Reimagining Rural Health Care in Vermont with Anna Tempesta Noonan

Summary

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Episode Summary: "Reimagining Rural Health Care in Vermont with Anna Tempesta Noonan"

Becker’s Healthcare Podcast | February 17, 2026
Guest: Anna Tempesta Noonan, President, Central Vermont Medical Center
Host: Scott Becker

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Overview

In this episode, Scott Becker speaks with Anna Tempesta Noonan, President of Central Vermont Medical Center (CVMC), about the evolving landscape of rural healthcare in Vermont. The conversation explores key challenges such as aging populations, staffing shortages, high healthcare costs, and the need for innovation and collaboration. Anna also discusses opportunities brought by federal funding, regionalization of care, and advice for emerging healthcare leaders.

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Guest Introduction and Background

[01:15 – 02:48]

• Anna Tempesta Noonan is a nurse by background, celebrating 45 years in healthcare and 30 years in executive leadership roles.
• She has been CVMC’s president for nine years.
• CVMC is the largest community hospital within the University of Vermont Health Network, serving a largely rural area with a catchment of 68,000 and about 1,500 employees.
• The University of Vermont Health Network includes:
  • 1,465 beds across the system (including a 562-bed academic medical center and five community hospitals)
  • 16,000 employees and 141 outpatient sites.

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Rural Health Care Challenges and Trends

Unique Rural Considerations

[03:46 – 06:46]

• Vermont is “one of the healthiest states in the country” with low unemployment and low uninsured rates.
• “Affordability of healthcare in Vermont is a critical issue… Vermonters are noted as paying some of the highest prices nationwide for individual health coverage.”
• End of ACA enhanced tax credits has tripled premiums for some residents.
• High drug cost inflation, especially with specialty meds like GLP-1s.
• Aging Population:
  • “Roughly a quarter of Vermonters are in the 65 plus range, and Central Vermont...the only demographic that's really increasing in numbers is over 65.”
• Staffing Challenges:
  • Recruitment of providers is somewhat aided by the academic network.
  • Other roles (e.g., nurses, respiratory therapists) are harder to fill, prompting the development of local talent pipeline programs for career progression from LPN to RN and beyond.
• Hospital Sustainability:
  • 2023: 9 of 14 hospitals had negative margins;
  • 2025: 5 of 14 remain in the red.
  • Heavily regulated health system, requiring strong partnerships with the state.

Notable Quote

“The only demographic that's really increasing in numbers is over 65. So our population is aged. And that has impacts also on staffing.”
— Anna Tempesta Noonan [05:01]

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Impact of Aging Population on Rural Healthcare

[07:28 – 09:04]

• Increased need for intensive, complex care as population ages.
• Young people leaving Vermont reduces local workforce available to support elder care.
• Support structures are declining:
  • “Many of our patients that are aged, their support systems don't live in our state. They live in other states and they live in urban areas.” [08:13]
• Other major challenges: housing for elders, daycare for staff, and mobility/transportation for patients.

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Regionalization and Labor & Delivery Services

[09:43 – 11:03]

• Declining number of births is causing rural hospitals to close labor and delivery (L&D) suites; CVMC absorbing patients from recently closed nearby L&D sites.
• Regionalization is seen as both a challenge and “an opportunity…more regionalization of services so that we're staying relevant and appropriate around just pure volume.”
• Low patient volumes impact the ability to maintain quality care in specialized departments.

Notable Quote

“It's hard to keep the quality up when you have lower volumes of patients coming through a particular service. And that's certainly true for us in Vermont with the birthing centers.”
— Anna Tempesta Noonan [10:13]

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Positive Developments: Federal Funding and Innovation

[11:11 – 12:45]

• Vermont awarded a $195 million Rural Health Care Transformation Grant from CMS, to be distributed over five years.
• Key priorities for the funds:
  • Enhancing partnerships and collaborations statewide.
  • Reengineering care delivery for a shrinking and aging population.
  • Leveraging technology: AI, electronic health records.
  • Much-needed infrastructure updates, given reliance on aging Hill-Burton Act-era facilities.
• Vermont’s small population (“approximately 647,000 individuals”) enhances collaboration across organizations.

