Vermont Legislature SmartTranscripts:

[Speaker 0]: Hi, welcome back everybody. It's also Vermont two eleven day today. We have representatives from two eleven.

[Speaker 1]: I don't

[Speaker 0]: think we've ever actually heard from anyone on this, in this committee. So really interested in hearing what you do. We did hear the other day about how there's sort of an integration now with nine eighty eight and two eleven possibly happening to be able to route calls to be correct. I'll

[Speaker 2]: tell you all about Yes, thank

[Speaker 0]: you so much for yourself and thanks

[Speaker 2]: for the opportunity to speak with you all. So I'm Alison Lemagna. I'm the Executive Director of the United Ways of Vermont and Vermont two eleven. A quick logistics thing is that I do have a few slides. So am I able to share my screen? Okay, why don't I quickly do that so we can get that out of the way? Okay. It's been a while since I've been on Zoom. Great, so that's out of the way. Okay, so am here to talk about two-one-one and two-one-one Day and get to all of your important and great questions. I also want to just introduce, I'm joined today by Doctor. Keith Robinson, who is the Vice Chair of Quality Improvement and Population Health at UVM Children's Hospital, among many other titles that we'll get to later. And I want to point out that also joining us is Kristen Fontein from the Community Access Health Equity Program at UVM Health Network, another United Way's colleague, Theresa Francis here, and Beverly Bogat, our supporters as well. So just wanted to acknowledge those folks in the room who may also be able to answer some of your questions. So let me start by giving you a little bit of background about 02:11. As you said, we traditionally have been aligned with the House Committee on Human Services, so I don't believe we've had a lot of time with your committee in the past. We're here today to not only share about two eleven Day and two eleven services, but also to highlight some innovative initiatives that directly impact health care systems and community health outcomes. Today is the National two eleven Day, observing and celebrating the three digit resource that helps millions of people across North America to connect to health. In Vermont, two eleven provides free statewide access to community resources by phone, text or 20 fourseven online searchable database. And I do just want to say, I know we're not here to focus on budget matters, but before we launched into sharing more about what we do in our closed loop initiative, I wanted to just note that a fully funded Vermont two eleven is essential to keeping Vermont's informal referral system strong. And thanks to the legislators support last year, we were able to reach a sustainable funding level. And that has allowed us to really listen and evaluate to community needs and explore new impactful ways to expand support, like you'll hear about today. And there is a proposed decrease in the governor's budget this year to reduce our funding by $332,000 which would really directly impact our core services and thus limit our ability to advance initiatives like this closed loop referral that we'll share with you today. So we really need our level of funding consistent with fiscal year 'twenty six in order to have our core services fully staffed and be able to respond to our highest call volume times and remain responsive to programs like the General Assistance Program and disaster recovery efforts and the rising needs that we're seeing as federal changes impact Vermont. So some background about us. Our mission is to promote the health and well-being of all Vermonters through a statewide information and referral system that streamlines access to community resources. We are also nationally accredited. So we are accredited information and referral program, and we serve as the centralized trusted source of health and human service information for the state. We are Essentially, we're like the front door to the complex systems of social supports that exist around the state to help people navigate what is best for them and what will meet their needs. We offer interpretation services for callers who speak other languages other than English. And we're also an integral partner in disaster response and recovery. We've supported the communities during going as far back as tropical storm Irene, the COVID-nineteen pandemic, and the flooding events of 2023 and 2024. Our database includes over 11,000 services, and it's constantly updated and vetted for accuracy. In 2025, we responded to more than 61,000 contacts from Vermonters across the state, and we're able to make over 22,000 referrals to those individuals. Our most requested referral is for housing. And we are sometimes known for our role with supporting the General Assistance Emergency Housing Program, but that is not all we do. We also connect people with services for utility support, tax preparation, public assistance, individual and family supports, disability services, programs for veterans, mental health. You mentioned 988, and we do have our relationship with 988 for a warm handoff. So if a caller that contacts 211 is having a mental health crisis, we can make that warm connection over to the emergency crisis services that they need. So one of the things that when we are sustainably fully funded for our core services, it gives us the opportunity to look at exciting innovations and other things that we can do to support the community. And so what we wanted to talk a lot about with you today is an exciting new closed loop referral initiative. And this is something that we're seeing across the country, two on ones partnering with health systems to address social factors that affect health and well-being. We're very excited to be working with UVM Health Network to build a closed loop between Vermotulinum one's database and UVM's EPIC system. This will strengthen coordination between health care and human services and ultimately improve outcomes for Vermonters. So I can pause if you have questions about two eleven specifically, or we can continue on with our overview of the project. Thanks, Lee. I'm looking at your proposed budget cut and curious if that has anything to do with combining these services with $9.88. Are they supposing to pay for that portion with $9.88? Or is there any Can you explain what that cut means in terms of service delivery? Sure. Yeah. So what it means for us is that the sustainable level of funding we need to perform our core duties, which is the expectation that we'll provide information and referral, that will support the general assistance program, that will be available in times of disaster. A cut like this would have us reexamine what we're able to provide out of that menu of things. We have done a lot of work talking with community partners, reaching out to the community, and looking at how we can best have an impact in the community. And our busiest time is between 4PM and 10PM in the evening. So we're looking at reducing some of the overnight time when we don't have the data to support the number of calls that come in and the cost that it is to maintain services for very few calls and needing to instead staff up during 4PM to 10PM hour when we're getting inundated with calls, quite honestly, and also to be able to have the appropriate staffing levels for when crises happen. So for example, in November, when there was a threat to SNAP benefits, we see calls spike. When there's a change to the general assistance housing rules, we see calls spike. When there's a disaster, we see calls. And we need to be nimble to be able to respond to that. And historically, we just have not had the staffing levels that we need. So we're looking to support our busy times when we have an impact and think about our operational needs in that way. The cut, I think, it comes because there's a misunderstanding that that will somehow save us $332,000 which it will not.

