The opportunity before us
Vermont has an unprecedented opportunity to reshape its healthcare system. Through the federal Rural Health Transformation Program and other recent and proposed state reforms, we have the chance to build a system that is more sustainable, more coordinated, and better able to meet the needs of future generations. But funding, planning, and policy are only part of the challenge. The hardest part of healthcare transformation will be making difficult decisions together.
The window is narrowing
Vermont’s healthcare system is under increasing strain. Healthcare providers continue to face significant financial pressures. Workforce shortages persist across nearly every part of the system. Our population is aging. Birth rates continue to decline. Demand for behavioral health services continues to grow. These are not isolated challenges. They are interconnected forces reshaping healthcare delivery and costs across our state.
The encouraging news is that Vermont still has choices. But opportunities have a shelf life. Every year meaningful change is delayed, financial pressures narrow the options available to hospitals, communities, and policymakers. If we wait until another hospital is forced to eliminate a service, or worse, becomes financially unsustainable, the focus will no longer be on designing a stronger healthcare system. It will be on managing yet another crisis.
The decisions ahead won’t simply determine where and how healthcare is delivered. They will help define what access to, and the cost of, healthcare looks like in Vermont for the next generation. That means we need to begin talking more honestly and transparently about the compromises required to preserve healthcare for the long term.
The challenge isn’t just financial
That may be an especially difficult conversation in Vermont. Our identity is rooted in local communities. We value local schools, local government, local businesses, and local hospitals. We take comfort in decisions being made close to home and in neighbors helping neighbors. Those traditions are woven into the very fabric of our state. But, preserving healthcare for future generations may require us to rethink what “local access” means in a changing world.
Healthcare transformation increasingly requires us to think beyond individual communities and consider what best serves an entire region. That isn’t simply an operational challenge. It’s a structural and cultural one.
For decades, many Vermonters have understandably equated preserving healthcare with preserving local services. Increasingly, those goals may not always align. In some cases, preserving long-term access may require delivering certain services differently than we have in the past. That is precisely why these conversations are so difficult and so important.
The birthing center lesson
The recent closure of the birthing center at Copley Hospital and the announced closure of Brattleboro Memorial Hospital’s birthing center illustrates this tension. No community wants to lose services that families have relied upon for generations and that new families will demand.
Yet these closures also reflect broader national realities. Studies have found that only 41% of rural hospitals offering obstetrical services report that their obstetrical units generate more revenue than they cost to operate. In a separate study, rural hospital administrators reported that approximately 200 births per year were needed for both the financial viability and clinical sustainability of an obstetrical program. At Brattleboro Memorial Hospital, 230 babies were born in 2024, down from 325 in 2014. At Copley Hospital, births declined from more than 300 annually in 2006 to fewer than 200 in recent years.
Those realities do not make the loss of local services any less painful. But they do remind us that hoping things remain the same is not a strategy.
Sustaining healthcare in Vermont will require rethinking how and where some services are delivered. That may mean greater collaboration among hospitals, stronger regional networks for specialized services, and increased investment in primary care, emergency care, preventive care, telehealth, chronic disease management, and community-based services. While none of these approaches are predetermined solutions at this point, all deserve thoughtful public discussion before changing circumstances leave us with fewer options.
From communication to participation
One lesson I’ve learned from working alongside healthcare organizations is that successful transformation rarely fails because of a lack of good ideas. More often, it struggles because people haven’t had an opportunity to understand the challenges, wrestle with the tradeoffs, and see how individual decisions fit within a broader vision. Communication, therefore, isn’t simply about explaining difficult decisions after they’ve been made. It’s about helping people participate in shaping the future before those decisions become unavoidable.
Many of these discussions are already underway. Healthcare providers are exploring partnerships and new models of care. State agencies are developing implementation plans. The Green Mountain Care Board, legislators, employers, and many others are grappling with extraordinarily complex issues, and those efforts deserve recognition. But, meaningful transformation also requires engaging the people healthcare exists to serve.
A better way forward
No single organization can, or should, solve these challenges alone. Hospitals understandably view issues through the lens of their own organizations. State agencies have statutory responsibilities. Legislators face political realities. Employers worry about affordability. Clinicians focus on patient care. Communities experience the system differently than those responsible for managing it. The next phase of healthcare transformation should bring those perspectives together.
The greatest need may not be for another report, another commission, or another study. It may be for a coalition of leaders willing to convene an ongoing public conversation about the future of healthcare in Vermont. Whatever form that takes, it should begin before major proposals have been developed and create meaningful opportunities for Vermonters to help shape the principles that guide difficult decisions.
Those conversations should help establish the principles against which difficult decisions are evaluated, such as keeping care as local as possible while maintaining quality and long-term sustainability; organizing specialized services where they can be delivered most safely and reliably; acknowledging and accepting workforce and financial realities; and strengthening the healthcare system as a whole rather than simply preserving today’s configuration.
Building trust before crisis
Of course, these conversations are unlikely to produce unanimous agreement but they really don’t need to. Their purpose would primarily be to build public understanding, trust, and a shared framework for making difficult decisions before changing circumstances make those decisions for us.
Handled well, these conversations can strengthen, not weaken, public trust. People are far more likely to support difficult decisions when they understand the challenges, the alternatives, the guiding principles, and the long-term vision those decisions are intended to achieve.
As Vermont redesigns its healthcare system, I believe it is also time to rethink how we define success—not hospital by hospital, but community by community and region by region. Ultimately, the future of Vermont healthcare will be determined not only by the difficult decisions we make, but by the way we make them.
Related Healthcare Commentary:
How Will We Know if Vermont’s Healthcare Reforms Are Working?
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.