Notable Quote

“We have an opportunity to really collaborate differently and think about some innovative opportunities to deliver high quality care to the communities we serve.”
— Anna Tempesta Noonan [12:34]

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Leadership Advice for Emerging Leaders

[12:54 – 14:14]

• Prioritize building professional networks locally, regionally, and nationally.
• Leverage knowledge and best practices from diverse sources.
• Adapt and adopt strategies that accelerate performance in your own organization.
• Exhibit self-care and “wellness behaviors” as role models to maintain sustainability for future leaders.

Notable Quote

“Make space to take care of yourself. Health care is more challenging now than it's ever been...So being a role model to our teams and exhibiting wellness behaviors for the next generation of leaders I think is going to be critical for long term sustainability.”
— Anna Tempesta Noonan [13:50]

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Closing Reflections: The Nature of Caring in Rural Vermont

[14:22 – 15:25]

• Vermont’s small, tight-knit communities shape the care environment:
  • “You are literally taking care of your neighbors, your friends, your family in all the roles we serve in. So I think it brings the caring concept close to home and makes everything we do even more important.” [14:35]
• Anna expresses gratitude and pride in the culture and mission of CVMC.

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Key Timestamps

• 01:15 – Anna’s career and CVMC profile
• 03:46 – Rural health challenges and Vermont context
• 05:01 – Impacts of the aging population
• 07:28 – Staffing and support system challenges
• 09:43 – Labor & delivery: regionalization and declining birth rates
• 11:11 – CMS grant and innovation priorities
• 12:54 – Advice for future healthcare leaders
• 14:22 – Reflections on the rural spirit of care

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Memorable Quotes

• “Affordability of health care in Vermont is a critical issue...Vermonters are noted as paying some of the highest prices nationwide for individual health coverage.” — Anna Tempesta Noonan [04:09]
• “The only demographic that's really increasing in numbers is over 65.” — Anna Tempesta Noonan [05:01]
• “We have an opportunity to really collaborate differently and think about some innovative opportunities to deliver high quality care.” — Anna Tempesta Noonan [12:34]
• “Make space to take care of yourself. Health care is more challenging now than it's ever been.” — Anna Tempesta Noonan [13:50]
• “You are literally taking care of your neighbors, your friends, your family in all the roles we serve in.” — Anna Tempesta Noonan [14:35]

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Summary

Anna Tempesta Noonan offers a candid look into the realities and hopes of rural health care leadership in Vermont. She highlights persistent challenges—ranging from eldercare and workforce shortages to hospital sustainability and infrastructure needs—while also expressing optimism about collaboration, innovation, and the impact of transformative funding. Anna closes with advice for those rising in the field and a reminder of the deep connections that define rural community healthcare.

Transcript

[A]

Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit Beckershospitalview.com and click on the Events tab in the upper right.

[B]

This is Scott Becker with the Becker's Health Care Podcast. We're thrilled today to be joined by a fantastic leader. We're joined today by Anna Tempesta Noonan and Anna serves as the president of the University of Vermont Central Vermont Medical Center. Anna, you're in a beautiful part of the country. Take a moment and tell us a little bit about your career, your background and then we'll get a chance to visit about trends you're watching, what you're most focused on, advice for leaders and a little bit more. Anna, can you take a moment and introduce yourself and tell us about the Central Vermont Medical Center?

[C]

Thanks Scott. I'm happy to introduce myself. So yes, Anna Tempesta Noonan. I'm a nurse by background. This is my my 45th year in healthcare and I've held a variety of executive, administrative and quality leadership roles for the past 30 years and have had the privilege of serving as the president for Central Vermont Medical center for nine years. Central Vermont Medical center is part of the University of Vermont Health, which is a rural integrated academic health system in Central Vermont through the northern part of Vermont and northern New York State. The vision for our health system is reimagining rural health, leading with innovation and transforming lives. There's 1,465 beds in total across our system. We're anchored by a 562 bed academic medical center and five community hospitals. CVMC is the largest community hospital in that system. We have a total of about 16,000 employees, 141 outpatient sites. Bringing it down to Central Vermont Medical Center. We have 271 licensed beds, 122 of those are acute care beds and 153 are long term care and rehab beds. And our catchment area here in Central Vermont is about 68,000 and we have about 1500 employees. So again, very rural part of the country, beautiful state as you said Scott, but very rural in nature.

