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Reimagining Rural Health Care in Vermont with Anna Tempesta Noonan · Becker’s Healthcare Podcast

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Every year, Becker's annual meeting brings health care
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leaders together to unpack the most pressing issues
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facing the industry.
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And every year, those conversations shift in profound
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Join us April 13 through the sixteenth.
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For the agenda and event details, visit beckershospitalreview.com
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and click on the events tab in the
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upper right.
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This is Scott Becker
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with the Becker's Health Care podcast.
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We're thrilled today to be joined by a
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fantastic leader.
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We're joined today by Anna Tempesta
0:49
Noonan,
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and Anna serves as the president of the
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University of Vermont Central Vermont Medical Center.
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Anna, you're in a beautiful part of the
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country.
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Take a moment and tell us a little
1:00
bit about your career, your background,
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and then we'll get a chance to visit
1:05
about trends you're watching,
1:06
what you're most focused on, advice for leaders,
1:09
and a little bit more. Anna, could you
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take a moment and introduce yourself and tell
1:13
us about the Central Vermont Medical Center?
1:15
Thanks, Scott. I'm happy to introduce myself. So,
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yes, Anna Tifesta Noonan. I'm a nurse by
1:21
background.
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This is my my forty fifth year in
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health care and I've held a variety of
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executive administrative and quality leadership roles for the
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past thirty years and I've had the privilege
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of serving as the president for Central Vermont
1:34
Medical Center
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for nine years. Central Vermont Medical Center is
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part of University of Vermont Health, which is
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a rural integrated academic
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health system
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in,
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Central Vermont,
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through the Northern Part of Vermont and Northern
1:49
New York State.
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The vision for our health system is reimagining
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rural health, leading with innovation, and transforming
1:56
lives.
1:57
There's a 1,400,
1:59
65 beds in total across our system.
2:03
We're anchored by
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a five sixty two bed academic medical center
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and five community hospitals.
2:11
CVMC
2:12
is the largest community hospital in that system.
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We have a total of about 16,000
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employees,
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141
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outpatient sites,
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bringing it down to Central Vermont Medical Center.
2:24
We have two seventy one licensed beds, 122
2:27
of those are acute care beds, and 153
2:31
are long term care and rehab beds. And
2:33
our catchment area here in Central Vermont is
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about 68,000
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and we have about 1,500
2:39
employees. So again, very rural part of the
2:42
country beautiful state as you said Scott but,
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very rural
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in nature.
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I I so I'm gonna ask you a
2:49
non serious question first, and then I'll move
2:51
to serious discussions about rural health and state
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of rural health.
2:55
The first non serious question, which may be
2:57
a serious question for New Englander,
2:59
is do you cheer for Patriot the Patriots
3:02
in the Super Bowl? And and second is,
3:04
was it unfair that Bill Belichick
3:07
didn't make the hall of fame on the
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first ballot?
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Yes and yes.
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There you go. God bless you. Thank you
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so much. So talk to us about talk
3:18
to us about rural health today,
3:20
and and and what does it look like?
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What do you see up there? You know,
3:24
years ago, I talked to somebody at
3:27
Dartmouth about, you
3:29
know, access,
3:30
And we talked about Uber, and they said,
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you know, when you get to rural areas,
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Scott, there is no Uber. You know, there
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there there's not those easy things for access.
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Talk about rural health care,
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staffing,
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physicians,
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challenges,
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and maybe what's working, what's exciting, and what's
3:45
positive. Okay.
3:47
So,
3:48
one of the the trends we're seeing in
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rural health, in addition to some of the
3:52
system properties like you mentioned, unlike urban areas,
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there is no Uber. For by and large,
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for Vermont in general, absent Chittenden County, which
4:00
is where our academic medical center is anchored.
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So a lot of those things that individuals
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are used to having,
4:07
for support systems simply don't exist in rural
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states like Vermont. We rank as one of
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the healthiest states in, the country,
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with low unemployment and low uninsured rates but
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affordability
4:21
of health care in Vermont is a critical
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issue.
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So Vermonters,
4:25
are noted as paying some of the highest
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prices nationwide for individual health coverage
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and with estimates of health care premiums tripling,
4:34
for some due to the expiration of the
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ACA enhanced tax credits, that's a huge impact
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for Vermonters.
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Drug cost inflation has impact been impactful particularly
4:44
with
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increased use of specialty meds like GLP ones.
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There's rising utilization
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in our state and rising acuity. We are
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an aged state
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so roughly a quarter of Vermonters
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are in the 65
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range
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and Central Vermont in particular, the only demographic
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that's really increasing in
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numbers is 65.
