Vermont Legislature SmartTranscripts:

[Meghan Hope (Financial Director, Vermont Department of Health)]: We are live.

[Andrew Perchlik (Chair)]: This is Senate appropriation. It's January 13. We're going through budget adjustment and requests. Today, we have the Department of Health up to the record if you introduce yourself. Do you have anybody else with you?

[Unidentified Commissioner of Health (male physician)]: Yes. I'm Philip Baruth, Commissioner for the Department of Health, and I've got Human Health with many things. Great. So as I've done a couple of times now, I'd like to use this as an opportunity just to really introduce myself Yeah. A little bit about what landed me in a seat and some of the observations I made priorities for this coming year, and then we'll we'll have a brief BAI, which is short. So I've been in Vermont now for thirteen and a half, fourteen years. I finished my residency training program over at Dartmouth and I'm an inpatient hospital medicine doctor, so I see folks in the admission unit at Beth Mellon. When I started my clinical practice, there was a couple of things that were immediately apparent to me in medicine. One was that I can't solve the problems of my patients within the four walls of the hospital. The problems are too big. The challenges that our patients face really require more than just getting to the bedside. They require community partners and a whole system of care. And that led me to reach out to our community partners, primary care physicians in that community, the ENA system, the skilled nursing centers, to try and coordinate care better. There was some real gaps that I was seeing leading to increased care utilization, readmissions, eating utilization, a lot the problems that we still see now. We've worked with a stakeholder group that ultimately turned into something called the Remote Community Collaborative, which is a really great organization that continues to this day and does help improve outcomes related to those. Unfortunately, despite that great work, the problem is still existing. We still see revolving door emissions. We still see that for the state. And in no small part, it's due to the social drivers. The health issues that we see around our state, lack of access to transportation, finances, food, healthcare, and those really led to a lot of these challenges. We started working on that both at the hospital, I started working outside of the hospital to try and help with some of these challenges. Mean, were some commissions, both locally and across the state. The other thing that was very clear to me when I started working was that there were decisions that were being made in the hospital that didn't really have any clinicians at the table. So I started inviting myself to a lot of committees. It wasn't that they didn't want physicians or nurses there, it's just that there wasn't people who were interested in doing that work. People didn't really raise their hands. And that found me on a leadership track at the hospital and a series of promotions over the course of ten years into a sort of executive position, which before leaving, was something called the chief medical information officer, which is this interesting interface between IT systems, EMRs and physicians. Really interesting work, a lot of data work and electronic systems and gave me a broad perspective of some of the challenges we see not only locally, but around. I did join the board in medical practice, served as their chair for four years. So I got involved a little bit in the very important space and licensing space, which was really interesting to me. I introduced me to the federal groups as well, Federation of State Medical Boards, which is a great organization that I've worked with for over the years. And some other board commissions around the region and the state, the local designated agency I got involved there because I'm at a public session for pharma, pharma, physical health and coordinating those systems would have been important, as well as, is a IT. So anyway, that work was really interesting and exciting to me. I also was the COVID czar before the hospital and got very involved in the COVID response, which served as the protection committee chair for a number of years. And for a while I had said to myself, if mind blowing the size to retire, I considered throwing my hat in the rain, and then that time came a lot of people sort of pushed me to consider that, and, six or eight months later, I found myself, at the Department of Health, after a pretty long process.

[Andrew Perchlik (Chair)]: And how long when when did that happen just last summer?

[Unidentified Commissioner of Health (male physician)]: October 13. Today, that's when it's the end of my third month. Great.

[Andrew Perchlik (Chair)]: Well, thanks for doing this.

[Unidentified Commissioner of Health (male physician)]: Yeah.

[Andrew Perchlik (Chair)]: You're not able to

[Unidentified Commissioner of Health (male physician)]: practice at all. I am. You're right. Yeah, so my practice is very limited. I see inpatients four days a month, which is great, and it keeps me grounded in sort of patient care, and no leadership or any kind of

[Andrew Perchlik (Chair)]: Yeah, any way to run along to do that. Yeah.

[Unidentified Commissioner of Health (male physician)]: So since being at the health department, I've been really infrapped with a lot of the work that happens there. There's so much, and I've learned so much. Yeah, so mission, ambition, and values is something that really spoke to me, even before I started seeking out this role. One thing that was also true and still is true is there's this attack on science and public health around the nation, and that's sort of a calling to me as well to sort of seek out this role. And this sort

