Open Letter to UVMHN Board of Directors
VHC911- Stat v.15
Over the past ten days we have had a productive back and forth with UVM Health Network Board Chair Tom Golonka and the Executive Committee. They responded to a letter from us summarizing concerns we have laid out in past newsletters. Following our discussions, we sent this letter which we share as part of our mission to help Vermonters understand the complex leadership dynamics and system changes necessary to lower our healthcare costs and improve quality of care.
Dear UVMHN Board of Trustees:
Thank you to the Executive Committee for meeting earlier this week to talk through some of the concerns the Vermont Healthcare 911 coalition has worked to bring to light. We appreciate your time and hope we can continue the discussion in the months ahead.
As you know, we believe Vermont sits at a moment that requires a new approach. While Mike Smith and the settlement panel are likely to uncover potential changes, your leadership as the governing board will be important in setting the public tone and forward-looking attitude at the Network.
We are eager to see the 2026 budget details but are heartened to hear of the 7.5% commercial rate decrease. That is a good beginning to address UVMMC having one of the highest rates of profit for commercially insured patients in the nation.
We know you have focused on the Network’s credit rating. And amassing over $1.5 billion in reserves by 2024 obviously satisfies your fiduciary duty to the Network. We ask that you please remember your record-level reserves come at a time when Vermont’s largest insurer, primary care providers, and regional hospitals all struggle to remain solvent. We believe the Network’s role at the head of Vermont’s healthcare system puts an onus on the board to consider the broader negative impacts of financial practices made in the name of the Network’s bottom line.
As we said during our meeting with your Executive Committee, we are not persuaded that your leadership team grasps the magnitude and severity of the affordability crisis in Vermont healthcare. Nor do we detect more than a passing acknowledgement of the Network’s part in its genesis.
The June 12th community letter from your Government Relations office is illustrative. It points blame to Medicare, Medicaid, and state legislative reforms for the severe affordability crisis that plagues Vermont’s healthcare. How about acknowledging the Network’s top-heavy management structure or hefty commercial profits?
After the Fall 2024 response to the Green Mountain Care Board’s effort to rein in costs, the Network opted to cut services rather than administrative costs. This is another example of your leadership team being out of touch with Vermonters. That three significant healthcare bills (H.266, H.482 and S.126) passed with bi-partisan support and were signed into law this session underscores the loss of trust legislators feel with respect to the Network, UVMMC, and their associated Boards of Directors.
Our coalition understands there is a plan to reduce levels of leadership in order to gain savings across the Network. That was one of the promises when the Network was formed and it has yet to be realized. This now comes at a time when systematic reduction in costs is essential, so we are eager to see local hospital leaders empowered to drive a reform process.
Health systems like Geisinger, Dartmouth and elsewhere offer a model to bring costs under control and improve outcomes. But these changes are only achievable through a well-coordinated, broad-based program of self-criticism, data analysis, planning, and action steps. And, the best transformation models require decision makers to work directly with service-area teams to set targeted goals and measures, which in turn are utilized by service area teams to drive ongoing improvements.
We believe an intensive, thoughtful restructuring program must emerge at your direction. We have faith in the service professionals that work for the Network. They frequently tell us they are frustrated and see the need for change. Fixing the top-heavy management structure will help drive down costs. But the type of cultural change necessary to craft a long-lasting system for Vermont requires empowering medical and non-medical personnel alike to collaboratively design and implement a new framework of hospital care (Dr. Pronovost and the Medicare Breakeven Project in Cleveland is an interesting example).
We are at an all-hands-on-deck moment. If Vermont is to revitalize our hospital and community care system, as imagined by Act 167 and the Oliver Wyman report of 2024, the Network must lower costs, cut wasteful spending, and reduce the volume of potentially avoidable care.
Your governance oversight in this complex process is essential in determining the pace, scope, and effectiveness of its outcomes. Your leadership is vital to holding the Network accountable to patients, regulators, and the public interest.
We are asking this board to ensure that the practice of unjustifiably high profits and accumulation of reserves on the backs of commercial insurance will come to an end.
We are asking that you acknowledge the urgency of the current moment, only made more difficult by the uncertainty at the Federal level. Businesses, taxpayers, families and our state community need your partnership now more than ever. We, and many others, are ready to work with you to build a system that serves everyone across our region. But that cannot happen without a shift in the approach from the UVM Health Network.
Your leadership is a necessary guiding hand to effectuate a new direction and establish a framework for your staff to carry out. We are hopeful that your 2026 budget will be a significant first-step to reducing costs and look forward to learning how the Board will create the systemic changes and leadership culture required to provide affordable access to high-quality, high-value care for all Vermonters.
Sincerely,
Chris Pearson, Chair
Gov. Jim Douglas, Leadership Council Co-Chair
Lisa Ventriss, Leadership Council Co-Chair