As we dive into the complexities of health care reform in Vermont, I’m thrilled to be speaking with Faisal Zain, a renowned expert in medical technology with a deep background in the manufacturing of diagnostic and treatment devices. His innovative contributions to the field provide a unique perspective on how technology intersects with policy and community health care systems. Today, we’ll explore the challenges and opportunities in Vermont’s health care landscape, touching on local hospital strategies, statewide payment reform models, funding concerns, and the potential for universal health care.
Can you share your insights on the consultant’s recommendation for North Country Hospital last year and what it meant for the community?
Certainly. The consultant’s suggestion was quite drastic—they proposed converting North Country Hospital’s inpatient, emergency room, and surgical services into primary care offices and an urgent care clinic. This would have stripped the Northeast Kingdom of critical lifesaving services, potentially forcing residents into long ambulance rides of up to three hours for emergency care. The community and hospital leaders were understandably alarmed and pushed back hard, correcting the consultant’s data and emphasizing the dire consequences of such a change. Ultimately, the plan was rejected because it overlooked the unique geographic and health care access challenges in the region, prioritizing cost-cutting over patient needs.
How did North Country Hospital manage to preserve its essential services in the face of such a threat?
The hospital took decisive action to address financial pressures while keeping critical services intact. They focused on reducing administrative costs, streamlining billing processes, and bolstering recruitment and retention of staff. Additionally, they forged a collaboration with St. Johnsbury’s community hospital to enhance access to specialty care, which helped ease some operational burdens. Their 2026 budget, which maintained inpatient, surgical, and emergency services, was a testament to these efforts and received approval from the Green Mountain Care Board without revisions—a significant win for the community.
What can you tell us about Vermont’s experience with the all-payer model and the role of OneCare Vermont?
The all-payer model, launched in 2017, aimed to control health care costs while improving population health by aligning payments across Medicare, Medicaid, and commercial insurers. OneCare Vermont, as the accountable care organization managing this system, was tasked with coordinating care and incentivizing value over volume. Unfortunately, it didn’t achieve the intended outcomes—costs continued to rise, and population health metrics didn’t improve as hoped. The decision to shut down OneCare by the end of 2025 reflects these shortcomings and signals a pivot to a new approach, though it leaves uncertainty about how care coordination will evolve in the interim.
Speaking of new approaches, can you explain what the AHEAD program entails for Vermont’s health care future?
The All Payer Health Equity Approaches and Development, or AHEAD, is Vermont’s next step in payment reform, set to run from 2026 to 2037. It builds on the all-payer concept but emphasizes equity and development in care delivery. Funding will come from Medicare, Medicaid, and commercial insurers, with oversight continuing under the Green Mountain Care Board and the Vermont Legislature. The goal is to create a more sustainable system, but it’s hard to say if it will succeed where the previous model struggled, especially with external challenges like funding cuts looming on the horizon.
What concerns do you have about the upcoming funding cuts and their impact on Vermont’s health care system?
I’m deeply worried about the ripple effects of these cuts. The loss of premium subsidies on Vermont Health Connect will likely leave more people uninsured, pushing the burden of uncompensated care onto hospitals already operating on thin margins. Additionally, cuts scheduled for 2027 threaten vital programs like Dr. Dynasaur, which provides coverage for children and pregnant women, and Blueprint for Health, which supports community-based care. Without these, we risk worsening health outcomes and increasing disparities, especially in rural areas where access is already limited.
Why do you think Vermont continues to pursue all-payer models instead of exploring other reforms like universal health care?
It’s a complex issue, but I believe there’s a combination of political caution and institutional inertia at play. All-payer models are seen as a middle ground—bringing together various payers under regulated oversight without fully upending the existing system. Universal health care, while appealing for its simplicity and equity, is often dismissed as too costly or politically unfeasible, despite evidence that the current fragmented system is already expensive and ineffective. Vermont took steps toward a single-payer system with legislation in 2011, but it was never implemented, and there’s hesitation to revisit that bold vision.
What is your forecast for the future of health care reform in Vermont over the next decade?
I think Vermont is at a crossroads. If the AHEAD program can address equity and cost control more effectively than its predecessor, it could stabilize the system for a while. However, without tackling the root issues—such as funding shortages and the uninsured population—I foresee persistent strain on hospitals and communities. Technology will play a growing role, with innovations in telemedicine and diagnostics potentially bridging some access gaps, especially in rural areas. But ultimately, I believe pressure will mount for a more transformative shift, possibly toward a state-administered universal health care model, as Vermonters grow frustrated with incremental fixes that don’t fully deliver.
