Care Corps

Brumsted leads a growing group of cohorts

by Will Lindner

uvm_brumsted0119John Brumsted is CEO of The University of Vermont Medical Center and president and CEO of The University of Vermont Health Network, a coalition of medical care facilities in Vermont and upstate New York.

Someday, Dr. John Brumsted hopes, he’ll have more time for volunteering in his community.

“You get hooked on the whole service approach to life and interaction with folks,” he says. “If invited, I try to do things like the Spectrum fund-raiser [the “Empty Bowl,” held by Spectrum Youth & Family Services in Burlington], and I’ve been in the VNA [Visiting Nurse Association] fashion show in the past.

“But as far as committing to be on the board of an organization …” He lets the thought hang momentarily, then adds, “Right now, as the network CEO, I’m involved with eight boards. It’s pretty all-consuming.”

Those eight boards reflect the structure of The University of Vermont Health Network, the vast and complex health care organization of which Brumsted, a former surgeon and practitioner in obstetrics and gynecology, is both president and chief executive officer.

The network encompasses three hospitals in Vermont (Porter Medical Center in Middlebury, Central Vermont Medical Center in Berlin, and The University of Vermont Medical Center in Burlington, where Brumsted serves as CEO); three more hospitals in New York state (Alice Hyde Medical Center in Malone, the Elizabethtown Community Hospital, and Champlain Valley Physicians Hospital Medical Center in Plattsburgh); plus The University of Vermont Health Network Home Health & Hospice (“A mouthful, I know,” he acknowledges), which, before it joined the Network in January 2018, was called the Visiting Nurse Association of Chittenden & Grand Isle Counties.

He’s involved with planning and other issues at all these affiliates. The eighth is serving on the board of the umbrella organization, The University of Vermont Health Network itself.

It is, unquestionably, a structure heavy on administration, but Brumsted quotes the adage, “Form follows function.” The several boards and their interaction enable each hospital or service provider to participate in decisions that affect them all.

“You start with what we’re attempting to do,” he says, “which is to improve access to the highest quality of care we can possibly provide for a broad region of northern New York and Vermont. It has been obvious that, with independent hospitals spread across our region without any connection between them, care is fragmented — you duplicate some services unnecessarily; you have gaps in some services. What we’ve attempted to do is bring the hospitals and their care teams into a family of organizations that can, and must, have difficult conversations on where we’re going to provide what services, and who’s going to provide them.

“Everybody knows that health care costs too much,” Brumsted adds. “The network is one approach to improving the health of the population we’re serving, and making the delivery system as efficient as it can be, and sustainable.”

Seeing the region holistically helps the network participants fill needs in one community and, perhaps, restructure services in another. As an example, Brumsted cites two critical services that were insufficient in the Middlebury-Addison County area before Porter Medical Center joined the Network in 2017: end-of-life care and cardiac rehabilitation.

“At the Medical Center here in Burlington, our physician workforce has palliative care physicians. Having Porter come into the Network, we can share that resource.”

A similar “fix” pertained to patients with heart conditions. “They would have to come all the way to Burlington to do their rehab,” says Brumsted, “or just not have that service. We’ve been able to launch a cardiac-rehab program so the folks in Addison County can have those services without having to travel.”

Conversely, network participants might decide upon strategic reductions in local services to reduce duplication and better support those that remain.

Over the past year, Brumsted explains, the network has developed a relationship between the Elizabethtown Community Hospital and the former Moses Ludington Hospital in Ticonderoga, which Elizabethtown absorbed and is being converted into an outpatient location. “Now Ticonderoga has an emergency room that is well-staffed and sustainable, with X-ray and laboratory services and physical therapy.”

These are not easy conversations. When medical communities throw their lot in with a broader regional consortium, they sacrifice some of their autonomy. The six that have joined since The UVM Network was launched in 2011 — initially a compact between Fletcher Allen Health Care and Central Vermont Medical Center (as the two were known back then) — concluded that sharing medical resources and expertise, achieving greater financial security through unity, and improving their access to capital (because the ratings agencies evaluate the network rather than the individual facilities) was more important than autonomy.

Importantly, the network does not take ownership of the member hospitals and services. “We’re not empire-building,” says Brumsted. Its board must approve hirings of hospital presidents, capital and operating budgets, and trustee appointments, but organizations remain locally owned, with boards that represent local interests.

Furthermore, joining the network is not a choice everyone makes.

