Tom Torti: A rational approach to health care reform

Editor’s note: This commentary is by Tom Torti, who is the president of the Lake Champlain Regional Chamber of Commerce.

[T]he Lake Champlain Regional Chamber of Commerce broadly supports Vermont’s attempt to reform our health care system. This support was driven by three realities. The cost for commercial insurance was escalating at rates unsustainable for any business. Access to high quality care remained elusive to those uninsured or underinsured. The current fee for service system that rewarded volume was an anachronism and needed to be reformed in order to properly align incentives for the delivery of high quality care.

Regardless of the action taken recently by Gov. Shumlin, health care will likely take center stage at the Vermont Legislature this year. Although “single payer” may be off the table for now in Vermont, there are meaningful steps that the Legislature and administration could take to move our state toward our goal of more affordable, quality health care for all.

I suggest we commit to achieving four goals. These goals are connected and must be approached holistically.

First, we must commit to improving the delivery of primary care and continue to support the Vermont Blueprint for Health. Ensuring that those with ongoing medical needs receive wrap-around care that prevents future, more costly care makes sense and measurable results are beginning to be realized as a result of our decade-long commitment to the Blueprint.

Second, the Green Mountain Care Board must focus on how hospitals and other providers are paid. Paying doctors and other health care providers for each test they run or service they perform is expensive and does not allow providers to spend their energy preventing illnesses. Fee for service is anachronistic, expensive and not rooted in outcome-based medicine. In that regard, Vermont must aggressively pursue the “all payers” federal waiver. This waiver will provide the incentives necessary for health care providers to accept payment reform that provides incentives for focusing on patient wellness.

Third, we cannot control the increase in health care premiums until we stop underfunding Medicaid. Underfunding transfers costs to Vermonters with private health insurance and is a root cause of double digit premium increases.

Finally, and perhaps most critically, Vermont must invest in a uniform, provider-based, technology system that combines electronic medical records with patient scheduling and patient billing. This goal is the platform upon which all other improvements are built. While it seems odd that health care quality and cost containment are linked to information system improvements, in fact they are. Excellent examples of systems that have reformed care are available to study at such notable institutions as the Mayo Clinic, Kaiser-Permanente and The Cleveland Clinic.

Success carries a cost with it. However, those costs are unique in that they are transparent, easy to understand, affordable and with a proven track record. These are the types of costs that businesses and all Vermonters should be willing to shoulder.