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So our population is
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aged. It's rural as I've already mentioned
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and that has impacts also on staffing. So,
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your question of what are some of the
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challenges? Staffing is a challenge for us. No
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question. Provider recruitment,
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obviously helped by the fact that we're part
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of an academic health network that does help
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us a great deal.
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But as far as other staff roles nurses,
5:35
respiratory therapists, rad techs, etc,
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We launched a number of pretty innovative pipeline
5:40
programs before the pandemic to grow our talent
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locally.
5:45
People that were not
5:47
able to go on to college, we've put
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through programs here at Central Vermont Medical Center
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where we support them in,
5:55
completing their academics and becoming, you know, a
5:58
member of our team at an LPN level
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to an RN back, associate, then baccalaureate,
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etc.
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So those pipeline programs have been really important
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for us.
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The other challenge we have in rural Vermont
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is hospital sustainability.
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So in 2023,
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nine out of our 14 hospitals, we only
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have 14 hospitals in our state, most of
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which are critical access hospitals,
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nine out of 14 had negative margins and
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in 2025,
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five out of 14 had negative margins.
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So
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really challenging. We also have a pretty heavily
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regulated health system here in the state,
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and we have good partnership with our regulators.
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But, again, I think all of those dynamics
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make it challenging,
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for us here in rural Vermont.
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No. A 100%. And and and talk for
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a second, Anna.
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When you look at this year, 2026,
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so many different challenges going on, so many
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positives.
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What are you most focused and excited about?
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And then I wanna talk to you in
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a moment about some of the stats you
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just gave us on the aging of Vermont,
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the aging of the population.
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And let me ask let me tackle that
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question first quite frankly.
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As a population ages like that,
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what does that mean for the long run?
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And is that one of the plights that
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we're seeing in rural America is the aging
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of the population as more and more people
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move to the top 30 metro areas.
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What does that look like and feel like
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for the vibrance of a community?
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So I think it's hugely challenging for, our
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community, but communities across Vermont
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and probably rural states around the country. So
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with that aging demographic,
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obviously those individuals are more likely to require
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more
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uncommonly that's a factor.
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The other piece
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on the other side is not having
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youth in our state to
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support the care provisions that our aged population
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will need. So again, the need for us
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to really establish some pipeline programs
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to help people stay in Vermont with
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jobs that are
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able for them to progress in their career
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track has been critical. But I think the
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aging demographic
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is incredibly challenging
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and then you add that to what you
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talked about earlier in our conversation which is
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transportation issues, mobility issues,
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supports.
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Many of,
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our patients that are aged,
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their support systems don't live in our state.
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They live in other states and they live
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in urban areas. So the support systems that
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traditionally
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existed maybe twenty, thirty years ago are not
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here for those,
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individuals that are more senior. So again, another
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challenge
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for us also,
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housing is a challenge
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as well as,
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elder care and then the opposite for our,
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staff are, day care challenges.
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Just finding those kind of resources in a
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rural state is also, difficult.
9:04
Thank you. And and and take a moment
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on sort of labor and delivery. We hear
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about so many rural places,
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you know, shutting labor and delivery,
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and and sort of the general press will
9:15
sometimes blame
9:16
profit thoughts or margin thoughts
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on that, but
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we generally know it's because it's really hard
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to staff.
9:24
Talk a bit about what you see throughout
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the region in terms of labor and delivery.
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And, obviously, if you're not labor delivery, it's
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somewhat the Delfinel of a community
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because it just makes it harder and harder
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for people to come back to
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plant
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families in those areas and grow. But talk
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about what you're seeing with labor and delivery
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and and maybe what can be done about
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it too. Yeah. So for us, the I
9:45
think the answer is regionalization
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of our labor and delivery suites which is
9:50
happening,
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simply because our numbers of,
9:54
birthing individuals has decreased with the aging demographic.
9:57
So we have seen,
9:59
at least one, center,
10:02
proximal to us, a critical access hospital, who
10:04
closed their labor and delivery suite, and we
10:07
are,
10:08
taking those,
10:09
patients,
10:10
into our labor and delivery suite.
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So I think one of the challenges
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and, again, also opportunities
10:17
is more regionalization
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of services,
10:20
so that we're staying
10:22
relevant and appropriate around just pure volume.
10:25
So it's hard to to keep those
10:28
the quality up when you have, lower volumes
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of,
10:32
patients coming through a particular service and that's
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certainly true for us in Vermont with the
10:37
birthing centers we have. So,
10:39
our academic center, which is part of our
10:41
network, obviously takes,
10:43
more the higher acute
10:45
high risk
10:46
pregnancies and has been for some time and
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we in the last year have taken on,
10:52
since November,
10:53
actually taken on
10:55
more bursts
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from a critical access hospital that,
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based on volume alone, had to close their
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service.
