This was published on October 16, 2023 as a VT Digger Spotlight Article.
Reforming our healthcare system requires interventions that address the barriers and inefficiencies that prevent patients from getting the right care, at the right time, and at the right place. Fortunately, Vermont’s accountable care organization (ACO), OneCare Vermont, has the unique ability to get federal rules and regulations waived to clear the path for local health care delivery innovation. An example of this is the story of how Vermont’s hospitals, Rescue Inc. emergency medical and transportation services, and Brattleboro Retreat all worked together with OneCare to efficiently get the right care to those in need of urgent and compassionate mental health and/or addiction treatment.
The Brattleboro Retreat provides compassionate, evidence-based mental health and addiction treatment for Vermonters and the faster patients can be discharged from emergency departments (EDs), the sooner they can get to their best care setting to meet their needs. Due to capacity challenges with emergency medical services (EMS) in communities across Vermont, patients in need of mental health and/or addiction treatment often get stuck in emergency departments because they lack safe transport. This inefficiency in our healthcare system reduces the quality of care received, and therefore negatively impacts health outcomes.
“When patients are left to wait in the ED for transport to the Brattleboro Retreat for days—sometimes four or even six days—they are not only delaying getting the right care, but their symptoms can be exacerbated by being in an often overcrowded and highly stimulating environment,” says Dr. Javad Mashkuri, emergency medicine physician at Central Vermont Medical Center. “Furthermore, expediting appropriate discharges for our boarding ED patients frees up limited resources to provide care for other ED patients and helps address ED overcrowding which we know can negatively impact patient care.”
As an ACO, OneCare meets the federal regulatory requirements to be able to issue waivers that break down the silos in our local healthcare system and make it possible for those delivering care to have more flexibility and innovation. OneCare has issued a waiver that permits patient transport via Brattleboro-based Rescue Inc. from Vermont hospital’s emergency departments to inpatient treatment at the Brattleboro Retreat.
Since this OneCare waiver went into effect in February 2023, it has enabled over 150 Vermonters in emergency departments across the state in need of voluntary inpatient treatment to be transported and admitted to the Brattleboro Retreat to get the care that they were asking for and needed. “These patients would have otherwise been left boarding in the emergency department with a delay in access to the care that they need because they lacked safe transport,” states Jill Maynard, MSN, RN, CEN and director of emergency nursing at Southwestern Vermont Medical Center. “This ED bottleneck is detrimental to the patients themselves, the community who may need quick access to emergency care and ED staff.”
Ambulances, like emergency departments, can often have too much stimulus for a person in need of mental health care or addiction treatment, and EMTs have a specific training that makes them well-suited for the adrenaline rush of emergency response. To provide a more appropriate care experience for patients in need of transport to the Brattleboro Retreat, the OneCare waiver has made it possible for Rescue Inc. to specially train a workforce on how to provide compassionate transportation to patients in need of mental health and/or addiction treatment.
As the Chief Operating Officer of Rescue Inc., Drew Hazelton puts it, “This is a win-win for everyone involved. Patients are getting to the care they need faster, EDs are freeing up critically needed beds and resources, and I can keep my trained EMTs available for emergency response while employing an additional workforce dedicated to transporting patients in a manner that will not aggravate their symptoms.”
Meanwhile, the Brattleboro Retreat benefits when those who need their specialized care get to them sooner. This is not only because the patients presenting with mental health in emergency departments are in distress and need immediate care in an appropriate clinical setting with health care professionals who have the expertise in managing mental health crises; but also because of what it means in terms of maximizing access to care. “When a bed is available at the Brattleboro Retreat, but sitting empty because there is no transportation, someone in need is being denied care,” remarks Brattleboro Retreat’s chief executive officer, Linda Rossi. “Waiting days for transportation to a specialty facility like ours can intensify acuity for the patient and magnify anxiety for the family. Having a statewide ambulance service run by an EMS team equipped with behavioral health training goes beyond improving access, efficiency, and timeliness. It is a solution that enables compassion and the quality of care that Vermonters deserve.”
OneCare’s waivers support various health care organizations in better coordinating delivery of care to get patients in the care settings that best meet their needs. “Providing an efficient transportation method and an appropriate care team are key elements of high-value, patient-centered care,” says Abe Berman, interim CEO of OneCare Vermont. “ACOs were designed to provide the legal and financial pathways for these types of care delivery innovations. Our role is to bring the players together and set the stage for meaningful change—and then get out of the way to let those delivering care do what they do best; design and implement innovative solutions to better care for their patients.”