[Speaker 0]: I think in the budget it says that your hours are reduced. Our

[Speaker 2]: hours that were open and available to the community may be reduced. We haven't actually determined what our hours will be going into the state's next fiscal year. They may be reduced, but that would be to bolster the times when we need support. We also remain available seven days a week, three sixty five days a year, which means weekends, holidays. Our online database maintaining that 20 fourseven, people always have access to that. So our base level of service needs the sustainable budgeting in order to continue. Leslie?

[Speaker 0]: I'm just curious, two things, but similar to that question. What percent of your budget is three thirty two? A Percent of our budget is What is

[Speaker 2]: your bottom line in your budget? So the level of funding we received in fiscal year twenty six is $1,638,029 That's our That's that

[Speaker 0]: global funded. That's the same. So your total budget is $1,600,000

[Speaker 2]: Yes. That's the total amount of funding the state gives us, which is our primary source of funding for our core services. We do have other initiatives, and we do seek funding in other ways to support community initiatives like the one we're going to share with you today.

[Speaker 0]: Okay. So cutting, does the state, maybe you've been in contact with them, I don't think you know, but I don't know anyway, they expect this to be covered. Did they expect it to

[Speaker 2]: be covered elsewhere? I don't know.

[Speaker 0]: They didn't have any information about it. No. Okay. No. Thank you. Sorry, we're trying to get our budget spreadsheet here. It's okay. It's in a section of the budget we usually don't deal with. Okay.

[Speaker 2]: Go ahead. That's our section. It's our section.

[Speaker 0]: Who is it? It's DCF.

[Speaker 1]: Human Services.

[Speaker 2]: Human Services. So we don't have any

[Speaker 0]: Unless we lobby the political director. It's just

[Speaker 2]: understand my thinking. Our contract is with economic services because we also support the general assistance program, but that's actually a smaller portion of our core services. Thanks. Yeah, thanks for your questions. Okay, so why don't we invite Keith to jump in the conversation here and share more about our closed loop project, which I think this committee will actually be interested to hear more about. And again, Doctor. Robinson is a pediatric pulmonologist, vice chair of quality improvement and population health at UVM Children's Hospital, medical director of clinical informatics and improvement science. And there's more.