[Andrew Perchlik (Chair)]: of mission and vision spoke to

[Unidentified Commissioner of Health (male physician)]: me and still does about the work of public health within our state and the work that we do. Public health is a challenging thing to define for folks since it's sometimes difficult to articulate. We use this way of describing it as detect, connect, or as you respond. I can give a a tangible example of how this works. So a few months ago, we detected the case of the process moving bots in Washington County that led to a loose number of cases there. We responded by providing the community with resources and information to protect themselves, PPE, immunization support if they needed it. We alerted the healthcare providers in the area to help prevent the spread of that disease. So that sort of detect and that prevent respond approach really worked well there. Our work goes beyond infectious diseases. Have federal and state, including in our school liaisons, collaborating with partners to improve mental health outcomes, promoters that have chat rooms with hot or cold during hot and cold seasons, workshops on healthy behaviors, drinking, smoking, you name it. There's so many different ways. All of us connects with our community to try and move things out of our state. This is our organizational structure, which I find very helpful to remind myself all the ways in which we help support our monitors and also the ways in which they're connected. Just as to orient yourself, sort of the green, those are called chiclets here are parts of the commissioner's office, and the blue ones are the different divisions that support various things around our state, so whether it's environmental health, the lab, local health, family and child health, the different divisions are in the blue areas. Our work is pretty varied. We have some very concrete clinical works, such as the Office of the Medical Examiner, do some clinical nursing visits for new families, laboratory testing. And then we have more community based work like preventing chronic disease, health promotion, environmental health, water, and air quality as well as food safety. We have experts in all these fields, which is great because I am not an expert in all these fields, but we have wonderful folks who have a lot of knowledge that we can rely on. If there's ever a question about these fields, I've got someone I could bring in to give you all the information you can to the bottom. So one thing that was very clear as a job for me was to preserve the trust in public health. We left the pandemic with a high degree of trust in the health department, that is not the case around the entire country. There's some health departments that really lack the pandemic with a very tarnished reputation. And I credit that to the work of Doctor. Levine and the health department and serving as that resource. It is my responsibility and our responsibility to make sure that we remain that trusted source for Vermont for the stable rock that people can rely on. The good news is we have a lot of resources in local communities that people do know, and when people make personal connections, that's where trust comes from. So in our district offices, in our schools, we have workers that connect with the local individuals there within our hospitals and health systems as well. And they are really huge resources that we have to go on to ensure that we continue to connect with the public. So there's a few specific things that have come up in the last three months that, I know our focus is a month, will be focuses in the coming months. The first one is on immunizations. And speaking of trust, there's been a lot of false claims and falsehoods in recent months that have been fueled by uncertainty and some of the changes in the CDC. We have been working very hard to ensure that Vermonters continue have access to vaccines, they continue to have access to evidence based information on what's recommended. We had a pretty big announcement last week from HHS around changes to the vaccine schedule, which

[Andrew Perchlik (Chair)]: has caused so much confusion. The announcement is you're not changing the schedule.

[Unidentified Commissioner of Health (male physician)]: Our announcement is we're not changing anything. The HHS announcement is that they're changing a whole heck of a lot. Right. And we are working with our legislative partners to ensure that we have some changes that are needed to make sure that we can continue to rely on trusted sources, that we continue to have access for Vermonters and that our insurers are going to work with us.

[Andrew Perchlik (Chair)]: Have you seen any reduction in vaccines or is it purely?

[Unidentified Commissioner of Health (male physician)]: So the feedback I've received from pediatricians is there's lot of confusion by folks. So a lot of people are confused about those changes and that can lead to a lot of the questions, which is good. Questions are good. They just, people need to go to the right source for their question, which is their trusted healthcare provider, their pediatricians, their nurses, or those sorts of things. So yes, it has caused a lot of confusion, and that's really been the main sort of change, if you will, right now, just confusion and uncertainty. There hasn't been any financial impacts to access to vaccines or things of

[Andrew Perchlik (Chair)]: that nature, it's just cost of talking. So people choosing not to vaccinate? Vaccinating rate going down at all.

[Unidentified Commissioner of Health (male physician)]: So we do track vaccination rates, the good news is overwhelming majority of the moderators just vaccinate their children and vaccinate themselves. The things that can fluctuate from year to year are things like COVID, and we've seen a little bit of a dip in those, which is concerning to me, especially this year where we have a particularly bad flu season. Flu has really been a challenge around the country and we're seeing that more and more now locally. So, there has been a bit of a dip in that. So, substance use disorder is another large focus of mine because it's a need. I mean, we've had challenges in substance use disorder in Vermont for years. Frankly, we've done a very good job in responding to this hub and spoke model. I seen in my clinical practice it's very effective. Many folks that I see on the inpatient unit, ten years ago I saw a lot of patients that were actively using IV drugs and had no engagement in treatment at all. It's rare that I see that now. I see relapses for sure. I see folks that are using IV drugs, but most people are engaged in treatment at some level, and a lot of folks are on MOUD, are on Suboxone or Methadone for treatment, which is really, really encouraging. The number of cases I see of infective endocarditis, which is an infection of a heart valve, see with IV drug use, those have gone down a lot. They're not gone, they're dead. But the field is changing. Not only do these substances change, and we're seeing a transition to a stimulant use disorder, which is a significant concern of mine, because the treatment for that is entirely different. There is no MOUD essentially for stimulant use disorder. What's that actually? Oh. Yeah, meth, cocaine. Cocaine is