11:03
Thank you. And and and take a second,
11:05
Don. Let me get back to the person
11:06
I was asking earlier.
11:07
What are you most focused on and excited
11:09
about this year?
11:11
So what's really exciting to us and hopefully
11:13
to others in the country this is a
11:15
positive, I think, is that Vermont received, a
11:18
$195,000,000
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in the rural health care transformation grant from
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CMS for the next five years.
11:25
And I'm really excited about that infusion of
11:27
dollars coming into Vermont. I think it's going
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to go a long way in supporting the
11:31
continued partnerships and collaborations we have within our
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state.
11:35
Tremendous opportunity to potentially reimagine care delivery.
11:39
You know just thinking about how do we
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do this differently
11:42
with fewer
11:44
people in our state
11:46
and likely down the road fewer health systems
11:48
to support that care,
11:50
the opportunity to leverage
11:52
a AI, our electronic health record
11:54
and we frankly need some significant investments in
11:58
our hospital infrastructure across our state. Many of
12:01
our organizations
12:02
receive dollars back with the hillburton act era,
12:06
so our innovate, our infrastructure is in in
12:09
need of,
12:11
renovation,
12:12
not just here at CVMC but across the
12:14
state and so I think that infusion of
12:17
those dollars and the opportunity
12:20
in the state of Vermont, which I think
12:21
is a very highly collaborative state because we're
12:24
so small.
12:25
Total population is approximately 647,000
12:28
individuals. I mean
12:30
that's pretty rural
12:32
and small and so we have an opportunity
12:34
to really collaborate differently and and think about
12:37
some innovative opportunities to deliver high quality care
12:40
to the communities we serve. So I'm excited
12:42
about that opportunity.
12:44
Thank you. And and, Anna, you've had this
12:46
remarkable leadership career.
12:49
Take a moment on what advice you would
12:51
give to emerging leaders.
12:54
So for an emerging or involving leader, I
12:57
would say
12:58
to really think about developing professional networks
13:02
both locally, regionally, and nationally. I think Becker's
13:04
is a great opportunity
13:06
to,
13:07
engage with your national meetings and your topical,
13:10
conferences that you have. That exploration and leveraging
13:14
of the collective wisdom that one gets from
13:16
networking,
13:18
understanding what the best practices are, what the
13:20
wins
13:21
have been for those that, are around you
13:24
and either adapting or adopting those strategies
13:27
that make sense within your own, organization or
13:30
sphere of influence
13:31
and and using that kind of strategy to
13:34
really accelerate perform performance within your own organization
13:37
and teams
13:38
is something that I would
13:40
strongly encourage
13:42
you know younger leaders or evolving leaders to
13:45
engage in And then the other thing is
13:47
and this may be the nurse in me
13:49
is to make space to take care of
13:51
yourself.
13:52
Healthcare is more challenging now than it's ever
13:55
been. Like I said, I've been doing this
13:56
for forty five years. It is it's more
13:59
challenging now than ever for all the reasons
14:01
we know. So being a role model
14:04
to our teams
14:06
and exhibiting wellness behaviors for the next generation
14:09
of leaders, I think, is going to be
14:10
critical for long term sustainability.
14:13
No. I think that's fantastic. You know, anything
14:16
else you'd like to share with our listeners
14:17
today
14:18
even about the beauty of Central Vermont because
14:20
that's a beautiful part of the country.
14:22
Thank you. It is a beautiful part. Even
14:24
when it's two degrees outside, it's still gorgeous.
14:28
So yes, we're very fortunate to have a
14:30
very high quality
14:32
of
14:34
of standard of care here in in Vermont.
14:37
The ruralness really allows
14:39
us to think about health care delivery.
14:42
We are taking care of our neighbors and
14:44
in every community
14:46
in our state.
14:47
It's it's a it's it's a small state
14:50
and so you are literally taking care of
14:53
your neighbors, your friends, your family,
14:55
in all the roles we serve in so,
14:58
I think it brings the caring concept close
15:01
to home and makes everything we do even
15:03
more important.
15:05
It's all about the patients, the families that
15:08
support those patients,
15:10
and the team members that provide the care.
15:11
So, really feel fortunate
15:13
in my tenure to have worked here at
15:16
Central Vermont Medical Center. We have an incredibly
15:19
caring culture
15:20
and,
15:21
very honored to have been able to serve
15:23
in the role for sure.
15:25
Fantastic. Anna, what a pleasure to visit with
15:28
you. Again, Anna Tempesta Noonan,
15:30
magnificent leader of Central Vermont Medical Center. Thank
15:33
you for taking the time with us today
15:36
on the Becker's Healthcare podcast. What a pleasure
15:38
and and what great work you do. Thank
15:40
you so much for joining us. Thank you,
15:42
Scott.