“We’ve been invited [by organizations] to talk about why we’re doing what we’re doing, and what we think the values are to the communities and patients. I’ve had plenty of those conversations,” says Brumsted, “and had the boards of trustees say, ‘Well, not now.’

“I have never gone to one of those organizations making a sales call,” he insists. “Ever.” The growth of The UVM Health Network in its first seven years, Brumsted believes, reflects the value that smaller organizations have perceived in forming relationships with each other and with the area’s largest and best-resourced medical university and hospital.

So-called “integrated delivery systems” are not new. The Geisinger Health System in Pennsylvania has pursued this course for over 100 years. Brumsted’s commitment to developing it here is heightened by his affection for a region he identifies as the locus of both his family and professional roots.

Brumsted was born in Ithaca, New York, in 1952. His parents, Harlan and Evelyn, were employed by Cornell University, and from his earliest recollections, the academic environment “was just totally a part of my being.”

Brumsted earned his medical degree at Dartmouth in 1978. Following a surgical internship in Hartford, Connecticut, and a stint with the U.S. Public Health Service, he studied obstetrics and gynecology at the UVM College of Medicine. He then embarked on a 30-year career as a practitioner and as an educator traveling to other medical schools to introduce advanced, minimally invasive surgical techniques.

In July 2011, just as the relationship between the Burlington and central Vermont hospitals was coalescing, the president of Fletcher Allen Health Care departed and Brumsted stepped in on an interim basis, also taking the reins of the incipient health network. He was offered, and accepted, the position full time in February 2012. Within a year, Plattsburgh’s hospital had joined the network, originally called Fletcher Allen Partners, and growth was underway.

Allie Stickney, current president of The UVM Medical Center board, observes that Brumsted is at the helm at a time of extraordinary changes and challenges. These include not only piloting the continued development of the Network, but adapting to the OneCare payment model, a Vermont-federal partnership that presents an alternative to the costly fee-for-service structure. Another change she cites is the hospital’s investment in prevention programs, like the conversion of a decrepit motel into a transitional facility for homeless patients when they’re discharged from the hospital.

“He is an outstanding leader, which I say without equivocation,” Stickney says. “Dr. Brumsted is excellent at looking out at the horizon and articulating a vision of where the Medical Center needs to go.”

Projects like the converted motel strike a chord with Mark Redmond, the gregarious executive director of Spectrum Youth & Family Services, who has succeeded at drafting Brumsted to don an apron and ladle out soup at the Empty Bowl fundraiser.

“He believes in the social determinants of health,” Redmond says, “investments in jobs, housing, and living skills that lower the chances of people ending up in the ER.”

With Brumsted’s support, the Medical Center helped finance Detail Works, a Spectrum-owned auto-detailing shop that gives at-risk youths work experience. Brumsted then became a customer.

“It’s a great place,” he says enthusiastically. “You talk to the kids, and they have this wonderful sense of accomplishment. It’s unbelievable!”

Brumsted confesses he is less happy about the protracted labor negotiations with UVM Medical Center nurses that roiled the hospital and community in 2018. It ended in September, with a pay-raise compromise (Brumsted’s generous compensation was a bone of contention for the nurses) and agreements to reform certain aspects of working conditions and patient care.

“It’s disappointing to me, personally and professionally, that this happened,” he says. “Having one essential component of our care-delivery team feeling so disenfranchised from the administration and organization is a problem.” He is hopeful that remedial measures will heal the rift

Brumsted and his wife, Jessica, live in Shelburne, in a district she represents in the Vermont House of Representatives. From 1984 to ’96, she worked for U.S. Rep. James Jeffords, serving in both the House and Senate. With a master’s degree from UVM in public administration, she later served as director of government affairs for Fletcher Allen Medical Center. She has volunteered for a number of organizations and causes.

Married 16 years ago, the Brumsteds each brought children into their union, creating a family of seven youngsters. This fall, their sixth and seventh grandchildren were born, fittingly, at The UVM Medical Center.

The couple finds respite skiing at Sugarbush or on cross-country ski trails in winter, and boating and fishing, primarily at their camp in the Adirondacks, in summer.

“During mud season,” Brumsted says, “if I can’t get out and do stuff — and this goes back to my passion for surgery — I really love to tie flies.”

It seems a suitably meditative pastime for someone contemplating the horizons of a still-evolving system of care for his fellow human beings. •