[Speaker 1]: I also work with the Vermont Child Health Improvement Program at UVM to do quality improvement and population health across the state with family medicine and primary care practices. So kind of have my hands on a lot of different population health quality driven projects to make sure that we're advancing health of Vermonters. And this particular project is one really cool one because it kind of integrates the clinical side of things as a lung doctor, the population health perspective when we start thinking about social drivers of health, the informatics piece. So I built an electronic health record, I built an EPIC, do some light programming in it to help improve the systems. And so I'm

[Speaker 0]: then looking at data.

[Speaker 1]: So this is kind of at the center of a lot of this and having us think differently about how to deliver healthcare and think further upstream about how to help patients and families when they need to really think about their whole health. So this pictographic, all it's really showing you is that the care that we deliver in clinic and hospitals represents a very small relative portion to what actually comprises an overall patient's health. And I'm sure you guys all know this. It's the environment that we live in, it's tobacco use, it's housing, transportation, employment, other economic factors. So this is just a signal for all of us and our guiding light at White House to say, as healthcare organizations, we need to think more holistically about where healthcare costs are coming from and how to think further upstream about how to mitigate those. That's why we started this work. We started specifically working with Kristen, who I can't say enough great things about, and the team of 50 plus people in the Children's Hospital that we've been meeting monthly for six and a half years to address food insecurity in the children's hospital. That's now extended out into the rest of the medical centers who are starting a food and medicine program that's taken up tomorrow afternoon. So this is really to try to address food insecurity. Of that work to address food insecurity comes down to a couple of things, though. On the next slide, what ends up happening is we see a family in clinic or in the hospital. All of our clinics are screening, all of our inpatient units are screening for food insecurity and social drivers of health. The problem is this: we ask validated questions, we put them into electronic health records like Epic, which we spend a lot of money on, and then from there, we have to fax or place a phone call or give a number to a patient or family and then have them call 211 to go the distance to actually get connected to the health. Healthcare organizations, we want to be screening for this. The issue is we don't have the resources and know about what's local to the patient or family of the community. 211 does. And so that's why for years we've been partnering to try to think differently about how do we deliver care, how do we form these community partnerships, and then how do we lean on our partners like two eleven to make sure that we're actually addressing the upstream issues. So the current state, to be quite simple about it, it's inequitable because for healthcare organizations that are able to screen and that are able to provide resources to patients and families can provide a little bit better care than practices that are not supported with this automated referral. It's fragmented. Again, in 2026, the fact that we're relying on fax machines and phone calls instead of data systems is a little outdated, I think. So this is to try to get us further ahead into more data driven world that we need to be living in. It's also confusing and burdensome. So we have to train everybody to figure out who do you call, when do you call, and then we don't actually really have visibility into what resources patients and families are connected to. So that leads to a lot of frustration from families to say, I already was connected to that resource, but we can't really tell because the data systems are not connected. So families are sitting in the middle of having needs and they're not feeling like the systems are working for them and connecting them to the resources that they need. And then I also need to point out that the care teams are also very frustrated. So there's moral injury when we're screening for social drivers of health and not able to do something. We have an ethical principle. We don't screen for something unless we have interventions. And this sounds a little bit odd, but it challenges us to think differently about if you're going to screen, you have to have an intervention, so find out what that is. And for us, we've been, again, relying on two eleven for this. Because our vision for this is to have universal access to screening and interventions, to have the data systems be integrated and talking to each other. This will allow us to be more efficient. It'll have us connected with IT systems. We'll be able to have more discrete data about confidential data around what patients need, what resources are working, and where do we need to make more investments in our community to support our patients and families. And then that will result in improved health. So what UVM Health did is we've gotten a grant that Kristen led from the medical center to fund an automated referral from Epic, the electronic health record, to two eleven that will give confidential referrals to two eleven and then information back into Epic. So we will know what resources patients have been connected to, what's working and what's not, and it'll allow more collaboration between us and two eleven. That will allow us to be better informed about what patients and families need and then advocate for them and then change how we invest dollars to help address upstream issues. So what we hope that this will result in is a better return on investment as it relates to how we connect patients and families to community resources. The collaboration, this is Vermont. Vermont is all about collaboration. This is one of those projects that I love working on just because, honestly, this is what it's all about. It's about finding people in your community that have the same perspective on the importance of making sure that everybody in the community is happy, healthy, and has the resources that they need. This also addresses the upstream drivers. We can't keep doing what we've been doing, which is to not address food insecurity, to not address housing as it relates to health care. So we have to get in the mix more and think further upstream. We have to build trust between patients and families. We have to be data driven. Again, in 2026, with AI coming on for Fast and Furious, we have to be data driven to understand what our patients' families need. And we think that this will improve care team wellness and also decrease health care costs. And then I'll let you

