Editor’s note: This commentary is by Julie Tessler, who is the executive director of the Vermont Council of Developmental and Mental Health Services.
[H]ealth care reform in Vermont has always been a far bigger initiative than creating a single payer financing plan. There are tremendous benefits to Vermont created by health care reform that should continue to move forward.
The goals of Vermont’s health care reform efforts as stated by the Agency of Administration are to:
1. Reduce health care costs and cost growth
2. Assure that all Vermonters have access to and coverage for high-quality health care (health care includes mental and physical health and substance abuse treatment)
3. Support improvements in the health of Vermont’s population
4. Assure greater fairness and equity in how we pay for health care
Community developmental and mental health agencies are playing an active role in health care reform and strengthening our provider network by developing: electronic health records, a statewide data repository, outcomes using results based accountability and application of evidence based practices and training. These efforts are important components of health care reform because the children and adults we serve who have developmental, mental health and substance use challenges often have high health care needs, utilizing both acute and long-term care services.
Our work to address the social determinants of health is critically important to achieving the goals of health care reform. When Vermonters have support to address challenges caused by mental health conditions, addictions and disabilities they are more likely to have active lives: thriving in their jobs, family and social relationships. Research shows that addressing social determinants of health reduces utilization of emergency rooms, inpatient care, and other high cost health interventions.
Given Vermont’s fiscal projections, the state should strategically invest our limited resources to maintain our advances through health care reform and to achieve the best return on investment possible.
These efforts are important components of health care reform because the children and adults we serve who have developmental, mental health and substance use challenges often have high health care needs, utilizing both acute and long-term care services.
Medicaid rates should be high enough to recruit and retain quality staff across the full continuum of health care providers. There is insufficient room left in commercial insurance rates to continue shifting costs from public to the private payers. Community developmental and mental health agencies that rely almost entirely on Medicaid for their funding have the greatest need for improved Medicaid rates. For instance, social workers at community mental health and developmental disability agencies are paid nearly $16,000 less than those who work for the Department for Children and Families. This compensation differential is consistent in the workforce of these agencies. It reduces the quality of care for individuals with significant health care needs as agencies struggle to recruit and retain experienced and skilled staff. In fact, some community developmental disability service agencies have staff turnover rates above 40 percent per year. A strong investment in Medicaid rates could improve quality of care and avoid higher cost interventions, ultimately saving taxpayer dollars.
In a publicly financed health care system reimbursement rates will need to be set at reasonable and equitable levels and then increased on a predictable and reliable basis to sustain quality services. Currently, state employees benefit from a contract with regularly scheduled COLAs and step increases, while nonprofit provider reimbursements have trailed behind inflation by 12 percent over the last 10 years and often must absorb funding rescissions.
The state should not delay working with willing providers to develop bundled payment models that reimburse for specific population outcomes. The current fee-for-service payment model from multiple funding streams with varied bureaucratic requirements wastes funding and prevents the flexibility needed to best meet people’s needs. The experience to date with Integrated Family Services in two regions of Vermont has shown improved services, reduced administrative expenses and cost savings.
We are certain that any reductions in Medicaid funding in the state budget for services to individuals with disabilities and long-term service and support needs will only lead to higher costs for medical and institutional care, as well as for correctional services.
We have commitment, determination and innovative ideas to move health care reform forward to improve the lives of Vermonters, but we won’t succeed if the budgets for community health providers, particularly developmental and mental health agencies are cut.
