Vermont Legislature SmartTranscripts:

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Off Devon or if you want.

[Devon Green (Vermont Association of Hospitals and Health Systems)]: I can go ahead and introduce Sean if that would.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Yeah, why don't you sit in a seat? We are now back live, Senate Health and Welfare, and it is still January 13. And we've invited, Deborah Green of the Vermont Hospital and Health Systems Association in to talk with us and brought a guest from Northeastern Vermont Regional Hospital, Sean Testers. So thank you for being here. Yes. And I'll turn it over to you.

[Devon Green (Vermont Association of Hospitals and Health Systems)]: Great. I am just going to introduce myself, Devin Green with the Vermont Association of And Hospitals and Health for today, we wanted to have our board chair. Our board is comprised of all of our hospitals, all of which are nonprofit. They're CEOs and some clinicians as well, clinical voices, nursing voices, community voices. And Sean is the chair of our board, and he is in here today to talk a bit about the work that's been happening in the hospital space. So with that, I will turn

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: it over to Sean. Thank you. Thank you.

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: Hi, How you doing? Good. Thank you all for having me here, And I know you've done work at this. You guys all have a lot of work ahead of you, as you were at the beginning of the session. So I just appreciate you all giving me an opportunity to share what hospitals across the state are doing around affordability. And then I thought I might use some specific examples of what Northeast Denver Hospital is the one. So state your name, So my name is Sean Pastor, and I'm the CEO of Northeast Denver Regional Hospital. Okay. So I did want to start with the work that we have done over the past year around addressing the affordability challenges facing all of the Mars. And I'm really proud to share that through the collective action and efforts of Vermont's hospitals last year, as we built our fiscal year twenty twenty six budgets, which, as many of you may know, started October 1, we collectively saved or cut two thirty million dollars from the system. Those are the savings that we're able to achieve in that work. And I think what I saw working with my colleagues in that state was this real strong sense that this was important, but they really needed putting them to do that work and make it happen. I thought it might be illustrative to share what that looked like at Northeastern Vermont Regional Hospital so that you can see examples of how we're able achieve those savings. Now, obviously, Northeastern Vermont is on the smaller side of the Mount Hospital. We're not a large hospital, so so the portion of that, 230,000,000 was much smaller. But for us, it meant finding about $2,500,000 of expense reductions to meet our budget goals for fiscal year twenty twenty six. So the steps we took in order to do that included offering a voluntary retirement program for some of our more senior employees, and we had about 15 people take advantage of that program, We're really pleased with, that helps us reduce our total overhead in many of those positions. We did not, some of them, not many of them, but some of them we were able to get away without replacing them.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: Do you want to be interrupted? Sure. I was

