Bennington County tries to stabilize chronic care costs

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(Host) Today, the largest amount of money in health care is spent on people who have chronic illnesses. Listen to this statistic: roughly 80 percent of our health care money is spent on 20 percent of all Vermonters.

In Southwestern Vermont, doctors running an innovative program are trying to stabilize the costs of chronic care. VPR’s Bob Kinzel visited Bennington County for today’s special report on health care solutions.

(sounds of hospital rehab)

(Kinzel) The rehab room at Southwestern Vermont Medical Center is full. Stationary bikes, treadmills and weight machines are spread across the room and patients are hooked up to heart monitors as they work out.

Vermont’s chronic care initiative is designed to better monitor the condition of these patients, provide them with timely care and teach them how to manage their illness. Exercise is also an important component of the program.

Chronic care is a central focus because it consumes so much of the state’s health care budget, and the number of cases has increased dramatically over the past few years.

Many of these individuals have a chronic illness such as diabetes, heart disease and high blood pressure. Recent studies indicate that only 55 percent these patients receive appropriate care.

One of Vermont’s first chronic care projects was created in Bennington two years ago. The primary focus is on diabetic patients and preliminary results show the program has been successful in improving the health outcomes of its participants.

Carol Rickel, who is a type 1 diabetic, is one of the success stories:

(Rickel)"So it’s definitely changed my life yes for the better I still have my illness and my days when I don’t feel good and get frustrated but I know there’s always something to fall back on in this just always a positive outlook now."

(Kinzel) Dr. Peter Witham is president of the Medical Staff at the hospital. Before this program was put into place, he says many physicians would see their chronically ill patients only when a serious complication developed:

(Witham) "But you might not address all those ongoing problems for their diabetes for their hypertension for their heart failure because you were relying on memory and best intentions rather than having a plan in place to address those ongoing problems."

(Kinzel) Dr. Greg King is a family practice physician who participates in the Bennington project. He’s a strong supporter of this approach:

(King) "We’re seeing a lot more chronic diseases at earlier ages if we don’t manage these people with chronic diseases well we will be paying a very large health care bill down the road when these patients ends up getting the complications of their chronic diseases.

(Kinzel) Will these programs help control health care costs? Yes and no. There’s little doubt among medical officials that providing these patients with timely and appropriate care will reduce the need for more costly procedures in the future.

But there’s another factor. Jennifer Fels is a project leader for the Bennington program. She says it’s likely that patients will live longer with better care, so that their total lifetime health care expenses might actually remain the same:

(Fels) "Do we want to spend that on somebody in the hospital with you know bad disease consequences or do we want to spend that $100 keeping you well and a productive member of society so I think that’s we have to wrestle with cost savings I don’t think it’s going to be millions of dollars of savings I don’t think so."

(Kinzel) Dr. Carol Vassar is a Montpelier physician who supports the chronic care initiative. She says in order to reduce health care costs in the future, efforts need to be taken to help prevent people from developing these illnesses in the first place:

(Vasser)"There will be a lot more office time there will be more medication expense more lab expense more test expense because to manage it well you have to know how you’re doing and you have to treat it. Now one caveat there if we could get people to get more exercise for almost all of our chronic illnesses exercise is the most effective treatment."

(Kinzel) The Bennington program is addressing these concerns. Healthy Living Workshops are held throughout the year and a program known as the Trek for Health encourages people to strap on a pedometer and monitor their walking distance for a 6 week period. This year roughly 2000 people participated in the Trek.

Kim Turner is a regional coordinator for the program. She says it’s been a big success:

(Turner) "They’re sticking with the walking program long after the program ends and again that is supporting the preventive side of this picture and who knows it could prevent someone from ever developing heart disease."

(sounds of walking trails)

(Kinzel) Shannon McGibney Howlett participated in the first Trek and was a team captain for the second. Twice a day she heads out on the walking trails around the Medical Center. She’s says walking has changed her life:

(Shannon) "It’s been such a positive thing for me I have more energy I used to be really exhausted in the evening it was hard now it’s like I go until I go to bed I don’t watch TV very much any more I’m just always finding I have a lot of energy to be active and do other things that need to get done in my life and everything seems easier when you have more energy."

(Kinzel) Shannon says the key to the walking program is to improve a little bit every day:

(Shannon) "I remember walking a half a mile and I thought you know what it’s not that far but it’s farther than I have walked previous to now.

(Kinzel) Five other communities now participate in the chronic care program. In the next few years, state officials hope to expand the scope of these programs beyond diabetes to include many other chronic illnesses. They reason why? They think the program will eventually pay for itself.

For VPR News, I’m Bob Kinzel.

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