UVM Health Network Redesigns Governance Structure

July 18, 2022
Facing budget woes, Vermont health system seeks to become more nimble and strengthen alignment with its population health-centered mission

The organizations that make up the University of Vermont Health Network have made changes to their board governance structure to enable deeper integration of the health system, support the Network’s ability to become more nimble, and strengthen alignment with its population health-centered mission.

The UVM Health Network is comprised of an anchor academic medical center in Burlington, five community hospitals, a children’s hospital, a multispecialty physicians group and a home health agency, all governed by separate boards that ultimately report to the Network board. By comparison to many systems across the United States that are comprised of dozens or even hundreds of hospitals, the not-for-profit UVM Health Network is relatively small and seeking to make the most of what it means to be an integrated rural health system.

Like many hospital systems, UVM Health Network is facing a severe financial pinch. Citing inflation and staffing challenges caused by the pandemic, the Network is asking Green Mountain Care Board regulators for a 19.9 percent increase in 2023 commercial insurance charges for University of Vermont Medical Center, a 14.52 percent increase for Central Vermont Medical Center and an 11.45 percent increase for Porter Hospital.

In its budget proposal, the Network said that “in recent years, we have not been afforded rate increases that keep up with cost inflation. This has eroded our already-slim margins, forced us to tap into reserves to meet expense needs, and jeopardizes the sustainability of the healthcare services we provide.

One way the Network is seeking to address its financial sustainability issues is to reorganize. Input from all affiliate boards and a review of approaches at more mature health systems across the Northeast led to a decision to simplify and redesign the Network’s governance structure to more fully integrate decision-making and operations. With approval from all of the affiliate boards, that restructuring will now proceed.

Following votes in favor of the changes by the boards of each of the network’s six hospitals and home health agency, the UVM Health Network Board voted to adopt changes that more strongly align local affiliate board oversight on community-focused areas including local population health initiatives; healthcare quality; diversity, equity and inclusion; and philanthropy. To support this effort, key governance oversight functions – such as finance, budgeting and strategic planning – have shifted to the Network board.

“The UVM Health Network exists to preserve access to high-quality care in the communities we are privileged to serve. These changes will help our organizations across Vermont and northern New York work together more effectively as we make key decisions and guide initiatives that improve quality of care and the overall experience of patients,” said Allie Stickney, chair of the UVM Health Network Board, in a statement.

Affiliate boards will continue to maintain their current size, and members of affiliate boards will be a part of significant operational decisions, with representation on essential Network board committees that carry out this work, the network said.

In its budget request for 2023, the Network outlined some other ways it is pursing greater integration. “We are making necessary investments in the integration and sustainability of our Network through the addition of key senior leadership positions, including a Chief Nursing Officer (CNO), Chief Medical Officer (CMO) and Chief Diversity and Inclusion Officer (CDIO). The CNO and CMO are central to our efforts to standardize and better coordinate care across the Network. The CDIO is charged with implementing our Network-wide DEI strategy.”

In fiscal year 2022, the Network continued implementation of centralized IT platform services and applications across the UVM Health Network. Applications include the electronic health record (Epic), supply chain (Premier Connect), human resources (Workday), Cardiology imaging (Merge), Radiology (Visage) and other clinical, infrastructure and business systems. “This work is an investment in driving efficiency, reducing costs, improving staff satisfaction and more importantly, standardizing and improving patient care,” the Network said.

The Network also is deploying a Regional Transport System, which manages patient transport between care settings and care coordination, and regional allocation of healthcare providers to make care accessible even if it is not located in a specific community.

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