[V]ermont’s health care regulators have directed the Shumlin administration to improve how it funds a quasi-public nonprofit organization whose productivity has been questioned.
The Green Mountain Care Board instructed the Department of Vermont Health Access this month to figure out how to make cash flow more freely to Vermont Information Technology Leaders, a publicly funded 501(c)(3), by this week.
In a quarterly update to the board June 16, Rob Turnau, the chief financial officer of VITL, said the organization’s work has been “significantly delayed” because it has been waiting to get federal Medicaid money through the Shumlin administration.
The delay has affected work over the last six to nine months, Turnau said, and the organization can’t sign contracts, hire people or continue certain types of work without the funding. In one case, almost half of a potential contract period had already gone by without funding, he said.
Historically, the majority of VITL’s funding has come from state and federal money. The two main grant sources are Vermont’s umbrella Medicaid budget and the so-called SIM grant that funds health care reform.
Georgia Maheras, the deputy director for health care reform in the Agency of Administration, told the board that the federal government has a single person to unlock federal money to the administration, and that person was on medical leave. Maheras said that, because of the importance of getting the money to VITL, the state offered to help the federal government, but Congress doesn’t allow it.
Con Hogan, a board member, questioned “the idea that one person in a bureaucracy can stop a bureaucracy from doing its work.”
Green Mountain Care Board Chair Al Gobeille instructed Turnau and John Evans, the CEO of VITL, to tell the board within two weeks if the Department of Vermont Health Access, or its federal equivalent, is not able to free up the grant money.
“I am very concerned about the way that they’re funded,” Gobeille said in an interview. “I think if we can get them funded properly we can eliminate that as an excuse … and then let’s really start to measure the results versus the goals to see how this thing is actually performing.”
The Legislature had directed the board to oversee VITL starting in 2015. Gobeille said Gov. Peter Shumlin noticed the organization was getting “mixed results” in 2015 and needed someone to dig into what was going on.
On Feb. 4, VITL made a budget presentation to the board for the fiscal year that starts July 1. At the meeting, Gobeille said the organization did not provide sufficient budget information. After holding several more meetings with the organization, the board approved VITL’s most recent budget March 17.
In an interview, Steven Costantino, the commissioner of the Department of Vermont Health Access, said the department is negotiating a contract with VITL. He did not disclose the specifics of the new contract. He said there may have been delays in setting up funding contracts in the past but that he is confident the two parties can set up a new contract soon.
Between 2010 and 2013, VITL took in annual revenue of $4.3 million to $6.6 million, according to its Form 990 filings with the IRS. In fiscal year 2015, VITL’s budget was about $7.5 million, including $4.2 million from Vermont’s umbrella Medicaid budget, according to the Department of Vermont Health Access.
Between 2010 and 2013, between 38 percent and 55 percent of VITL’s revenue went to labor costs, according to tax returns, and executives made between $130,000 and $215,000 a year in 2013. Evans, the CEO, said in an interview that the organization does labor-intensive technical work and has about 35 employees now.
“I’m happy with the relationship with the Green Mountain Care Board,” Evans said. He said doctors across the state have seen their relationships with patients improved through VITL’s work. He said the challenge of his job is being legally accountable to the board but financially accountable to the Department of Vermont Health Access.
Gobeille called the board’s relationship with VITL “tense.” He said he would hold the organization accountable if it is not meeting performance objectives and that he would not allow the discussion over cash flow to be an excuse for not doing work.
“We need to verify that VITL is doing what they say they’re doing, and I don’t want the grant money to be a reason, or to cloud the reasoning,” Gobeille said. “I want to know if they’re doing what they need to be doing and if they’re on task.”