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: just wondering if those were administrative positions or, you know, surgical staff or It was a medics, but it was primarily administrative. So it might be like a front office secretarial, yeah, but it was a nurse. However, in addition to the voluntary retirement program, we did also eliminate eight positions. Five of them were administrative and three of them were clinical. Part of that is a little bit rightsizing for the patient volume that we have and then working with our teams to get a lot tighter and more efficient in having the women to carry with the loved one. We did, after careful evaluation, we made the difficult decision to eliminate our occupational medicine program, which was included in those staff positions that we eliminated for a variety of reasons, but it just made sense for our community. A lot of organizations approach occupational health in different ways today. And a couple years ago, in an effort to reduce our avoidable ED visits, we started an express care program. It's not quite urgent care, but more like walk in urgent care, primary care. And we're able to roll some of the services that we had provided through occupational medicine, for example, DOT exams, into a breast care setting, leveraging the existing staff. We did work closely with a couple of our internal departments at the hospital, notably our hospitalist program and our emergency department, to restructure how we staff those departments, which are staffed at 07:24. And through doing that, we reduced the total hours of clinical time required to staff those departments. Hasn't come with some pain. There are certain things like at the change of shift within our emergency department, we typically had about an hour overlap of clinical time. We reduced that to basically nothing. But through that, we were able to achieve about, well between the two, was almost $400,000 of those savings on an annualized basis. And that demonstrates just our working hard to make sure that we're as efficient as possible in the way we're delivering the care. Another big savings came from looking at our fringe benefits, including our healthcare plan. We're self insured, but one of the biggest drivers of expense out of the healthcare plan are our own drug costs. The biggest driver we have seen over the last four years are, say yes, what's that? Diet pills. Weight loss drugs. We had gone from four years ago having about 40 people on prescribed prescription weight loss drugs to of the total people on our plan, which includes family members, right? It's not just the employees, 150 people in four years. Costs had just gotten out of control. So we made a difficult decision to, among some other minor changes, but the big one was eliminating coverage of those drugs for weight loss diagnosis. If they're prescribed for diabetes or some other conditions, they're still covered. But with that change alone, we're saving about a million dollars. Painful, know, it doesn't make people very happy. We're continuing to monitor that. We know that we know that those those medications have been life changing to many people, so it was not a decision we took lightly. We are continuing to monitor the market. There are new weight loss medications coming on in pill form that look like they're gonna be much less expensive. And so hopefully, in subsequent years, we can revisit that decision and open up options for them. So that's what we did last year.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Moving forward, looking forward Can you briefly talk about the nine year collaborative? Remindler Collaborative Health Network? We're not None. Okay, we're not members. We're not personally members. Okay, that's on the bottom. I think I'm

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: back to Devin.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: No, we'll leave that to Devin. I will

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: say though, we have considered it. The reality is we are already in a group purchasing program. It's called NEEA, and it is Dartmouth affiliated program. When we brought in the consultants, Kaufman Paul, last year and they looked at our our our our expenses on supplies, etcetera, they saw no opportunity for real additional savings over what we're already getting. And a change like that is significant for a small hospital. You gotta change your con vendors. You gotta change what products are used throughout the hospital. It's not a trivial change. But the good news is between between the that program and NEHA, I think every single Vermont hospital is in a new purchasing program, particularly in the end of the purchase in one way or the other. So moving forward, the Los Possible's have pledged to find an additional $100,000,000 of savings over the next two years. I think that's reasonable and practical. I think asking for more than that is gonna be a really challenging stretch, especially when I looked at how our own possible NVR engine allowing at this point. We're incredibly lean, and at this point, it really the only way I would find significant savings part of this effort, we're looking at about another million to a million and a half of savings over the next two years, trying to squeeze out of our system. But anything more significant than that probably will come down to looking at what service lines we have and if there's another one we need to eliminate. I know there's a tremendous sense of urgency around that. A 100,000,000 over two years is not truly a little go, and I think we'll get that. There are risks in moving quickly, and I wanna also share a story of how that has impacted our own possibility. So as you all know, if you read The Digger or watch Channel three news or just are part of the health care conversation in this state, we're under tremendous strain. And the conversation has revolved around how do we transform our system, how do we consolidate services into centers of excellence, how do we lower costs, and what the impacts may be on hospitals. We had, for a small hospital, we try to offer a range of specialty care services because we know for the Northeast Kingdom that it's incredibly hard for many of our friends, families, neighbors to travel or to access care if it's not available locally. That's that's our primary driver for offering those services. Most of those services lose us money. Right? So that's a big challenge for us. But we also feel like it's incredibly important to have them. For twelve years, we've had a neurology program and a great neurologist at NDRH. Her last day was December 1. And one of the reasons, one of the prime reasons she left was because of the incredible uncertainty in Vermont's healthcare landscape and her concern that the regionalization process would result in consolidation of a specialty service like neurology being centralized at another location, she made a difficult decision with her family to to end her employment with NVRH and move out of state with her.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Fear is a terrible, terrible And

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: I can tell you that amongst my providers, that fear is pervasive. I'm sure of it. The problem I have as an employer and someone who works hard to recruit health care professionals to the state of Vermont, that's going to be an incredibly difficult position for us to fill. We're we we're working with recruiters. We're hoping to fill it, but I anticipate optimistically that it will take two years to work site certain. That's just the reality of the recruiting environment out there. And, unfortunately, amongst recruiters, Vermont now has a reputation and many healthcare providers are avoiding looking at career opportunities in Vermont because of the landscape.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Is landscape the financial landscape for them?

