Green Mountain Care Board begins health care reform effort in earnest

The five members of the recently appointed Green Mountain Care Board have their work cut out for them. Anya Rader Wallack, the board’s chair, reeled off a daunting to-do list for each of the new members at the board’s first official meeting on Tuesday.

Dr. Allan Ramsay, a primary care physician at Fletcher Allen Health Care, will take the lead on payment reform, workforce development and outreach. Dr. Karen Hein, a pediatrician from Jacksonville, will focus on developing a benefits package and concept framework. Con Hogan, former secretary of the Vermont Agency of Human Services, will address hospital budget rules, data and evaluation. Al Gobeille, who owns several restaurants in Chittenden County, will look at benefit design programs and examine innovative prevention programs currently being implemented by the business community in Vermont and elsewhere.

Wallack said she wanted to focus on fulfilling the principles behind Act 48, the legislation that created the board, and to “engage everybody and craft something that makes sense.”

The Green Mountain Care Board is the product of Act 48, which the Vermont Legislature passed in May. The legislation is designed to set the stage for a universal medical system, which would expand on the state’s existing public health care programs under Green Mountain Care. The act puts Vermont on track to become the first state in the nation to implement a form of “single-payer” health care in which one entity, answerable to the government, collects all health care fees and pays out all health care costs. Green Mountain Care is to “provide, as a public good, comprehensive, affordable, high-quality, publicly financed health care coverage for all Vermont residents in a seamless manner regardless of income, assets, health status, or availability of other health coverage.”

Proponents of the plan say the plan will result in administrative savings and universal coverage. Detractors believe the single payer approach will bankrupt the state and drive businesses out of state.

The members of the Green Mountain Care board were selected by a nominating committee. The final candidates were hand-picked by Gov. Peter Shumlin. Under the act, the board’s primary duties include oversight and implementation of a health care payment plan as well as implementing regulations for payment reform and containing costs. The board will also create rules defining and outlining a benefits package.

The Legislature handed the board a monumental task, and a tentative timeline on the Joint Fiscal Office Web site lists January 2014 as the earliest possible time the Green Mountain Care Program could go into effect. The board begins its work in earnest this month, as it begins to collect data and other information. More deliberative sessions will begin in November, Wallack said.

Ramsay, who will focus on payment reform, said the first step is to “get everybody on board with what we define as value in the health care system.”

He explained that he sees value as an equation of the quality of care provided and patient satisfaction over the costs. The bottom line, Ramsay said, is getting away from disease management and toward an emphasis on overall health.

“If we can shift the paradigm to maintaining better health, that’s the governor’s major goal,” Ramsay said. “That’s what Vermonters want.”

Wallack also said medicine should shift its focus toward preventive care. The current fee-for-service payment model rewards medical providers for conducting more procedures and tests. She wants to develop a payment methodology that rewards providers for being more efficient and offering better service. In order for this to work, Wallack said the board will have to integrate prevention services with the benefits package and overarching targets for controlling the rate of growth in medical spending.

“I want to see a healthcare system that provides access to quality care for everybody and costs are sustainable because we make the right kind of changes in health care delivery and cost containment,” Wallack said.

She said, as a Green Mountain Care program goes into effect, people will first see changes in insurance rates and hospital budgets. Many of the effects, however, will be invisible to the average consumer other than the fact that they will hopefully be gaining more access to health care.

For now, the Green Mountain Care Board’s future is somewhat vague, and it may take six to eight months to file rules. Appeals of board decisions would go straight to the Vermont Supreme Court, said Special Assistant Attorney General Clifford Peterson, who is acting as the board’s legal counsel.

The board will hold meetings Oct. 11 and 12 from 10 a.m. to noon and 1 p.m. to 3 p.m. respectively. These early meetings will focus on data and the hospital budget process. The board should have a website by the end of October; in the meantime,meeting dates will be posted on the Vermont Secretary of Administration website.

Alan Panebaker

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