Vermont is moving forward with an ambitious effort to transform its healthcare system. Millions of dollars are being invested in strengthening primary care, expanding access, addressing workforce shortages, improving technology, and developing new approaches to delivering care.
At the same time, the state is developing a comprehensive Statewide Health Care Delivery Strategic Plan, as required by Act 68 of 2025. That plan is intended to establish a shared vision and an operational framework for a more accessible, affordable, and sustainable healthcare system.
These are clearly important and promising developments. But how do we ensure that the many changes underway actually work together to produce the healthcare system Vermont is trying to create?
The challenge isn’t simply coordinating initiatives or making sure organizations are working toward common goals. It’s recognizing that changes in one part of our healthcare system can have significant consequences elsewhere.
Changes in One Part Affect the Whole
Consider the effort to shift more care from hospitals into primary care practices and community-based settings. When clinically appropriate, this can improve access, support preventive care, and potentially reduce costs. But it also changes the financial relationships among providers.
Hospitals may lose revenue even though many of their operating costs remain. Primary care practices may be expected to serve more patients or manage more complex conditions without sufficient staffing or reimbursement. Payment arrangements may continue to reward existing patterns of care rather than support the changes being pursued. The result could be a situation in which individual reforms achieve their immediate objectives while creating financial or operational pressures that undermine the broader system.
This isn’t an argument against shifting more care into community settings, which can be an important part of creating a more sustainable healthcare system. Rather, it’s an argument for ensuring that changes in healthcare delivery are accompanied, when necessary, by corresponding changes in financing, workforce capacity, and the allocation of resources.
The same challenge arises with other transformation initiatives. Regionalizing certain healthcare services, for example, may improve quality and efficiency but leave some communities with fewer local care options. Addressing those consequences may require investments in transportation, emergency response capabilities, or expanded outpatient and community-based care. These considerations need to be part of the planning and financing of regionalization, not addressed only after services have changed. A change that makes sense on its own may be less effective, or even counterproductive, if the other pieces aren’t in place.
Planning for Long-Term Sustainability
There’s also the question of what happens when federal transformation funding ends. While these investments offer an opportunity to change how healthcare is delivered, ensuring that those changes are financially sustainable over the long term will be equally important. The statewide strategic plan can help address this challenge and ensure that the broader transformation efforts work together.
Act 68 already recognizes the need to align healthcare financing, regulation, and delivery. It calls for identifying resources necessary for implementation, establishing measurable goals, addressing barriers, and providing for ongoing evaluation and adjustment.
Turning Alignment Into Action
Those requirements provide an important foundation. But translating them into a functioning healthcare system will require more than a comprehensive plan. It will also require examining how individual initiatives affect one another, identifying conflicts as they emerge, and ensuring that the responsibility and authority for coordinating these efforts and resolving conflicts are clearly defined.
Because transformation initiatives are already moving forward while the statewide strategic plan is being developed, that work must proceed alongside them, rather than waiting until the plan is complete.
But what does this mean in practice? Are changes in healthcare delivery being matched by appropriate changes in payment arrangements? Are workforce investments supporting the services and locations where care will increasingly be provided? Are regulatory decisions reinforcing the broader transformation goals? And are we considering the long-term financial consequences of investments being made today?
Answering these questions isn’t a one-time exercise. It requires ongoing attention as reforms are implemented and circumstances change.
Vermont has established much of the framework for this work, and state leaders deserve credit for advancing an ambitious transformation agenda. But the ultimate measure of success won’t simply be whether individual initiatives are launched or the statewide strategic plan is completed on schedule. It will be whether those initiatives reinforce one another, unintended consequences are identified and addressed, and the resulting healthcare system is more accessible, affordable, and sustainable for Vermonters.
Related perspectives on Vermont healthcare transformation
Transforming Rural Healthcare Means Transforming the Conversation
How Will We Know if Vermont’s Healthcare Reforms Are Working?
Vermont’s Healthcare Debate Must Move Upstream
Mark Crow is President of Tenth Crow Creative, a brand strategy, design, and marketing agency serving health and wellness organizations, with a particular focus on rural and small healthcare systems. We help these organizations clarify who they are, align their messaging, and communicate with confidence and purpose. Through strategic branding and messaging, thoughtful design, and integrated marketing, we strengthen external presence and internal clarity. The result: stronger connections with the communities these organizations serve and greater momentum behind their missions.