh, you’re so right. Let’s sit down and talk.” We had lunch, and it was then that we said, “Maybe there are some advantages to us working even more closely together,” and that was really the genesis of all of this.

Mike Smith: John, why the VNA of Chittenden and Grand Isle?

Dr. Brumsted: Well, Judy’s absolutely right, a big part of it is the overlapping of where we serve patients, but it goes well beyond that, and it goes to the fact that we’re really … have overlapping missions to improve the health of the communities that we serve, the people in those communities, and in coming together, we can do things so much better than we’re currently doing them, even though we’ve been friendly organizations and been simpatico for a long time. Let me give you an example.

Wouldn’t it be great if a visiting nurse sat down a couple of times a month in the primary care office that served that same geography and together, collectively, they ran through the patients that were most needy and how we could best serve those patients in the home, in the office, whatever they needed, if they needed other services. That’s an idea that we’ve talked about a long time, and when you’re independent organizations, even great ideas, sometimes you just can’t get there from here.

When you’re part of the same organization, you’re at the same management tables, those things happen. And I would almost guarantee that within the next six months, we’ll be moving down the path of having the VNA in our primary care offices. Openness to ideas like that, being able to see the value and come forward and tap me on the shoulder at a meeting, that makes the VNA of Chittenden and Grand Isle County a perfect first partner for home health for the Network.

Mike Smith: Let me ask you this. What’s sort of the biggest challenge for you in this affiliation?

Judy Peterson: I don’t think there’s what I would call a challenge for the affiliation. I think that the affiliation we see is just a great benefit and support of our mission and what we’re trying to do. The largest challenge that we face these days is really managing growth. There’s more and more demand for home care services, and so staffing and recruitment, those are our biggest issues. We really want more nurses and physical therapists and LNAs to discover the wonderful work of home care and just what a terrific job it is to be in somebody’s home, helping them learn to care for themselves. Now, working so closely with primary care and the hospitals, it’s really the work that I’ve loved, and I really invite more nurses and therapists and rehab folks to come join us.

Mike Smith: Judy, John, thank you so much for joining us on Open Mike today.

Dr. Brumsted: Thank you, Mike.

Judy Peterson: Thank you.

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