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: So it's the overall perception that Vermont is going through a significant tran transition right now, and that it might be a risky place to put down roots and to and to have a career.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So and I do have a couple of questions related to that. I mean, we are. We're in a gray area. We're in limbo. We're moving ahead. We've got the Rural Health Transformation Grant that just popped up, which is hopefully going to help with our transformation work that we've been doing and you've been doing. You're the boots on the ground with that and it's great to hear what you're doing. Obviously, we have some bills in here that relate to everything you're talking about. So when you talk about regionalization and centers of excellence and what are the criteria for determining where services belong? Should they be cut? Should they be added? So that whole discussion, we have a bill in here, I forgot the number of it, but it's a criteria for hospital services decision making. I only say cutting, but it's also adding. So that becomes That's an ongoing discussion as it's a conversation about how to improve primary care access and transportation. So, my glass is half full and I would hope that yours is too because I think we're at a stage where we can really make some improvements and save hospitals because remember the origin of a lot of what you're doing was those four or five hospitals that were perpetually red. So mean, there are bills in here and we'll ask you to consider, or your organization to consider as board chair. And I guess I do have a question here. Are you working regionally to make your decisions?

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: Senator, you set me up for the third point I wanted to make a brief

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: We're lucky. Absolutely,

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: yes. And first off, I think that my regional partners in the Northeast Kingdom recognize just how important it is for us to collaborate on this work even before city all of the wiremen before it is and so we've been we've been collectively putting effort into that. We're also leaning in with AHS and and their work. Matter of fact, I I have to hit send tomorrow on the draft transformation plan to go to AHS for my hospital, and then we're working with North Country Hospital on a regional transformation plan. I agree. I'm actually pretty optimistic that that work is gonna bear real fruit and that I see real opportunities to not only stabilize our rural hospitals, but also enhance our ability to deliver care to these rural communities. And I think there are a couple of things on that transformation that are gonna make a real difference. Number one is just the collaborative approach to providing, for example, the specialty cares that the region needs. And again, I'm gonna speak specifically to the Northeast Kingdom, even though I know all of Vermont's hospitals are participating in this conversation right now. North Country Hospital and MBRH have been having conversations around how do we collaborate on that service. I'll give you an example. Neurology's maybe a good one, because currently North Country does not have a neurology program, and now we just lost our neurologist. But we need access to neurology in the Northeast Kingdom. Between the two hospitals, we probably need two FTEs. But if North Country hires an FTE, and we hire an FTE, we both have small, fragile neurology programs. But if we collaborate and create a neurology program for the entire Northeast Kingdom, where may physically One person may physically sit in North Country, one person may physically sit in in, say, J, or they may move around, depending on people's flexibility and willingness to do that. You create a program where they can share patients. Two, healthcare professionals, have peers that they can work with to share resources with. And I think it will create a much stronger, stable program moving forward. So that's an example of the type of work we're we're doing. Thank you. You're welcome. Yeah. It's great. And there are also real opportunities around, like, staff trainings and education, getting developing commonality in our policies and procedures. Now right now, it's a little challenging because both our institutions are in very different electronic health record systems, which also translates into all the back end systems are different. So when you try to share staff or come up with common procedures, you get into some challenges there. However, we are now much more intentional about sharing, for example, HR policies. There's no reason why I have to create my team has created a set of HR policies, and their team has created a set of HR policies. You can achieve some savings there, but, also, the more common you can make things like that without violating any trust laws, it makes it easier for us to down the road share staff or share best practices and create efficiency. Terrific.

