The Shumlin administration and the Green Mountain Care Board introduced road maps Thursday for how they plan to implement health care reform.
The board’s annual report and the administration’s Strategic Plan for Vermont Health Reform shed light on the specifics of how the state will maneuver to a health benefits exchange in 2014 and into a single-payer system in 2017.
Download the GMCB Annual Report
Last week the board approved its work plan, identifying high priorities for 2012. Anya Rader Wallack, chair of the Green Mountain Care Board, fielded questions from legislators Thursday that have become somewhat of the norm: How will the board maintain its independence from the Shumlin administration and how is a reformed system going to control costs?
Sen. Kevin Mullin, R-Rutland, pushed both Wallack and Director of Health Care Reform Robin Lunge on the issue of containing costs through tort reform. A report by Harvard economics professor Dr. William Hsiao last February recommended moving to a no-fault medical malpractice system similar to New Zealand. Act 48, last year’s health care reform law, requires a report to the legislature on the costs of reform. It was due this week, but the administration requested an extension until Jan. 30.
Mullin, who is vice chair of the Senate Committee on Health and Welfare, told Wallack that he thinks analysis is the most important issue for the board as it designs what will be a new health care system for the state.
“We should be looking at the best results from all different health care systems in world,” Mullin said. “We need to see if they work.”
Mullin said the board’s analysis should address what impacts other systems have on factors like patient safety and quality of care then make a decision based on all available information.
“What I’m afraid we’re going to hear is it’s a political compromise rather than a reasoned analysis,” Mullin said.
Wallack, who has been working on health care reform efforts since the 1990s, assured Mullin that the board is working to make sure it does the necessary research.
“In terms of having analytic capability moving forward, that’s absolutely what we’re moving toward,” Wallack said.
Currently, the board has 13 staff members, and it is in the process of hiring three more full-time.
The board’s work plan includes a plethora of tasks for analyzing data for evaluating quality and performance in the health care system, implementing pilot payment programs, and dealing with a host of issues involving insurance rate review and hospital budget oversight. The board has also submitted a grant application to the Robert Wood Johnson foundation for a payment reform project. Vermont was one of 15 sites invited to submit a proposal for the $500,000 grant out of 120 applicants.
The annual report also outlines the board’s estimated expenditures, which total around $2.1 million for 2012 and nearly $2.5 million for 2013.
Legislators also pressed Wallack on the recently-withdrawn request for proposal for a communications consultant. The issue became a political hot potato when Gov. Peter Shumlin expressed dismay that the the board was trying to hire what appeared to be a public relations firm.
Rep. Patti Komline, R-Dorset, asked Wallack why the board decided to back off so quickly amid criticism.
Wallack emphasized that the decision to withdraw the RFP was not in response to the governor and that the board will likely go back to the drawing board and make more clear what it is looking for.
“It’s not about PR,” Wallack said. “It’s about communicating with the public and engaging the public.”
With somewhat of an overlap between the administration’s mandate to implement a health benefits exchange dovetailing with the Green Mountain Care Board’s mandate to lay the groundwork for a universal health care system, Rep. Chris Pearson, P-Burlington, said he was concerned people are becoming confused and losing sight of the ultimate goal of single payer.
“We’ve really got to keep our eye on the prize,” Pearson said.
The focus on a health benefits exchange, which is a federal mandate, has become a point of frustration, he said.
“People are deeply interested in seeing a real health care system that is effective, and there’s a lot of anxiety about that,” Pearson said. “It’s all geared to this goal, but we can’t talk about it in a way the public understands if we’re not talking about the goal. Nobody is mentioning Green Mountain Care.”
The exchange is a step toward single payer, however, and transforming health care involves lots of moving parts.
“Just focusing on single payer and saying that’s going to be the silver bullet would be very naïve,” Wallack said.
Rep. George Till, D-Jericho, commended Wallack and the rest of the Green Mountain Care Board for their efforts.
“I’m impressed with the work they’re doing,” Till said.
He echoed Wallack’s point that health care reform involves more than the single payer concept where one government-run organization accepts all the health care fees and pays out all the health care costs.
“It’s really about the clinical and payment reforms that will control the health care costs which is the real aim in addition to providing health care to everybody,” Till said.
Despite his commendation, Till said he thought the board missed a tremendous opportunity to establish its independence from the governor when it decided to withdraw the request for proposal for a communications specialist.
He emphasized, also, the importance of moving to a no-fault medical malpractice system where patients who are injured would receive government-funded compensation rather than suing physicians for negligence. This type of system, which the Hsiao report recommended, reduces defensive medicine, which can really contain costs, according to the report.
