Health regulators engage public

Tuesday April 9, 2013


Staff Writer

BENNINGTON -- The group that regulates hospital budgets, rates, and rates for insurance companies in Vermont held one of its regular meetings in Bennington on Monday, during which it conducted normal business and heard from local health care leaders on their success and challenges.

The Green Mountain Care Board was created by Act 48 and tasked with controlling the cost of health care in the state, said board chairwoman Anya Rader Wallack in an interview with the Banner. Wallack said the GMCB does this by having final approval of hospital budgets, large hospital capital expenses, and insurance provider rates. This year the board has announced it will hold Vermont's hospitals to a 3 percent increase in net patient revenue.

The board is also pushing efforts on payment reform, moving the health care system away from a fee-for-service model and toward a model that would encourage healthier populations and less redundancy. Wallack said a number of pilot programs are being implemented in the state experimenting with how health care providers will be reimbursed through Medicaid. One such model would take a particular health issue prone to redundancy and lack of communication such as heart problems or hip replacements, and have groups of health care providers who treat those illnesses form a collaborative group.

GMCB member Dr. Allan Ramsay, who also spoke with the Banner Monday, said such a collaborative would meet to discuss how to spend a bundled payment from Centers for Medicare and Medicaid. The collaborative would talk about communication issues, common problems they see with their patient groups, and find out how much would be spent per patient, with a goal to eliminate waste in the system and give people better care.

Wallack said such payment methods would come with high standards of care, so the incentive would be to do good work for less cost. Some models involve letting the medical provider keep a portion of the money saved if their patient outcomes are good enough. The current fee-for-service model rewards doctors for doing more procedures and seeing more patients.

What the GMCB is not doing is developing the health benefit exchange, which will require some 80,000 Vermonters to purchase health care through it in 2014. The Vermont Health Exchange is being developed because of requirements of the federal Affordable Care Act. Vermont had the option of building its own exchange and took it, and is the only state making it mandatory. Insurance companies have to apply to be sold through the exchange which imposes some requirements on what is covered and caps out-of-pocket costs.

Wallack said the GMCB does oversee the rates being offered through the exchange, however.

Another element of health care reform that it topical is a single-payer system. Wallack said the GMCB is not developing a single-payer system, which is under the Executive Branch's purview.

Wallack said there are many prongs to health care reform and even if not all move ahead many of the initiatives can save money on their own, however there are limits to what Vermont can do as a state.

At the meeting, Dr. Gregory King, of Mount Anthony Primary Care, spoke about how the practice he works for has worked with the Vermont Blueprint for Health, an effort to improve patient care and lower costs. Aiding him in his presentation was Dana Noble, Blueprint project manager for the Vermont Blueprint for Health in Bennington. King said the Blueprint strategy has cut down significantly on patient readmission's, however it faces some challenges such as having patients stick with the programs developed for them.

Also speaking was Thomas Dee, president and CEO of Southwestern Vermont Health Care who said the hospital is developing more of its outpatient services and actively seeking to get away from the fee-for-service model all while planning carefully about how to move forward with its renovation goals.

The GMCB typically meets Thursdays in Montpelier. Wallack said the board is trying to meet around the state more so the public can have a greater level of involvement.

Contact Keith Whitcomb Jr. at or follow him on Twitter @KWhitcombjr


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