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

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: One other, again, on the early side, but we are currently sharing a pharmacy directly to 200 hospitals. And again, it helps create that connection. It helps us share best practices, and it helps us share what is frankly a very difficult resource to find a pharmacy director with the skills and talents to serve our two hospitals.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: Questions? Yeah, but

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: the important thing I heard is, you're doing this. We're doing this. But until this that more in concrete than jello, it's hard to hire people because you don't want to bring in a neurologist won't come in and settle their family and get them in school and, you know, buy a home or whatever to find out that we're gonna create a center for excellence in Randolph for neurology, and neurology services are gonna go there and you gotta pick everybody up and move.

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: Yeah, that's part of it. And I don't wanna oversell the uncertainty of the healthcare environment as part of those challenges, because you just named a couple others that are I huge, cannot tell you, and I know you guys all hear it all the time, the housing crisis is real. Yeah. And when even well paid health care professionals cannot find a home in the Northeast Kingdom to relocate to, we've got a serious problem. And so we've gotta address the housing crisis. And and we we need to solve it five years ago to address that. The cost of living issue for the entire state, I know we talk about the cost of healthcare, the cost of education, but the overall tax burden in the state is also a significant barrier to us recruiting healthcare professionals to the state. So when we're recruiting a physician, typically our best recruits have some connection to Vermont. But the reality is even those healthcare professionals are considering career opportunities in New Hampshire, in Virginia, in Colorado, in Tennessee. And many of those states have a much lower cost of living than the state of Ohio. And as much as we like to think of Vermont special and they have great mountains, many of those states also have amazing mountains. And and people are making practical decisions based on pocketbook issues even though they may be on the higher end of the income spectrum. So it's something that just needs to be fair to ask.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: I hate to do this because we're just getting started, but I please would ask you to come back. Will schedule this in with you and Vas. Sounds good. I know you're out of time.

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: I just want to hit the high points. Vermont Hospital saved $230,000,000 last year as part of the budgeting process. We're committed to another 100,000,000 of expense reduction over the next two years, and we're leaning hard into the transformation work to to make our system more sustainable, affordable, and impactful for the people and communities we serve.

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

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: Thank you.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: And I still have lots of questions, but this is a great way to get started on this. I appreciate your time. Senator, thank you

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: for having me. Thank you all for having me.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Good to see you again.

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: Martine, looking to you on some

