In the world of state health reform, Vermont often plays the Jan to Massachusetts' Marcia. However, preliminary evaluations suggest that other states and policymakers would do well not to ignore New England's favorite middle child. My colleague previously wrote about Vermont's most recent legislative action on health reform passed in May of 2006. Now, a study published by the Robert Wood Johnson Foundation this week updates us on Vermont's achievements. Here are some of the successes from the Year 1 Interim Report:

• Universal health care legislation met its goal of significantly increasing the number of insured Vermonters. Between 2005 and 2008, the percentage of insured Vermonters between the ages of 0 and 64 increased by 2.4 percent -- from 88.8 percent to 91.2 percent. Insurance coverage expanded faster in Vermont than in any other New England state during this period.
• Vermont's health reform legislation created the Catamount Health Insurance Program, providing subsidized coverage to Vermont's uninsured with incomes below 300 percent of the federal poverty level. As of April 2009, Vermont was just shy of reaching the enrollment goal of 8,800 people.
• Participation in public health plans increased significantly once health reform was enacted; many of the new enrollees were previously eligible for coverage but may not have known. The increase is attributed to successful outreach campaigns. There was a 5.5 percent enrollment increase in traditional Medicaid and a 21.0 percent enrollment increase in Vermont's Health Access Program for childless adults.

Vermont's early accomplishments provide a few lessons for other states to consider as their own health reform efforts come to fruition:

• Stakeholder collaboration -- get all the key players (government, providers, insurers, business and consumers) on the same page.
• Federal assistance may be necessary for sustainability -- Vermont will not be able to continue its current programs -- unless new sources of revenue are located -- without the continued support of the federal government.
• Keep it simple -- lawmakers need to continue to address basic barriers and challenges to program enrollment.
• Health system-level improvements are necessary -- lawmakers need to address underlying  inefficiencies in order to make system-wide improvements in prevention, disease management, costs, and quality of care.

As Vermont demonstrates, health care reform is an ongoing process. It takes continued analysis and adjustments to make lasting improvements and changes to the health care system.