Karen Hein, '68: For love of state
On a Friday morning in late February, Karen Hein leads her 12 American Cashmere goats through the woods that surround her 19th-century farmhouse in southernmost Vermont. In the afternoon, she and her husband, Ralph Dell, wade through knee-deep snow at a cemetery in the town of Whitingham to show a visitor one of their favorite local sights: a quirky headstone that never fails to tickle their funny bones.
In the hours between these slices of Vermont life, Hein explains why she regularly interrupts her rural idyll to drive three hours to Montpelier, the can't-get-there-from-here capital city of Vermont, where she spends three days of each week poring over white papers and grant proposals and sitting through public hearings and conference calls with the Green Mountain Care Board. This five-member board was created in 2011 following the passage of Act 48, which guarantees universal medical coverage for Vermonters. The board's overall charge is to help control the growth of health-care spending and to seek ways to improve the health of residents. In effect, it serves as the health-care equivalent of a public utilities commission. Its work includes approving the budgets and capital-project plans of individual hospitals, reviewing the state's plan for health-information technology, developing a unified health-care budget for the state, and regulating the rates of health-care providers and insurance plans.
So what draws her away from home again, after more than 40 years of practicing medicine and exploring better ways to deliver care in resource-challenged settings ranging from the Bronx to Africa to Asia? What more could she have to prove by taking on yet another health-policy challenge, after tackling so many as a Robert Wood Johnson Fellow working on health-care reform for the U.S. Senate Finance Committee in the early and mid-1990s, and more recently in the boardrooms of nonprofit organizations?
"This job brings it all together," says Hein, an adjunct professor of community and family medicine at Geisel, who completed her medical education at Columbia University after graduating from Dartmouth's then-two-year medical program. "I can live in my favorite place in the whole wide world. I can live the way I want to live, spend more time in nature, and have the honor and the ability to do meaningful work.
David Corriveau is a freelance writer based in Lebanon, N.H.
"It's exhausting and it's delicious."
It's as exhausting, in its way, as the days and nights she spent tracking, treating, counseling, and advocating for HIV-infected youths in the Bronx from the late 1970s to the late 1980s. The work was so controversial at the time that Hein even fielded the occasional death threat for her efforts.
"There was so much stigma and denial—'Let's not deal with it,'" says Hein, who focused her research on such patients during her years training pediatric residents and fellows at Columbia University and the Albert Einstein School of Medicine. "There are a lot of lessons there now—how do you deal with controversial issues [and] diverse visions of how things should be."
And it's as delicious as the syrup that her neighbors on Maple Hill Lane brew from the sap of trees that they and their ancestors have tended for centuries, a legacy that reminds Hein of her charge as part of the Green Mountain Care Board.
"At all the various levels that each generation connects with the system, we're trying to figure out how the state can play a helpful and important role in their health," she says. "That's who I have to report to."
Fellow board member Cornelius "Con" Hogan—a former secretary of Vermont's Agency of Human Services—says Hein's presence on the board already is making a difference.
I've gone in my career from the theoretical to the very personal.
"I was fully retired," he says. "I wouldn't have come back unless you had a group like this."
Hogan adds that Hein sees the big picture, and helps fellow board members, staff, and policymakers to see it as well, thanks to her time with the U.S. Senate finance committee and with the boards of organizations focusing on global health and youth development. "Her view of health in the world is much bigger than ours—her definition, her scope." Moreover, he continues, Hein's experience in organizations such as the Institute of Medicine and the William T. Grant Foundation has helped place a national spotlight on Vermont's health-care initiatives. "Folks outside Vermont are paying more attention to this effort than would have been the case," he says.
As an example, the federal Center for Medicare and Medicaid Innovation (CMMI) recently awarded the board a $45-million State Innovation Model grant toward the goal of developing "a high-performance health system that achieves full coordination and integration of care throughout a person's lifespan, ensuring better health care, better health, and lower cost for all Vermonters."
The board will work on the Medicare part of this initiative with OneCare Vermont, the network of hospitals—including DHMC—that has formed an accountable care organization (ACO) to care for Vermonters.
"We're working well with the hospitals on community needs," Hein says. "We need them to be doing their work differently—to work on prevention, not just treatment. To avoid duplication of care. . . . We have an opportunity to create a truly integrated system."
The care board's director of payment reform has high hopes. "Everything is coming together," says Richard Slusky, a former chief executive officer of Mount Ascutney Hospital. "With Act 48, you have a real commitment on the part of the legislature, the governor, and the health-care providers. I think everyone recognizes that the system as it exists is not sustainable. The commitment is there, and now the resources are there."
Slusky includes Hein among those resources. "Her perspective, the experience she has in the population-health arena, has been very helpful," he says. "And she's part of what makes Vermont uniquely situated to do something like this. It's full of people with creative ideas who are able to have them well-received. People are respectful of different opinions. We engage in reasonable conversation. I think we listen to each other."
All of which made the decision to move to Vermont full-time in 2003—after five years in New York City presiding over the W.T. Grant Foundation—an easy call for Hein.
"I've gone in my career from the theoretical to the very personal," she says. "It's my state, the state I live in. This is our home. This is where we want to be buried. Vermont and its values and its ways—it doesn't feel small. It feels huge. It has a particular alignment of values and politics that is almost unique in my experience.
"The alignment of forces right now makes this the right time to do this."
Right now, Karen Hein and Ralph Dell are making the most of the sun shining on their first full day in Whitingham after three days and two nights in Montpelier. Emerging from the cemetery with the quirky headstone, Hein grasps her husband's hand for the walk back home to Maple Hill.
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