[G]ov. Peter Shumlin said he’s “cautiously optimistic” that his administration will make a deal with the federal government to set up an all-payer model for health care.
Shumlin said at a news conference Thursday that he expects to have a decision on the deal “in the next couple of weeks.”
He met with Sylvia Burwell, the secretary of the U.S. Department of Health and Human Services, and Shaun Donovan, the director of the U.S. Office of Management and Budget in Washington, D.C., on Wednesday.
“Really at this point, after two years of negotiations, what I said was pretty simple,” Shumlin said Thursday. “We either need to come to an agreement or stop working so hard because both President Obama and my terms are ending. The message was well-received.”
The Shumlin administration and the Green Mountain Care Board have been negotiating the so-called all-payer model since early 2015. The plan hinges on an agreement from the federal government to waive several provisions of Medicare law and antitrust laws.
Under the proposed model, Medicare, Medicaid and commercial insurers would pay OneCare, an accountable care organization owned by the University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center, monthly payments for taking care of their patients.
OneCare would then pay doctors based on the quality of health services they provide, not the number of procedures they perform. Over the next few years, OneCare is likely to merge with other smaller organizations to become the Vermont Care Organization, so more doctors working in Vermont would receive the same type of payments.
If the new accountable care organization — either OneCare or the Vermont Care Organization — can treat patients inexpensively, it can keep any additional money the insurers give it. If the organization cannot treat patients inexpensively, it must absorb the cost, thus making it “at risk” for the outcomes of its patients’ care.
Details on how much money per month Medicare would pay the accountable care organization have not been made public. However, the federal government may pay the organization more under the all-payer model than if the doctors it represents were billing for each and every service they provided.
“We made a plea for some additional money in the negotiation that we felt was important to make this work for Vermont,” Shumlin said. He said the difference between what the state asked for and what doctors and hospitals already get is in the tens of millions of dollars.
“They were very receptive, and I expect that in the next couple of weeks we will either have an agreement, or all agree that while we made a valiant effort, it will be up to future presidents and governors to see if they can do better,” Shumlin said.
Shumlin said consumers would likely still have to make copays at their doctor visits. He said the biggest change consumers would see under the all-payer model is an increase in the quality of care they receive.
The proposed all-payer model would be the first of its kind in the country. Maryland uses a process it calls “all-payer” to set how much hospitals are allowed to charge for services, but, unlike in Vermont’s proposal, Maryland’s system is not centered on an accountable care organization or the abandonment of fee-for-service medicine.
Under the proposed model, the Vermont Care Organization would become a regulated monopoly making payments to doctors and hospitals that serve virtually every patient in the state. The Green Mountain Care Board would be tasked with regulating the Vermont Care Organization.
Shumlin said he is confident the board can regulate the organization because of how it has regulated hospital budgets. “The outcomes have been extraordinary,” he said. “They’ve held health care spending in hospitals to the lowest level in four decades.”
Shumlin also criticized Lt. Gov. Phil Scott, a Republican running for governor. At a news conference outlining his health care plan, Scott said: “I don’t think that any of us fully understand (all-payer), and trying to get the details has been a bit difficult.”
Shumlin responded Thursday: “Anybody who’s been in government for the last two years, who still doesn’t know what this is, hasn’t been asking many questions. I mean, Phil’s a member of my Cabinet. This is not hidden information.”
The governor said if the state receives an offer in the next few weeks from the federal government, he and the Green Mountain Care Board would spend time discussing the proposal with the public before he signs it.
