October 18, 2018

Guest Column: Vermont healthcare system changing for the better

By Carrie Wulfman

I have been a practicing physician in Vermont for 18 years, and I have seen many changes in medical practice over these nearly two decades.

One of the most positive changes I have seen is the creation of OneCare Vermont, a collaborative initiative between the University of Vermont Medical Center and Dartmouth Hitchcock Medical Center.

One of the key aspects of OneCare is to reward primary care providers like me to work with our patients to keep them healthy rather than treating them only when they are sick.

This approach is an effort to move away from the current feefor-service system and move us to a value-based system focused on improving quality and promoting wellness by focusing on primary care for Vermonters. I have already put this new model of care into practice.

Thirty years ago, when I was applying to medical school, I wrote an essay titled “Treating the Whole Patient.” I recently came across this paper while going through some boxes, and had a lot of flashbacks and realizations. Being a primary care provider has been in my DNA since I first began thinking about becoming a physician, and I have had the honor of spending a career treating the whole patient.

I carry that desire through my work now, as chief medical officer for Porter Medical Center, where I have the opportunity to ensure that the work we are doing as an organization is in service to not just the whole patient, but our entire community.

I have more tools, training and resources now than ever before to do this work. I am convinced that the goals of payment and delivery system reform — to increase quality, access and affordability — can only be accomplished by bringing as many resources as we can provide to the patient, to help them engage in improving their health. When my patients are healthier, I will know that we have succeeded in this work. I have been treating a patient with diabetes and heart disease for several years.

I will call him “Joe.” Due to uncontrolled glucose levels over time, Joe required amputation below the left knee and a partial foot amputation on the opposite side. He walks without a cane, having adapted admirably to his metal fake leg, and is able to drive himself to his appointments. He recently needed to have a knee replacement in his right (good) leg due to breakdown of that joint over time. Because of his underlying complex health conditions, I referred him to an orthopedic surgeon at the UVM Medical Center to be evaluated for surgery.

Joe was sent home without a surgical appointment scheduled because his blood sugar levels were too high to safely operate. When I met with Joe and reviewed the note from the surgeon, the patient and I made a plan together to utilize resources for him that we are now able to access, thanks to programs like the Blueprint for Health and OneCare Vermont — our statewide accountable care organization.

This patient was able to access a care coordinator, a dietician, and a physical therapist, all within our office, which is his primary care medical home.

Together as a care team we developed a plan to get Joe’s blood sugar under control. The patient actively participated in his shared care plan and plant-based diet, and succeeded in getting his diabetes controlled to the level required by the knee surgeon in order to proceed with knee replacement. Not only was Joe able to have the knee replacement surgery, he changed his lifestyle and dedication to wellness and is back to health maintenance visits every three to four months.

This is one patient and one story, but know that primary care providers across the state are engaging in these reforms with the absolute same goal: to improve the lives of the people we serve. We can all continue to treat the whole patient, but now we get to do it with a lot more tools and resources, upheld by a team approach to coordination of care and prevention of illness. I realize that we have seen numerous programs come and go intending to improve both the delivery system and reduce the cost of health care.

I believe that the OneCare Accountable Care Organization will be successful and will support primary care providers like me who are true believers in health promotion and keeping our patients well rather than sitting back and waiting for them to come to us when they are sick.

It is a partnership between providers and patients that will make the difference and fundamentally change how care is delivered.

It aligns the incentives of the provider and the patient, and that does make all the difference in my opinion.

It is now time to stop talking about healthcare reform and start working on it — and that work has begun here in Vermont.

OneCare is investing in primary care and is promoting the type of medicine that I love to practice and that our patients need.

That is why Porter Medical Center is “all in” on healthcare reform and an active participant in the OneCare program. It is the right thing to do for our patients, our community and our organization.

It is a win-win for everyone and a promising investment in supporting the mission of UVM Health Network-Porter Medical Center.

Carrie Wulfman is a primary care physician and chief medical officer at Porter Medical Center in Middlebury

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