Larger burden requires more scrutiny

Thursday May 2, 2013

Allan Ramsay MD

Vermont's Legislature created the Green Mountain Care Board to control health care cost growth while improving Vermont's health care system. To achieve these aims, we set policy, review and approve hospital budgets, and approve health insurance rates.

Public participation plays an important role in our decisions. For example, to increase Vermonters' access to -- and voice in -- one critical aspect of our work, our hearings on health insurers' rate requests are open to the public. Prior to our involvement in the health insurance rate review process, there were no such publicly accessible hearings. Further, we recently proposed and are supporting legislative changes to the rate review process that will make more information available to the public through our website while each rate filing is under review. We have also begun having board meetings in other areas of the state. Our first meeting away from Montpelier was held in Bennington on April 8.

Insurance rate increases are often where health care costs most directly affect Vermonters. At a recent forum, Vermont employers described the crushing impact of large premium increases on their businesses and their employees. A 2011 analysis in the journal Health Affairs found that, while Americans' paychecks steadily increased from 1999 to 2009, a worker whose paycheck should have provided an additional $650 per month instead had only $95 to spend. The rest went to health care.

Vermont law requires that insurers submit requests for rate increases to the Department of Financial Regulation. The Department evaluates the request and submits a recommendation to the GMCB. Within 30 days, the GMCB must approve, modify, or disapprove the requested rate increase.

By participating in our review process, Vermonters can help usachieve our goals regarding insurance rates:

Make the process understandable, transparent and accountable. We encourage public participation in the rate review process by explaining it on our website and in our publications and by welcoming Vermonters at our public meetings.

Apply pressure on costs. Because health care utilization (demand for a specific procedure or service) and cost are notoriously unpredictable, we rely on certain principles in navigating rate review. Chief among these is that the quality of care can never be compromised. The next principle is affordability. Federal law requires that any rate increase of 10 percent or more must be reviewed to determine if it is "reasonable." In Vermont, the GMCB reviews all rate increases for commercial health insurance plans.

Reduce administrative expenses. While federal law allows insurers to spend up to 20 percent of premium dollars on administration, we in Vermont look for even lower administrative overhead. After more than 30 years as a family physician in Vermont, I am especially vigilant about eliminating wasteful administrative demands on health care professionals. A 2009 study in Health Affairs found that the average U.S. physician spends 43 minutes a day interacting with insurance companies, instead of treating patients. We seek to eliminate administrative burdens that increase the cost of health care but do not improve either quality or access.

Make sure government pays its fair share. Medicare and Medicaid don't pay their share of health care bills. This creates a "cost shift," where providers negotiate higher fees from insurers to make up for the lower government payments. We must fix this disparity. Invest in primary care. Studies confirm that investment in primary care improves quality and reduces the cost of health care over time. In Vermont, we applaud insurers for investing in the Blueprint for Health to establish patient-centered medical homes as a delivery model for providing primary care throughout the state.

A transparent health insurance rate review process is a necessary step in the march toward an affordable, high- quality health care system for all Vermonters. Just as we are holding hospitals and health care professionals accountable for improved health outcomes, the GMCB insists that insurers are also accountable.

We ask that you help us ensure that any health insurance rate increases are reasonable and justified. You can get involved by talking directly to your insurer to find out when and why they intend to file rate increases. Soon, we hope you can also participate inour public rate review meetings. For more on our full schedule of open meetings and to learn more about rate review, visit our website:

Allan Ramsay MD is a member of the Vermont Green Mountain Care Board.


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