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: I'm going to say we're going to bring Dana Hudson and Doctor. Grant up and we have we only have we have ten minutes we're gonna go over time just very briefly.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: Take care we hear from folks.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Please. Yeah, that'd be very good. Introduce yourself for the record. Yes, and I would like to hear what you have to say. Very good.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: Hello, my name is Dana Hudson and I am the coordinator of the Vermont Farm to School and Early Childhood Network. My employer is Shelburne Farms, but I really work for the hundreds of educators, farmers, school food professionals, organizations, and businesses that make up our robust farm to school and early childhood network. But most importantly is I actually work for the thousands of young Vermont students that are participating in farm to school and early childhood programs. So I first thank you all so much for having me here today and I'm excited to share about some of the impacts that Farm to School and Farm to Early Childhood have had on Vermonters. Because it supports our schools, our farmers, our local food economy, and our community. We are asking you to support the Vermont Farm to School and Early Childhood grant program and the local food incentive program for schools with level funding, base appropriations of $500,000 each.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: You understand we're not the appropriations committee. I totally know. You We're just set the policy on.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: Right. And so that's why I just wanted to share with you where we're at with the current and these have been funded for years. I'll tell you a little bit more about the programs. The Farm to School and Early Childhood Network was created in 2008 to address the growing movement within our schools that wanted to serve more local products in their cafeterias while using food and farming as an integrated education tool to address student learning and engagement. And so we utilize what we call the three c model of change, in which I'm gonna give you a handout. It's on the cover of your handout right here. In which we see this model of change as the best way for long term staying power. Because you need to connect the classroom, the cafeteria, and the community at the same time, which creates this win win win approach for our students and our farmers and our families and the communities. And I actually have seen the impact of these Farm to School programs firsthand myself. The school where my children go, they have a chicken coop, they have fruit trees, they have a prolific garden. And the Farm to School program at this school is woven into the school curriculum. And every single child in the building gets exposure every single year to these activities. They come home with the stories and memories, but more importantly, they feel a deep connection to their food, their community, and the world they live in. And Vermont has invested into three key programs to make this happen. And so I'm going tell you a little about the three programs and then I'm going to pass it to Doctor. Hildebrand to share with you some more. The three cornerstone programs that we have in Vermont is first, the Rosa McLaughlin Farm to School grant program that started in 2006. Senator Lyons, I worked with you back then with Roselle and Betsy to help make that happen. Senator Lyons is one of the big advocates. And has since served 300 schools and early childhood programs in every county of the state. The program provides capacity building, technical assistance to these schools and early child care programs to develop and strengthen their farm to school activities. So that's the first one, the Road to McLaughlin Farm to School Grant. The second one is a local food incentive program that supports the increase of local purchasing. And so of the $25,000,000 that schools in Vermont spend every year on food, we are working to increase the amount that's going to in the Vermont economy and to Vermont farmers. And we've actually seen in the past ten years, we've gone from the schools, cafeterias purchasing about 5% local. We're now at 14% local. So just in those ten years we've seen that increase. But we still have a goal of 30% by 2030. So we're working on it. And of that, about 150 farms across the state that now sell to schools in early childcare programs. So the third thing, the third cornerstone activity is universal school meals, which ensures equitable access to school meals for every student in every zip code in our state. Since for many students, about half of their calories come from school meals, if you count up the breakfast and lunches, about half their calories in a week, we know it's essential for our students' health, their learning, and their success to access nourishing food. So I'm pleased that Commissioner of Health, Doctor. Hildebrand, is going to be joining us for a few words in just a second and I'd be honored to come back and share more if you have the time. I could bring students, from the childcare providers, K-twelve educators, farmers, food service, health professionals. We have them all in the building today testifying in the different committees. I'd be happy to bring them back another time if you want to hear more of their work. But just to reiterate, we really are looking for support for the level based funding of the local food incentive program at $500,000 and Farm to School and Early Child Care grant program at $500,000 These programs have made a huge difference in the ability of schools to buy local food from Vermont farmers and engage students in understanding where their food comes from in the world. So if you have any questions, I'm happy to answer any questions. And I also just want to share in this handout. Try to cover a lot more than what I talked about, but I know that by handing the handouts out too early, it's hard not

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: to say. Well,

[Dr. Rick Hildebrand (Commissioner of Health)]: good to all of us. Good ahead, to

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: John. I went to this farm to school.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: The press conference. Press conference over at Harwood.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: I got you You hold a very nice chicken. But I wish I could eat as well in this building, and I did it. Mhmm. It was really good, and my memory of school lunches isn't that good.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: Was missing all chicken day, the whole Mecosto.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Missed, yes, and I asked, do you eat like this every day? And that was, yes, we do. I would think that day was definitely maybe a

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: little not higher, but the quality is But not the quality high end when it comes to, and they actually are 25% local, that school, that's why we did the press conference there because they've

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: been able to achieve so much. Red Hen is right there on the road and Red Hen makes white bread for the school. Right. White as you can

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: get it. I can't pass up the opportunity to mention that I was on the education committee when we passed University School Meals and I really advocated him for not having it in the education fund, but it was put in the education fund and I fear for what's coming because it appears that cuts will have to

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: be made. So that's why we're in this room. Yeah. Because it's really critical for it. Fundamentally.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: It's a little bit different formula. It's within the education formula, but I know it's very susceptible. So, that's why you're asking. Well, I'm

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: gonna ask, thank you. Yes. This has been great and we needed this, got us energized and we'll have Doctor. Hildebrand energize Very us even

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: good. You. Past chair off. Thank you.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: Thank you, Doctor. Wainwright.