[B]

So I'm going to ask you a non serious question first and then I'll move to serious discussions. About rural health and state of rural health. The first non serious question, which may be a serious question for a New Englander, is, do you cheer for Patriots? The Patriots in the Super Bowl? And, and second is, was it unfair that Bill Belichick didn't make the hall of Fame on the first ballot?

[C]

Yes and yes. There you go.

[B]

God bless you. Thank you so much. So talk to us about, talk to us about rural health today. And, and what does it look like? What do you see up there? You know, years ago, I talked to somebody at Dartmouth about, you know, access, and we talked about Uber and they said, you know, when you get to rural areas, Scott, there is no Uber. You know, there's not those easy things for access. Talk about rural health care, staffing, physicians, challenges, and maybe what's working, what's exciting and what's positive.

[C]

Okay, so one of the trends we're seeing in rural health, in addition to some of the system properties like you mentioned, unlike urban areas, there is no Uber for, by and large for Vermont in general, absent Chittenden county, which is where our academic medical center is anchored. So a lot of those things that individuals are used to having for support systems simply don't exist in rural areas. Rural states like Vermont, we rank as one of the healthiest states in the country, with low unemployment and low uninsured rates. But affordability of health care in Vermont is a critical issue. So Vermonters are noted as paying some of the highest prices nationwide for individual health coverage. And with estimates of health care premiums tripling for some due to the expiration of the ACA enhanced tax credits, that's a huge impact for Vermonters. Drug cost inflation has been impactful, particularly with increased use of specialty meds like GLP1s. There's rising utilization in our state and rising acuity. We are an aged state, so roughly a quarter of vermonters are in the 65 plus range. And Central Vermont in particular, the only demographic that's really increasing in numbers is over 65. So our population is aged. Its role, as I've already mentioned, and that has impacts also on staffing. So your question of what are some of the challenges? Staffing is a challenge for us, no question. Provider recruitment obviously helped by the fact that we're part of an academic health network that does help us a great deal. But as far as other staff roles, nurses, respiratory therapists, rad techs, et cetera, we launched a number of pretty innovative pipeline programs before the pandemic to grow our talent locally. People that were not able to go on to college. We've put through programs here at Central Vermont Medical center where we support them in completing their academics and becoming, you know, a member of our team at an LPN level to an rn, back associate, then baccalaureate, et cetera. So those pipeline programs have been really important for us. The other challenge we have in rural Vermont is hospital sustainability. So in 2023, nine out of our 14 hospitals, we only have 14 hospitals in our state, most of which are critical access hospitals. Nine out of 14 had negative margins, and in 2025, five out of 14 had negative margins. So really challenging. We also have a pretty heavily regulated health system here in the state, and we have good partnership with our regulators. But again, I think all of those dynamics make it challenging for us here in rural Vermont.

[B]

No 100%. And talk for a second, Anna, when you look at this year, 2026, so many different challenges going on, so many positives. What are you most focused and excited about? And then I want to talk to you in a moment about some of the stats you just gave us on the aging of Vermont, the aging of the population. And let me ask, let me tackle that question first. Quite frankly, as a population ages like that, what does that mean for the long run? And is that one of the plights that we're seeing in rural America is the aging of the population as more and more people move to the top 30 metro areas? What does that look like and feel like for the vibrance of a community?

[C]

So I think it's hugely challenging for our community. But communities across Vermont and probably rural states around the country, so with that aging demographic, obviously those individuals are more likely to require more intensive health care interventions as they age. Not uncommonly. That's a factor. The other piece on the other side is not having youth in our state to support the care provisions that our aged population will need. So again, the need for us to really establish some pipeline programs to help people stay in Vermont with jobs that are able for them to progress in their career track has been critical. But I think the aging demographic is incredibly challenging. And then you add that to what you talked about earlier in our conversation, which is transportation issues, mobility issues, supports many of our patients that are aged, their support systems don't live in our state. They live in other states and they live in urban areas. So the support systems that traditionally existed maybe 20, 30 years ago are not here for those individuals that are more senior. So again, another challenge for us also, housing is a challenge as well as elder care. And then the opposite for our staff are Daycare challenges. Just finding those kind of resources in a rural state is also difficult.

