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Board OKs Vt. All-Payer Health Care



Associated Press
Thursday, October 27, 2016

Montpelier — Vermont health care regulators approved a plan on Wednesday that would change the way much of health care is paid for in the state to promote services that keep people healthy as a way to avoid the costs of treating them after they get sick.

The Green Mountain Care Board’s approval sets the state on a yearslong path in the hopes of both reducing costs and keeping Vermont residents in better health.

Many details have yet to be worked out, such as setting up the accountable care organizations that will oversee care, contracts with both public and private insurance providers that would be paid under the new system, and work with the hospitals and care organizations to determine how much they would be paid, board Chairman Al Gobeille said.

“I feel like I just signed up to paint a really large house,” Gobeille said. “I mean, it’s going to be a lot of work, but I think it’s the right thing to do, that the work will be worth it, but it’s a big, big implementation process.”

Democratic Gov. Peter Shumlin plans to sign the plan today at the Statehouse.

Vermont and federal officials last month announced that payments could go to providers to keep patients healthy, including Medicare and Medicaid recipients and residents with private insurance. The board held hearings over the last several weeks on the plan leading up to Wednesday’s vote.

Once the new system is implemented, health care providers would be given a set amount of money for each person they care for. If the person needs little care, the provider would be able to keep the money not spent; if the person needs more care, the provider would have to perform the service without receiving additional money.

Robin Lunge, the governor’s director of health care reform, said after the board meeting that in the second year of the agreement, the new system would reach 36 percent of care services in the state. By the sixth year, she said, the system is supposed to reach 70 percent.

“It’s not a light switch,” she added.

Trish Riley, executive director of the National Academy for State Health Policy, said Vermont leads many states in experimenting with ways to reduce health care costs and improve care.

“I think it is fair to say Vermont is leading the nation,” Riley said.

House Republican Leader Don Turner, R-Milton, issued a statement decrying the Green Mountain Care Board vote, saying he had asked Gobeille to provide a letter assuring the all-payer model would comply with various benchmarks.

“Given the gross mismanagement of health care reform projects over the past six years by the Shumlin Administration, and the numerous unanswered questions regarding the risks and outcomes of the all-payer model, I would have liked to see the head of the independent GMCB offer a measure of certainty to Vermonters, at the very least,” Turner said. “I find the haste with which the Shumlin Administration has sought to enact (the all-payer model), coupled with the glaring lack of civic participation and media coverage leading to the GMCB vote today, deeply regrettable.”

The federal Centers for Medicare and Medicaid Services said the Vermont plan builds on one in Maryland by expanding the arrangement beyond hospitals. It’s hoped the Vermont plan “will provide valuable insight for other state-driven all-payer payment and care delivery transformation efforts,” the agency said in a news release.

Riley said that in other locations that don’t include Medicare, Medicaid and commercial payers in the system it’s harder on health care providers that have to deal with multiple payment systems.

“It really tips the system on its head and says we’re going to work together, hold providers accountable in global budgets for improving population health,” Riley said of the Vermont system.