ST. ALBANS — Approaching her fifth year as leader of Northwestern Medical Center (NMC) Jill Berry Bowen, chief executive officer, is excited but wary when it comes to the ongoing changes to the state’s health care system.

“Who wouldn’t want to be part of this? I’m not going to sit on the sidelines. I want to be part of it,” Berry Bowen said of health care reform. “I just want to make sure it’s a healthy process.”

Gov. Peter Shumlin campaigned for office on the creation of single-payer style health care system for Vermont, and that is still his goal.

But creating such a system means more than simply changing how health care is financed. It also involves determining how to best allocate resources across the state, and how to keep costs contained while insuring that every Vermonter has access to quality health care.

“We’re trying to be right in the middle of this exploration … of how are we going to provide care in a new way,” said Berry Bowen.

“Everybody should have access to care and everybody has access to care right now,” she said. “How do we pay for that care without being overly burdensome to our businesses and our community in taxes?”

Emergency visits

As part of the effort to contain costs, Vermont’s Blueprints for Health program, which includes NMC, tries to insure every Vermonter has a primary care provider. Berry Bowen described it as “wrapping around the patient with primary care as the anchor.”

Having a primary care provider can both reduce visits to the emergency room and provide coordination of services for patients receiving treatment from multiple specialists.

One of the cost-saving initiatives at NMC involves identifying patients who are frequent users of the emergency department, determining why those patients are such frequent visitors, and helping them find alternatives. Patients have a wide range of reasons for going to the more expensive emergency room rather than a less expensive primary care doctor. They may need care during a time their doctor’s office isn’t open or when there are no available appointments, or they may not be able to arrange transportation during office hours.

Working with patients to overcome those barriers, NMC has successfully reduced visits to the emergency department by 10 percent, from 30,000 annually to 27,000.

With a population of about 55,000 to serve, NMC needs an emergency department, said Berry Bowen. But the question becomes how to pay for that  department while actively encouraging patients whose illnesses are not acute, and who do not require emergency care, to go elsewhere.

NMC’s answer is to offer after-hours primary care in a walk-in clinic, explained Berry Bowen. The patients still need to be seen, and this would provide treatment in a less expensive setting than the emergency room.

The busiest hours for the emergency department are between 4 and 8 p.m., she said, and a walk-in clinic would provide care for those patients whose conditions are not acute enough to require treatment in the emergency department during those hours.

The clinic is still in the planning stages.

“That being said, it’s going to impact us financially,” she said of reductions in emergency room visits.

The risk curve

Although the Green Mountain Care Board (GMCB), which oversees hospital budgets, has barred hospitals from adding new services unless those services reduce the overall cost of care, Berry Bowen believes there is “room for community hospitals to expand in ways that promote wellness and prevention.”

Controlling health care costs is often spoken of as reducing the “cost curve” or the rate at which health care spending is increasing. Instead of bending the cost curve, Berry Bowen spoke of  “bending the risk curve,” meaning the risks for chronic, and costly, diseases.

NMC has a highly successful wellness program for its employees, which has saved the hospital money by reducing employee health care costs. More importantly, the program has a proven record of improving employee health.

“We were able to move employees from high risk to low risk,” said Berry Bowen.

As part of its strategic plan, NMC is seeking to expand the program to at least one other business.

The hospital already runs a regular series of ongoing community wellness programs, with programs in diabetes prevention, fitness for seniors and healthy weight among others.

Preventive care also includes NMC’s outpatient clinics. “We’ve integrated medical clinics into the fabric of care at NMC,” said Berry Bowen. With patients able to easily access services such as a cardiology exam in NMC cardiology and pulmonology clinic, doctors may be able to catch problems earlier.

There is also a focus on improved sharing of information with other health care providers such as Franklin County Home Health when patients are being transferred from the care of one organization to the other. “We’re thinking a lot more about the patient experience,” said Berry Bowen.

In an effort to manage costs, NMC has also launched “Efficiency for Excellence.”  The program is intended to locate waste and inefficiency.

“The fun of this is getting our staff involved,” said Berry Bowen, noting that one no knows how things are done and where improvements could be made better than the employees.

Some of the most important initiatives at NMC in recent years have been in the area of treatment for people with drug addiction or chronic pain.

“I’m really happy we’ve been willing to tackle some of the bigger issues,” said Berry Bowen.

While he was head of the emergency department at NMC, Dr. Ed Haak spearheaded efforts to educate physicians about the best practices when prescribing opiates for pain management. He also worked to create a database for keeping track of opiate prescriptions, particularly for patients with multiple providers, and to improve communication among those providers. “We’re working off of one care plan for the patient,” said Berry Bowen.

Haak has now joined Dr. Bill Roberts at NMC’s pain management clinic. The program treats people with chronic pain as well as those dealing with addiction to prescription and non-prescription opiates.

“We wrap around them… as we do any other condition,” said Berry Bowen.

“I really can’t take any credit for any of it,” said Berry Bowen of the changes at NMC. “I’m just hoping to stimulate an environment.”

She had nothing but praise for the staff at NMC and community it serves.

“Our commitment is to provide exceptional care to this community and, bar none, I think every one of the staff is committed to that,” said Berry Bowen.