Vermont Appoints Liaison to Consolidate Health Care Spending

University of Vermont Medical Center ordered to improve access, affordability, and quality of care

Published on Mar. 11, 2026

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The University of Vermont Medical Center has been ordered by regulators to spend up to $15 million to improve access, affordability, and quality of care in its hospital. This comes after the hospital made $80 million in unbudgeted patient revenue in 2023, resulting in higher premiums for Vermonters. The state has appointed a professional 'fixer', former Vermont Agency of Human Services Secretary Mike Smith, to oversee the hospital's efforts to bring down the cost of health care.

Why it matters

Vermont has some of the highest health insurance premiums in the country, with low-income and senior residents using state-sponsored health care that reimburses care at lower rates, causing the hospital to shift costs to those with commercial insurance. The state is trying to address this issue by consolidating health care spending and improving the quality of care at the state's largest hospital.

The details

The Green Mountain Care Board, Vermont's hospital regulators, found that the $80 million in unbudgeted patient revenue at the University of Vermont Medical Center resulted in higher premiums for Vermonters in 2023. In an effort to bring down the cost of health care, the state has brought in Mike Smith, a professional 'fixer' and former Vermont Agency of Human Services Secretary, to oversee the hospital's management and cost-cutting efforts. So far, the hospital has eliminated $8 million in administrative overhead and found savings in supplies and testing, and has also cut charges to the insurance company by at least 12.3%.

  • In 2023, the University of Vermont Medical Center made $80 million in unbudgeted patient revenue.
  • In April 2025, the state brought in Mike Smith to oversee the hospital's efforts to bring down the cost of health care.
  • On January 1, 2026, a new state law went into effect that limited the hospital's infusion drug prices.

The players

University of Vermont Medical Center

Vermont's largest hospital, ordered by regulators to spend up to $15 million to improve access, affordability, and quality of care.

Mike Smith

A professional 'fixer' and former Vermont Agency of Human Services Secretary, hired by the state to oversee the University of Vermont Medical Center's efforts to bring down the cost of health care.

Green Mountain Care Board

Vermont's hospital regulators, who found that the University of Vermont Medical Center's $80 million in unbudgeted patient revenue resulted in higher premiums for Vermonters.

Dr. Stephen Leffler

President of the University of Vermont Medical Center, who believes the hospital's high costs are due to Vermont's small and older population, with low-income and senior residents using state-sponsored health care that reimburses care at lower rates.

Blue Cross Blue Shield

The commercial insurer that the University of Vermont Medical Center has worked with to cut charges by at least 12.3%.

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What they’re saying

“Bottom line, they need to be more affordable. They need to bring down the cost of care in their organization. It's as simple as that.”

— Mike Smith, Former Vermont Agency of Human Services Secretary

“They have a role to play here, and it's a role that, you know, is bigger than just running an institution. They must meet the needs of Vermonters out there.”

— Mike Smith, Former Vermont Agency of Human Services Secretary

“We don't have enough people to spread that cost shift out to like in other places, which makes our premiums go up higher than other places.”

— Dr. Stephen Leffler, President, University of Vermont Medical Center

“Working with our commercial insurer, Blue Cross Blue Shield, we cut our charges to the insurance company across the board by at least 12.3% for everything we do.”

— Dr. Stephen Leffler, President, University of Vermont Medical Center

“We're trying to figure this out right now. We're working really hard on it. There's even more change coming on top of it. So it feels like it's cascading a little bit.”

— Dr. Stephen Leffler, President, University of Vermont Medical Center

What’s next

Mike Smith and his liaison team say they are focusing on improving the hospital's quality of care and plan to wrap up their consulting in the fall. It remains to be seen whether these efforts will lead to lower premiums for Vermonters.

The takeaway

Vermont's efforts to consolidate health care spending and improve the quality of care at its largest hospital highlight the ongoing challenges of addressing the high cost of healthcare, particularly in states with small and aging populations that rely heavily on state-sponsored insurance programs.