Initiative 1. Regionalization and Innovative Care Strategies:

Regionalization Planning and Implementation

• Transformation, innovation, and regionalization support grants: Grants to health care providers to support the implementation of regional care changes that sustain high-quality, cost-effective care for Vermonters, and the grants will primarily be provided to non-hospital providers to strengthen the continuum of care, encourage care delivery innovation, and better align services with population needs. Grants may also be used to purchase tools and technical assistance to enable interoperability between EMR systems.
• Transformation analytics and support: Hire a vendor(s) to gather and study data that will inform hospital and regional transformation planning over the next five years; and provide project management support.
• Facility upgrades to support regionalization: Renovations or upgrades to existing buildings and equipment in hospitals and clinics, so they can better serve their communities.
• Development of a statewide health care delivery strategic plan: Hiring a consultant to develop and implement a Statewide Health Care Delivery Strategic Plan.

Innovative Clinical Services to Support Regionalization

• Community paramedicine/Mobile Integrated Health model: Establish a mobile integrated health care and community paramedicine model that uses specially trained paramedics, Advanced EMTs, and EMTs working under physician/NP oversight, to deliver protocol driven care in patients’ homes.
• MH and substance use urgent care expansion: Expansion of urgent care centers to enable immediate, walk-in access to MH and SUD care as a lower-cost, community-anchored alternative to EDs.
• Mobile units offering medical, dental, and integrated MH/SUD services: Mobile clinic units to provide medical, dental, and integrated MH and SUD services for remote areas in the state.
• Improving availability and access to high-acuity services for nursing home residents including dialysis services and ventilators: Provide funding support for new grants to providers to purchase dialysis and nursing home ventilator equipment.

Initiative 2. Establishing a Clinically Integrated Network of Shared Services:

• Incentivizing adoption of a shared EMR platform: Implement a shared EMR that complements and continues to contribute data to the VHIE. Achieve seamless data exchange, support improved image and lab sharing, enhance cybersecurity, and allow advanced data analytics.
• Establishing a shared HRIS system: Invest in the development of a unified HRIS that will centralize core human resources functions, including benefits, payroll, recruitment, onboarding, licensure tracking, and compliance, while allowing each participant to securely manage tasks such as performance evaluations and regulatory reporting.
• Statewide e-Consult expansion and workforce capacity building: Implementation of a statewide e-Consult platform to ensure access for primary care providers to consult with specialists.
• Supporting a statewide closed-loop referral system: Purchase a digital care coordination platform to strengthen communication and collaboration among health care, MH/SUD, and social service providers.
• Creating a centralized tool to guide interfacility transfers: Develop a shared subscription to a real-time digital tool that tracks bed capacity and service availability across Vermont’s hospitals and health care facilities.
• Grants to providers to adopt RPM: Grants to provider organizations for the purchase of RPM equipment.
• Grant funds to providers to adopt telehealth technology: Provide grants to rural independent medical practices to purchase and implement telehealth technology solutions.
• Grants to providers to adopt AI transcription/scribe technology: Provide grants to providers to purchase AI scribe technology.

Initiative 3. Strengthening Primary Care:

• Providing enhanced capacity for team-based care: Fund payments to improve team-based care implementation to support care coordination and prevention-focused interventions such as chronic disease management, nutrition, and exercise programs. This payment will be a prospective PMPM amount to support community health team staff, who do not bill their activities. Practices will receive payment based on agreeing to implement new standards and their performance on these standards. The PMPM will help increase access to services, including provision of care, and evidence-based chronic disease prevention and management for all Vermonters.
• Incentivizing access to primary care: Primary care practices that meet access requirements will receive a PMPM capacity payment.
• Specialty and primary care performance payments: Performance payments, as PMPM payments, that will be shared between specialty and primary care providers to incentivize consultation, co-management, and coordination of care for the following conditions: diabetes, MH/SUD, COPD, CHF and hypertension (additional may be added in future).
• MH and community support integration into primary care teams: Funds to provide comprehensive, team-based care for activities that have no reimbursement model.
• Enhancing Blueprint transformation network capacity: Support technical assistance, training, and practice transformation that help providers implement new care standards and evidence-based approaches.
• Workforce support and system integration development: Strengthen the health workforce and provide tools for patient/family engagement, referral/consultation workflows and systems, and bilateral communication mechanisms. Implement evidence-based chronic disease prevention and management, training and technical assistance, and training.
• Enhancing primary care-focused data and analytics infrastructure: Expand statewide access to eCQM calculation tools, risk stratification modules, referral tracking, and team-based care documentation.
• Expanding access to FQHC primary care services: Provide funding for resources related to onboarding and training of staff, investments in IT, and minor infrastructure renovations/refurbishments and equipment upgrades to expand access to care (in alignment with HRSA’s approved scope).
• Expanding access to recovery housing for individuals with SUD needs: Provide grants for the minor renovation and refurbishment of existing housing to increase capacity to support individuals in recovery.

Initiative 4. Health Care Workforce Development:

Training Programs

• Expand access to LNA training programs: Invest in new LNA training opportunities across Vermont through hybrid education models and coordinated clinical partnerships.
• Establish the Maple Mountain Consortium Family Medicine Residency program: Invest in startup and the first four years of operations for Vermont’s first rural teaching health center family medicine residency programs.
• Health care professions residency program: Provide grant funding to support providers to identify preceptors, recruit residents, conduct training and education, and incentivize participants to remain employed at the provider organization.

Financial Assistance and Housing

• Health care workforce development tuition assistance program: Extend new coverage of licensing renewal fees, exam costs, continuing education unit training, and stipends to pay interns for community-based providers, including but not limited to MH, SUD, and intellectual and developmental disability providers.
• Health care “critical occupations” no-cost tuition program: Fund new activities to expand a “critical occupations” no-cost tuition program for high-demand health professions, including registered nursing, radiologic science, respiratory therapy, dental hygiene, and others.
• Health care workforce conditional financial assistance program: Invest in attracting and retaining qualifying students (e.g., nurses, radiology technicians, medical technicians) through financial assistance.
• Health care workforce housing program: Fund a new workforce housing program to increase the amount of housing stock available to health care workers in rural parts of the state.

Scope of Practice

• Expand pharmacists’ scope to include test-to-treat in more scenarios (i.e., COVID-19, flu, strep throat): Fund pilot program of pharmacists operating at the top of their license.

Initiative 5. Price Transparency and Insurance Competition:

RHT Program funds will support two complementary projects:

• The first will enhance the state’s ability to produce timely, accurate, and comprehensive analysis of cost, quality, and access metrics through a technical platform. This investment will allow policymakers, regulators, and the public to evaluate health system performance, identify improvement opportunities, and track progress toward statewide health reform goals.
• The second will support a statewide assessment to evaluate options to enhance health care coverage affordability for Vermonters. Findings from this assessment will inform state decision-making, guiding near and long-term policy actions to improve sustainability of the state’s Marketplace, called Vermont Health Connect, and explore new affordability strategies (e.g., reinsurance, Basic Health Plan).