[Andrew Perchlik (Chair)]: No, what's the treatment? MOUD,

[Unidentified Commissioner of Health (male physician)]: methadone and Suboxone, that doesn't exist. There's no, no. What we use is other types of incentive based programs that have been effective, but there's not as strong, you know, other spectrum therapies, so it's different. Meth specifically is a big concern among us. It's a really, really, really bad drug. The colleagues I have around the state here in the country who care for folks where there's a lot of meth, it's harrowing the stories you hear. People are very aggressive and violent. It's a really, challenging time.

[Meghan Hope (Financial Director, Vermont Department of Health)]: Is it just the acronym MOUD? Sorry.

[Unidentified Commissioner of Health (male physician)]: Medication. Medication, use. Probuphine use disorder.

[Andrew Perchlik (Chair)]: That's used.

[Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: As compared to, used to be MAT, right? Yeah. Right. Medication assisted treatment. And that's the methadone.

[Unidentified Commissioner of Health (male physician)]: Methadone and Spoxo, yes. It's the primary medication.

[Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Thank you.

[Unidentified Commissioner of Health (male physician)]: Anyway, yes, that is a concern. So the other piece though with substance use disorder is residential treatment is a really, really important part of this puzzle. We have some lack of capacity in some of our residential treatment areas. We recently were able to work with Validus to open a number of called 3.1 beds which are lower acuity treatment centers for longer durations of time that really meet a critical need. But there's more capacity needed in our substance use treatment spectrum. I think we'll see now that we have some more of the treatment, lower acuity treatment beds open, we're gonna see gaps in the recovery residences. So these are much longer term residences for folks who are getting on their feet and getting jobs and those sort of things. We have those, B4 is a big organization in Vermont that has a number of beds, as well as Jen's Promise and Ben's House. Organic eating work. So that's another area that we've been focusing a lot on. The last one is around access to care. I've seen a number of places where I'm concerned about access. This is obviously something near and dear to my heart in healthcare my entire career. And I've been concerned about some of the things that are happening in obstetric care, transportation challenges that we're seeing currently and that are exacerbated in healthcare. If we want to be, truthful to this, health care transformation and regionalization effort, we need to have to reach and organization systems in place. We don't have that much. And, that's something clearly that's within the health department and I am focused on and then reaching out there to ensure that we

[Andrew Perchlik (Chair)]: have access Do to you have any Senate liaison with the agency of transportation on the transportation issues?

[Unidentified Commissioner of Health (male physician)]: Most of the transportation that we work with is emergency medical services. So the EMT system is the primary sort of space, but absolutely we work with all state agencies around these sort of concerns, but that's the main one. Within the EMT system, the systems designed to respond to emergencies.

[Andrew Perchlik (Chair)]: Because the transportation we're dealing with more like it's getting people there, dialysis.

[Unidentified Commissioner of Health (male physician)]: And that is an issue. Know, the ability for someone to have services is, you know, is challenged. And, you know, I've seen that in my own community, and I know that I've seen that around the state where people just struggle with transportation. I've heard transportation challenges come up in almost every single discussion I've had on varied topics. It's not just healthcare or health.

[Andrew Perchlik (Chair)]: It's just so many transportation challenges. Hear that, Richie? Exactly. We

[Unidentified Commissioner of Health (male physician)]: get to put money in to help recruit volunteers. And we haven't caught up with where that effort has moved, but the public transit agencies have had less volunteers than we were able to reach out of. Went down during COVID, it hasn't come back, and I would suggest to you that as HHS talks about consolidation of healthcare services around the state, it becomes even more important to be able to respond, to push that. And there will certainly be an effort between health and welfare and our transportation community will push that. And I'm hopeful that in the governor's budget with the agency that they are backing up those efforts. I mean, certainly, again, in the healthcare sphere, the system's designed to do what was designed to do, which is respond to emergency, not to transport people between systems, which we need to do. Need to do that. The city needs to be paid for. Not current. It can't be floated by the state. It's to be something that insurance companies are reimbursing when transporting on the VMS systems or charcuteries. Well, we're gonna have centers of excellence and transit regionalizations. We need that. We've long transported people to the public transport agencies to dialysis and Yes, yes, yes. And it is concerning that we have less small tears now than I Agreed. And I'm sure that the chair of health and welfare will be

[Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: in bound, will back up all of this. I will, and maybe we can do something together.

