By Mark Crow

For decades, Vermonters have debated how to fix our healthcare system. We’ve debated payment reform, workforce shortages, hospital sustainability, primary care access, and the ever-rising cost of care. Along the way, we’ve launched pilot programs, created commissions, commissioned studies, and developed new models of care.

Now, Vermont has a unique opportunity to put many of those ideas into practice. Through the federal Rural Health Transformation Program, the state is expected to receive nearly $1 billion over five years to strengthen healthcare access, support providers, expand the workforce, and improve health outcomes. Combined with this year’s healthcare legislation, Vermont has an unprecedented opportunity to reshape healthcare delivery.

State leaders deserve credit for securing this opportunity and for the extensive work already underway. The planning is thoughtful, the goals are worthy, and the need is undeniable. But implementation is where transformation becomes challenging. Not because Vermont lacks good ideas or because dedicated people aren’t doing the work, but because meaningful transformation inevitably requires difficult choices.

Should every service be available in every community, or should some highly specialized care be regionalized to improve quality and long-term sustainability? How do we improve access while facing persistent workforce shortages? How do we strengthen primary care without further straining financially challenged hospitals? How do we improve quality while making healthcare more affordable?

These aren’t simply policy questions. They are questions about values and priorities. Every answer involves tradeoffs. That reality makes public trust essential.

Transformation of this magnitude will ask Vermonters to embrace far-reaching change. Some services may be delivered differently. Care may become more coordinated, more regional, or more technology enabled. Those changes are far more likely to succeed if Vermonters understand not only what is changing, but, more importantly, why the changes are necessary and how success will ultimately be judged.

To be clear, Vermont is already putting in place a comprehensive evaluation framework to measure and report on the impact of these investments over time. But the challenge is not simply measuring progress. It’s defining success.

Before Vermonters can determine whether this effort is succeeding, we should share a common understanding of what success actually looks like. The real test of rural healthcare transformation will not be the number of grants awarded, programs launched, organizations funded, or reports produced. Rather, it will be whether the experience of receiving healthcare in Vermont actually improves.

One way to reinforce that shared understanding would be to identify a small set of public “north star” measures that reflect the outcomes Vermont is ultimately trying to achieve. Not dozens of metrics or hundreds of performance indicators, but a handful of outcomes that ordinary Vermonters can easily understand.

Those measures might include timely access to appropriate care, improved quality and patient outcomes, a stronger healthcare workforce, financially sustainable providers and care systems, and healthcare that is more affordable for patients, employers, and taxpayers.

Reasonable people may disagree about the criteria used to define those measures, but that seems surmountable. The more important point is that Vermont’s transformation effort should have a clear, public definition of success that transcends individual projects, grants, or legislative initiatives. Doing so would strengthen transparency, guide decision-making, and build public trust and support. People are far more willing to accept challenging tradeoffs when they understand the destination, the principles guiding the journey, and how everyone will know whether we’ve arrived.

The Rural Health Transformation Program is not simply another grant program, a collection of projects, or a series of reports. It is an opportunity to build a healthcare system that better balances access, quality, affordability, workforce realities, and long-term sustainability. Five years from now, the question won’t be what Vermont did. It will be what Vermont achieved. Did we end up with a healthcare system that provides the right care, at the right time, in the right place in a way that is more accessible, affordable, sustainable, and effective than the system we have today?