Small, mighty Vermont a national leader in health care reform

Tuesday April 9, 2013

It's an exciting time for health care reform in the state of Vermont.

"For the first time, we are having a statewide conversation," said Anya Rader Wallack, chairwoman of the Green Mountain Care Board.

"We're testing different models ... which can create a fair amount of anxiety and uncertainty."

Wallack and Dr. Allan Ramsay, a longtime family practitioner in the Burlington area and member of the GMCB, visited the Banner just before the board held a public meeting at the Bennington Fire Department Monday.

The GMCB was created in 2011 as part of the enactment of Act 48, which calls for a universal and unified health care system in Vermont. The board regulates hospital budgets and rates for insurance companies.

Vermont is known for being progressive when it comes to health care reform. Vermont was the first state to pass non-group rate health care reform and is one of the most progressive states when it comes to health care reform -- namely for using Medicaid to enroll as many people as possible, according to Wallack. The state has the lowest rate of uninsurance of children in the nation because of its use of Medicaid.

"Vermont has taken it beyond what he national Medicaid requirements are," Wallack said.

That progressivism is now being applied to various sort of experimental reforms that include a pilot program in Rutland for congestive heart failure that uses a new model for how health care providers are reimbursed through Medicaid. According to Ramsay, current models show Medicaid making payments to eight different "zones" of care, including emergency room, hospital care, rehabilitation and home health care.

"Instead of each of them getting paid separately, they get one lump sum," Wallack said.

The Rutland pilot program explores a bundled payment for the entire continuum of care for the heart failure. The group of zones, or providers, have to decide how to best divvy up that payment while keeping an eye on quality.

"We'll pay you more to take better care of your patients," she said.

Also under consideration is a plan for enhanced payment options to providers, which would emphasize value of care over quantity of patients seen, Ramsay said.. A physician would be awarded enhanced payments for treatment of a diabetes diagnosis, for instance, rather than the fee-for-service model currently employed.

With such types of payment innovation, the cost of health care is more sustainable in the long-term, Wallack noted.

"We're doing thing sin Vermont differently," Wallack said. "We're encouraging efficiency in the system."

Within the next three or so years, GMCB hopes to determine which of the "experiments" are the best for Vermonters. Patients, when all is said and done, should notice better coordination amongst different health care providers.

Vermont will see a health care system that is very different from the rest of the country. Our state's smaller size than most U.S. state has something to do with our flexibility, but also noteworthy is Vermont's willingness to explore several options to see what works best has been unmatched in other parts of the country. Some states are looking at different facets of change: Ohio has had some success when it comes to universal health records management; New York is studying health planning; and Massachusetts is looking at different options.

Vermont is an innovator.

"Nobody is doing this on a statewide basis," Wallack said. "There's nobody that's going whole hog like us."

We applaud the forward-thinking organizations such as the Green Mountain Care Board that are making Vermont a frontrunner in health care reform. The work they are doing now will help the way we use health care in the future.

~Michelle Karas


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