Building a Culture of Health in Vermont

Transforming Vermont's INvestments in Health and wellbeing

In Vermont, major health reform initiatives are underway to expand health care access, reduce costs, improve accountability for citizens’ quality of life, and improve health outcomes. As part of this effort, we recognize the potential mismatch between what we currently spend on health and that which makes us healthy. Clinical care is only a small contributor to our overall health and wellness. Other factors – such as social, environmental, and individual behaviors – influence both our health and our ability to make healthy choices. We need to better understand current health-related investments across sectors and rebalance health spending.

What is the project?

This project seeks to widen Vermont’s lens on health reform to incorporate factors associated with a culture of health and to create joint accountability for health across sectors. Vermont’s efforts to quantify the state’s total investments in health and track their successes must be expanded to capture spending, wellbeing, and health improvement across key social determinants of health. To do this, the Vermont Department of Health is conducting two important efforts:

  Total Health Expenditure Analysis

A state-level total spend on health analysis that includes population-based spending on health a whole, not simply individual health care-related expenditures. This project captures investments in major determinants of health, such as individual behaviors, economic stability, educational attainment, physical environment, sociocultural factors, and clinical care.

An inventory of health-related spending across sectors at the state level will lay the groundwork for deeper impact analysis, including assessing the health effects of specific investments (e.g. bike paths) and their associated monetary effects, such as reduced health care spending and other economic impacts (e.g. productivity).

 Shared Health Metrics

Recommendations will be provided to non-health state agencies to integrate health-related metrics into their existing performance dashboards. These model dashboards will foster shared accountability for health across sectors.

Project Goals

By including the many factors that impact health and wellbeing, we can:

  • Widen the lens on health reform to assess total spending across sectors;
  • Shift the paradigm from a focus on health care to health and wellbeing;
  • Foster cross-sector collaboration and accountability for population health and wellbeing through data-driven health metrics;
  • Make informed policy decisions on how we spend health dollars.

Guiding Questions

What are we spending now? In order to spend more effectively, we need to better understand how we are currently investing in health beyond medical care and across sector

What is our spending getting us?  With a total-spend-on-health assessment, we can better determine if our current health spending aligns with and contributes to our population health goals

What happens when we change the way we spend? Applying what is known about evidence-based interventions and using other data sets, we can analyze how shifts in spending impact population health outcomes.

Building on Health Reform in vermont

As a vanguard for health reform, Vermont excels in implementing innovative health strategies that seek to better the health of all Vermonters. The Expanded Health Expenditure Analysis and set of Shared Health Metrics will work synergistically with and advance the efforts of the Green Mountain Care Board’s Health Care Expenditure Analysis, Vermont Blueprint for Health, Vermont’s Accountable Care Organizations, Vermont State Health Improvement Plan, Vermont Unified Health Budget, Vermont Health in All Policies Task Force, and development of the All-Payer Model.

Project Contact:

Jane Wolforth - Senior Policy Analyst -