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: Of course.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: You for being here. Just wanted to one a simple comment.

[Dr. Rick Hildebrand (Commissioner of Health)]: Yep.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: My first year in this building, was on three committees, one of which was vice being vice chair of agriculture. I'm in Natural Resources and this woman. And Senator Chittenden was Chair of Ag and I forgot her first name, I think it was Dawn Sprague. Oh no. In Ag, the Agency of Agriculture and we started talking about why can't we have farms sell produce and food directly to schools. And so we had some orchards come in and some farms come in and I credit that initial work. That was really good work by Senator Chittenden, I think it's Donna, but from AG getting everybody's own. We were all excited about it. Joe Boucher. Joe, Josephine Boucher. Thank you very much. Yeah. Appreciate that. Okay. So enough of that.

[Dr. Rick Hildebrand (Commissioner of Health)]: Good afternoon. Rick Hildebrand, commissioner, atomic health. I will be brief, and I'll give you some some time back. One thing that's been important to me my entire career is nutrition. It's something that I see gaps in routinely in my patients' not only education, but access to healthy food. For a long, long time, I've been a pharmacy program, which is sort of a prescription food program. I was not familiar with this until I started in the sea. And within the first month,

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: I was able to go to

[Dr. Rick Hildebrand (Commissioner of Health)]: the Harvard School and see the program there. And I was really impressed with it because the level of knowledge that students had about agriculture, about the food, about how prepare it was really phenomenal, lays the foundation for healthy eating early on, which can significantly reduce disease burden in older age. So when you're talking about healthcare, when you're talking about health cost, this is a preventative measure that is so beneficial to our kids in this this state and lays the groundwork for healthy eating behaviors going forward. Something I couldn't support more and really, really would encourage you all to support this in whatever venue you can. It is a public health measure. It is a health care and public health measure, eating healthy foods. We are the highest nation highest state in the nation for eating fruits and vegetables currently. We wanna stay there. It was not by accident. Oh, yeah. National. We wanna stay there.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Keep it at the top of the food pyramid. Ah. Wait. Where what happened to the food pyramid?

[Dr. Rick Hildebrand (Commissioner of Health)]: They they they turned it by 33 degrees.

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: 53 degrees.

[Dr. Rick Hildebrand (Commissioner of Health)]: He just needs to rotate it back.

[Dana Hudson (Coordinator, Vermont Farm to School & Early Childhood Network, Shelburne Farms)]: Back with the.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: 70%. Right. 30% fat cut.

[Dr. Rick Hildebrand (Commissioner of Health)]: I mean, the important the important piece there is eat real food. Right? And this is exactly what this is. It teaches kids how to eat, prepare, and value food in the way that they should. So I don't know if I have a prepared statement that you guys have that can give you some more facts and figures. I just wanted to say this is a really great program. Love to see if

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: you send me back home.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Thank you. Thank you for that. This is important to us to have your support. Absolutely. Understand that. And you know what might be helpful at some point when we get closer into budget time or other prevention discussion to have hardwood in with you and have you come back, doctor Kelly. Bring the chicken. Commissioner. They could bring the chicken. Yeah. I've never thought of a chicken as something that their chicks carry around and fold, but this was a very well handled chicken. Right, no. And I'm very concerned about the changes to the food pyramid. Someone who is extremely familiar with the research that leads to all this stuff.

[Dr. Rick Hildebrand (Commissioner of Health)]: It's the incentives are concerned. Why are the changes happening if there's not a science to drive those changes? That's concern to me.

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: It's interesting. I think the rationale that I see implied is that this is the way people eat, so this is the way it should be. And, well, put processed foods out on people and that's the way they eat so that you're gonna allow for those, we're fortunately seeing a better decision there. Think I agree. Thank you. We are over time and thank you committee

[Shawn Tester (President & CEO, Northeastern Vermont Regional Hospital; VAHHS Board Chair)]: for being

[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: a