[Speaker 2]: this oh, sorry, go ahead. I just had one question. So this interface would

[Speaker 0]: be reliable on having that quick gadget system?

[Speaker 1]: Right now it would for the dollars that were spending. Also do, so I can speak to informatics, the IT systems a little bit because I do that at the health network. This connection could be available to other people, either that had EPIC in the future, either FQHDs or others, or different EHRs around the state. I have worked a lot with other EHRs in the state to try to see how we can do different quality measures outside of EPIC. So this is the first use case to say like this works, and then we could spread it to other clinics and hospitals. I've talked to other people nationally that are doing the exact same thing, and this is what is happening in states. We used to be a leader in this space and we're falling behind in terms of our connections. That's a great question, Debra.

[Speaker 2]: What this looks like at 02:11, and I'll just add that this is two eleven spread of virus. This is what we know how to do. Our experts, our community resource specialists are nationally certified and trained to do this. So it takes the burden off of the healthcare providers and brings it to two eleven, where we have the know how and we have the tools and resources at our fingertips. So a referral would come in from the medical provider and our research specialists would be able to contact the individual and work with them to understand what their needs were, the need that they were referred to us for, but also understand secondary needs. So up and through those conversations, we learn about secondary needs and we're able to connect with those resources as well. This would also allow our resource coordinators to do follow-up a couple of weeks later. How did that go for you? Are you able to connect? And then a closer loop back to the medical provider. And I think just

[Speaker 1]: to close, too, this is one of those things that I really feel strongly. We won't be able to do our job in terms of thinking holistically about what patients' families need. And this program, in terms of our screening program and connecting to two eleven, really can't happen without two eleven. We, as health care organizations, we don't know what resources are out there in the community. So to have it built again would just be cost prohibitive and inefficient. And so if we're going to address health related social needs or social drivers of health in any healthcare setting, UVM Health or not, everybody's going lean on two eleven, I think, to make sure that we have That's the central place where people would go to get these services, understand what people need. So I think this really helps us do our job.

[Speaker 2]: And we're working to get connected to the statewide conversations about a statewide post loop. We've had some preliminary conversations around that, but I really think there is a role for two eleven in those conversations as well. Leslie? Yes. So would this system require more staffing for you to be able to do

[Speaker 0]: I'm thinking about this cut. It

[Speaker 2]: likely would. And the other piece is that we have some outdated technology systems at two eleven that are the base for all the services we provide in order to upgrade those to modern technology that can make the connections, the interface connections that we need to have with Epic and other systems. We need to sustain our funding so we can make improvements like that.

[Speaker 0]: You're only asking for level funding here. Correct. But have you thought about what the funding need? High in the sky, but if you were to implement this, what it would look like?

[Speaker 2]: Well, the hope is that the health system will be supporting this in some way or another. This is in the end of service to them. But because it's replicable in other parts of community and with other systems eventually in the future, that's in fact a way that two eleven can be less. But we can be finding funding in other ways so that our core services can be funded by the state, which the way based on the expectations the state has of us. That makes sense. But then special projects like this can diversify to find other funding streams for those kinds of things. But again, without before funding, we don't have the capacity to do that. We're stressed with staffing. We're trying to respond with limited resources. We don't have the technology systems that we need, etcetera. Is there more? That's it.

[Speaker 1]: That's it. We're gonna do more.

[Speaker 2]: Any other questions?