[Unidentified Commissioner of Health (male physician)]: Yes. So those are some of my immediate priorities for the year, I've got Megan here to talk a little bit about our BADI, if there's any other questions you have. Thank you, for sure. Welcome aboard. Thank you. We appreciate that.

[Meghan Hope (Financial Director, Vermont Department of Health)]: Hello, Doctor. Meghan Hope, financial director for Montclair Falls. We have a brief budget adjustment this year to present to you all. The first item, as you can see, is sort of housekeeping, if you will, similar items with past years. That's a transfer from the Agency of Human Services Central Office to the health department for our agency of digital services expenses. So, annual costs there originally to the agency, and then once the agency kind of looks at all those allocations and figure out each department's needs. They then allocate the money out to the department. So that is that

[Andrew Perchlik (Chair)]: first Do do you know what where it is in that? Oh,

[Meghan Hope (Financial Director, Vermont Department of Health)]: I'm sorry. Yes. It is B3. Yep. B three eleven, because it's

[Unidentified Commissioner of Health (male physician)]: in our ad appropriation. I'm sorry about that.

[Meghan Hope (Financial Director, Vermont Department of Health)]: Don't know I'm getting the page number. I believe it was on page 11 of the age, Justin.

[Andrew Perchlik (Chair)]: It's on three that

[Meghan Hope (Financial Director, Vermont Department of Health)]: Oh, we okay. Oh, yes. You have

[Andrew Perchlik (Chair)]: I only have

[Unidentified Commissioner of Health (male physician)]: You have a big.

[Andrew Perchlik (Chair)]: Yeah, B three eleven.

[Meghan Hope (Financial Director, Vermont Department of Health)]: Yeah. B311.

[Andrew Perchlik (Chair)]: Alright.

[Meghan Hope (Financial Director, Vermont Department of Health)]: So that's the first item. Our next item is in section P312 in our public health appropriation, and we are asking for a swap of funding from investment global commitment dollars to general fund to help replace the funding that the health department issues to Planned Parenthood of Northern New England through a subrecipient grant. This funding use was a global commitment investment, but because of the federal HR1 bill, there's a one year moratorium or pause on Medicaid payments to Planned Parenthood. So, in order for us to continue providing these services and this funding to Planned Parenthood, we're asking for general funds to back up

[Unidentified Commissioner of Health (male physician)]: the global commitment that we can no longer reflect something from the government.

[Meghan Hope (Financial Director, Vermont Department of Health)]: That's our Those are the two items.

[Andrew Perchlik (Chair)]: There was an email on our worksheet that we don't have the details of all the reversions, but we've got a reversion report that shows permanent health reverting from health disparities and health equity.

[Meghan Hope (Financial Director, Vermont Department of Health)]: Oh, yes, that is in, it's a one time request within the, it's a one time appropriation to basically, when the Office of Health Equity, and I apologize, sometimes I get the Office of Health Equity and the Health

[Unidentified Commissioner of Health (male physician)]: Checker the

[Meghan Hope (Financial Director, Vermont Department of Health)]: Advisory Commission confused,

[Andrew Perchlik (Chair)]: went out Did pull up those posts within the wasn't the question about where they were going to live?

[Meghan Hope (Financial Director, Vermont Department of Health)]: Yes. They were originally appropriated within the agency of administration, and then they've sent some move to the Department of Health. So that one time funding request is basically to revert from AOA back into the

[Unidentified Commissioner of Health (male physician)]: general fund to then give the money back.

[Andrew Perchlik (Chair)]: It's reappropriated to AOA, but since it's within the department it needs to be reverted and reappropriated.

[Meghan Hope (Financial Director, Vermont Department of Health)]: Yep, and that is a one time, that's in the one time section for 163,000 of general funds.

[Andrew Perchlik (Chair)]: Makes sense. For the record, all nine on joint fiscal, if

[Unknown Joint Fiscal Office analyst]: I can point something out really quick about the grant, the 300. Even though it looks like it's a general fund of 300, it's actually only an increase of like 170 something thousand because the GCs match, so that's the federal and state, so it's really only an increase of like 170,000 general fund. Okay. But you would know that. So I just want to flag that it's not really 300, it's less.

[Andrew Perchlik (Chair)]: Yeah, Richard, the early scientists. Okay. Thank you. Any other questions? Department of Health Finance, with the Department of Health, the Commissioner and State. You think they're good? Okay. All right. Well, thank very much.

[Unidentified Commissioner of Health (male physician)]: Thank you.

[Meghan Hope (Financial Director, Vermont Department of Health)]: No. Do

[Andrew Perchlik (Chair)]: we have IOCs online or It should be. In person. Maybe that's We'll move directly to DOC if they're neighbors. Well, we go online by week.