[B]

Thank you. And take a moment on sort of labor and delivery. We hear about so many rural places shutting labor and delivery and sort of the general press will sometimes blame profit thoughts or margin thoughts on that, but we generally know it's because it's really hard to staff. Talk a bit about what you see throughout the region in terms of labor and delivery. And obviously if you don't have labor delivery, it's somewhat the delta of a community because it just makes it harder and harder for people to come back to plant families in those areas and grow. But talk about what you're seeing with labor and delivery and maybe what can be done about it too.

[C]

Yeah. So for us, I think the answer is regionalization of our labor and delivery suites, which is happening simply because our numbers of birthing individuals has decreased with the aging demographic. So we have seen at least one center proximal to us, a critical access hospital, who closed their labor and delivery suite, and we are taking those patients into our labor and delivery suite. I think one of the challenges, and again also opportunities, is more regionalization of services so that we're staying relevant and appropriate around just pure volume. It's hard to keep the quality up when you have lower volumes of patients coming through a particular service. And that's certainly true for us in Vermont with the birthing centers. We have our academic center, which is part of our network, obviously takes more of the higher acute high risk pregnancies and has been for some time. And we in the last year have taken on, since November of last year actually taken on more births from a critical access hospital that based on volume alone, had to close their service.

[B]

Thank you and take a second. Don, let me get back to the question I was asking earlier. What are you most focused on and excited about this year?

[C]

So what's really exciting to us and hopefully to others in the country, this is a positive, I think, is that Vermont received $195 million in the Rural Health Care Transformation Grant from CMS for the next five years. And I'm really excited about that infusion of dollars coming into Vermont. I think it's going to go a long way in supporting the continued partnerships and collaborations we have within our state. Tremendous opportunity to potentially reimagine care deliver. Just thinking about how do we do this differently with fewer people in our state and likely down the road, fewer health systems to support that care, the opportunity to leverage AI, our electronic health record, and we frankly need some significant investments in our hospital infrastructure across our state. Many of our organizations receive dollars back with the Hill Burton act era. So our infrastructure is in need of renov not just here at cvmc but across the state. And so I think that infusion of those dollars and the opportunity in the state of Vermont, which I think is a very highly collaborative state because we're so small, total population is approximately 647,000 individuals. I mean that's pretty rural and small. And so we have an opportunity to really collaborate differently and think about some innovative opportunities to deliver high quality care to the communities we serve. So I'm excited about that opportun.

[B]

Thank you. And Anna, you've had this remarkable leadership career. Take a moment on what advice you would give to emerging leaders.

[C]

So for an emerging or evolving leader, I would say to really think about developing professional networks both locally, regionally and nationally. I think Beckers is a great opportunity to engage with your national meetings and your topical conferences that you have. That exploration and leveraging of the collective that one gets from networking, understanding what the best practices are, what the wins have been for those that are around you, and either adapting or adopting those strategies that make sense within your own organization or sphere of influence and using that kind of strategy to really accelerate performance within your own organization and teams is something that I would strongly encourage younger leaders or evolving leaders to engage in. And then the other thing is this may be the nurse in me is to make space to take care of yourself. Health care is more challenging now than it's ever been. Like I said, I've been doing this for 45 years. It's more challenging now than ever for all the reasons we know. So being a role model to our teams and exhibiting wellness behaviors for the next generation of leaders I think is going to be critical for long term sustainability.

[B]

No, I think that's fantastic. Anything else you'd like to share with our listeners today? Even about the beauty of central Vermont, because that's a beautiful part of the country.

[C]

Thank you. It is a beautiful part. Even when it's 2 degrees outside, it's still gorgeous. So yes, we're very fortunate to have a very high quality of standard of care here in Vermont. The ruralness really allows us to think about healthcare delivery. We are taking care of our neighbors and in every community in our state, it's a small state and so you are literally taking care of your neighbors, your friends, your family in all the roles we serve in. So I think it brings the caring concept close to home and makes everything we do even more important. And it's all about the patients, the families that support those patients, and the team members that provide the care. So really feel fortunate in my tenure to have worked here at Central Vermont Medical Center. We have an incredibly caring culture and very honored to have been able to serve in the role for sure.

[B]

Fantastic. Anna, what a pleasure to visit with you again. Anna Tempesta Noonan, magnificent leader of Central Vermont Medical Center. Thank you for taking the time with us today on the Becker's Healthcare podcast. What a pleasure and what great work you do. Thank you so much for joining us.

[C]

Thank you. Scott.