[Speaker 0]: Brian? It sounds like

[Speaker 3]: 211 has evolved from being just a simple hotline, not to minimize it, but like a place you pull to just get to a more holistic, strategic referral hub of sorts, and that it really has the potential with further investment to improve population health, because you're not just connecting people with a resource in the moment, but you're looking at other additional factors with them, you're tracking the data, etcetera. Absolutely. That your funding request, it reflects that evolution?

[Speaker 2]: Yes. Yes, thank

[Speaker 3]: you for

[Speaker 0]: summarizing that. I'm only sure I'm understanding it all too. Why are

[Speaker 2]: you still waiting to accept someone, this is not your grandma's two eleven. You should not laugh.

[Speaker 3]: This is your great grandchild's two eleven.

[Speaker 2]: Are part of the National member. And when I attend meetings with other National two two eleven leaders and hearing what's going on in other states, these are the kinds of things that are happening. And two eleven is evolving and is poised and positioned. And we have the data, we have the expertise to be amplifying the impact that we can have on communities in this way.

[Speaker 0]: It appears, because we heard about global commitment dollars this morning, your global commitment investment. But I think that $3.32 is about 140, if I'm doing math in my head, 140 general fund. Federal match.

[Speaker 2]: Alright, go ahead.

[Speaker 1]: Since we have a few minutes, I might as

[Speaker 3]: well ask my perennial question of the year, because you mentioned it in your testimony, which is How, say more about, or would, please say more, not can you, because you probably could, but please say more about the role artificial intelligence might play in improving population health when used in an ethical fashion through your plan? Wow, that's a great question.

[Speaker 2]: I hear the bells are ringing. Yeah, right. So

[Speaker 1]: we use AI right now in clinical visits to essentially translate conversations into clinical notes. Yeah, we heard about this. Yeah, and so that's a really good power. I think the one thing I want to make sure of is that when we're using AI, it's got to be secure and it's got to be accurate. So as it relates to We're talking about health related social needs and social drivers of health. I would be very careful around applying artificial intelligence in this particular situation without understanding exactly where the data is going be stored, how it's going to be used, and how it can be error prone. These are things that you do not want to get wrong. There is no room for error to understand what a patient family needs in this regard. These are sensitive questions. And then sharing this data inappropriately is devastating. So I think as an AI case in regard to health related social needs in this particular situation, I'm cautious at this point. And that's why I need to rely on the humans at two eleven to make sure that I trust two eleven. I think if you ask any other healthcare worker in the state of Vermont, they would say the exact same thing. I just talked to my friends at Franklin County office too, and everybody relies on two eleven.

[Speaker 3]: So it sounds like it might be a tool to improve the functioning of the system, but that it's always going to need a human review and human oversight.

[Speaker 1]: I think so, because in my experience, I've had patients that have screened for food insecurity, and they've screened negative. They've said, No, I don't have any issues. And I've known these patients for years, and I love them. And then eventually they will say, Oh, I was embarrassed to tell you about this. And so that just speaks to the deep personal implication of, yeah, and shame of this. So I don't think, sorry, I'm just concerned about reducing this to AI when it is such a human and very sensitive

[Speaker 0]: topic. If

[Speaker 2]: I could add to that, I wanted to Can you say

[Speaker 3]: your name for the record?

[Speaker 2]: I'm sorry, Clarissa French. Thank you. And I'm a board chair of Unileys of Vermont. And we're lunch buddies, apparently. To AI being a tool for efficiency and productivity, because we manage complex systems. That said, it does take capacity to achieve the confidentiality and rigorous testing that you need to, and it takes that capacity to overemphasize the budget cut. But the budget cut, we're not asking for more, we're asking for what we were getting last year.

[Speaker 0]: We're going be thinking

[Speaker 2]: to augment and answer questions like what you're getting to and utilize things appropriately. And AI will never replace a human at 02:11. That's the whole point of 02:11. There's a warm person there to reduce that stigma to help you help discuss your needs to do the follow-up questions. But it can help

[Speaker 3]: the humans there help humans.

[Speaker 2]: Yes, thank you and thank you for coming in.

[Speaker 1]: Thank you.