[H]ome health agencies and community health centers raised questions for months about creating a statewide health care system based in part on an organization owned by the regionโs two largest hospitals.
The pushback came before one accountable care organization, Community Health Accountable Care, filed a bid to compete with the stateโs largest and preferred organization, OneCare Vermont, owned by the University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center.
John Michael Hall, the executive director of the Champlain Valley Agency on Aging, was one of the leading voices questioning what he called a โhospital-centricโ form of health care reform. Mary Moulton, executive director of Washington County Mental Health Services, and Patrick Flood, CEO and executive director of Northern Counties Health Care, were others.
Hall and Flood testified Nov. 13 in front of the Legislatureโs Health Reform Oversight Committee. The two said discussions with the federal government about creating an all-payer model in Vermont, which started in early 2015, were moving too fast, were too focused on hospitals, and were not prioritizing community-based health care.
The Shumlin administration, which has been negotiating the all-payer deal in partnership with the Green Mountain Care Board, has planned to use OneCare as a regulated monopoly to receive monthly payments from Medicaid, Medicare and commercial insurers and then pay doctors based on how well they care for people rather than how many procedures they perform.
Back in November, Hall called the all-payer model proposal โa top-down approach to managing health care, as opposed to a vision that we think works, a community-based, community-driven approachโ that uses home health workers to lower the stateโs health care spending.
โOur view is that in reality, health happens at peopleโs homes, not in hospitals,โ Hall told lawmakers. โHealth happens in peopleโs living rooms. It happens in their kitchens. It happens when hundreds and hundreds of home health nurses walk into peopleโs homes every day.โ
Flood said: โThis is just moving too fast, if weโre not having those conversations now. Weโre going to make decisions that are going to lock us in and are going to make it much harder โฆ setting structures in place, and then theyโre too hard to change.โ
โI donโt want to sound like, cause Iโm not really, criticizing the individuals who have been working on this process,โ Flood continued. โI just think we have been having the wrong conversation for too long. At a minimum we need to slow down, and we need to get more input into the design from the people who really matter.โ
He cited four small hospitals that left OneCare to join Community Health Accountable Care: Northeastern in St. Johnsbury, Gifford Medical Center in Randolph, Springfield Hospital and Grace Cottage in Townshend. โThe very reason was to buy time, to basically say that this is moving too fast,โ Flood said.
There is no way to confirm the exact terms of the all-payer deal until it is final. The state released a terms sheet in January to show what it wants to set up for Vermont, but the all-payer negotiations started at some point in early 2015 and have all happened in private, often in Washington, D.C. Negotiations to combine the stateโs three accountable care organizations also have been going on in private, often in Colchester, since early 2015.
Hall testified again Jan. 14, this time at a joint hearing of the House Human Services Committee and House Health Care Committee. Moulton, from Washington County Mental Health, and Judy Peterson, president and CEO of the Visiting Nurse Association of Chittenden and Grand Isle Counties, also testified.
โWhat we need to figure out are the details for how will we be involved,โ Peterson said. โBoth our ACO partners and the all-payer model should be focused on using the services that exist. Buy them from us. Donโt build something new.โ
Hall said the state was planning to use hospitals and nursing homes โ โthe most expensive conceivable settings that mankind has imaginedโ โ to keep people healthy. He said that โassuming that hospitals will be able to change this reality is flawed.โ
Al Gobeille, chair of the Green Mountain Care Board, testified shortly after the community health organizationsโ representatives on Jan. 14 and jokingly introduced himself as โAlfred John Michael Gobeille.โ He said he agrees with Hall that health care reform should take a holistic approach to keeping people healthy.
