[T]he Green Mountain Care Board voted Wednesday morning to sign an agreement with the federal government to set up an all-payer model for health care reform.
Three of the members — Con Hogan, Jessica Holmes and Betty Rambur — voted to sign the agreement. Al Gobeille, the chair of the board, did not vote. Allan Ramsay retired in September and is no longer on the board.
The board cited more than 20 letters of support it received from major health care companies and hospitals.
Many independent doctors objected to the new system. Questions raised by the Legislature’s nonpartisan Joint Fiscal Office were not answered in advance of the vote.
“I’ve read all of the letters of support from the provider community, and I feel confident that the agreement meets the criteria set out by the Legislature in Act 113,” Holmes said, before making a motion to have Gobeille sign the deal.
“In the biggest sense, (the agreement) achieves the holy grail of policymaking in that it moves the system away from fee-for-service and toward paying for value,” Holmes said. “It’s giving us access to 200-million-plus-dollars that we would not otherwise have without this agreement.”
Holmes also said that if the all-payer model does not work well, “we can exit with no financial penalty.”
Hogan, who voted by phone, said the agreement was about lowering the cost of health care, which he said is responsible for increasing property taxes and causing state agencies to cut back on security for state workers.
After the vote, Gov. Peter Shumlin issued a statement praising the board for approving the deal, calling Vermont “the first state in America to ensure that your doctor can focus on keeping you healthy, rather than running tests or procedures.”
“We will help Vermonters lead healthier lives and more effectively manage chronic diseases, allow doctors to better treat their patients and identify health issues before they become severe, and reduce costs in a health care system that, if left unchecked, will bankrupt our state and Vermont families,” Shumlin said.
The U.S. Centers for Medicare and Medicaid Services also issued a press release calling the model “an exciting advancement in CMS’s partnerships with states to accelerate delivery system reform” that builds off of what Maryland created decades ago.
“This model is historic in terms of its scope, aiming to include almost all providers and people throughout the state in an all-payer ACO model to drive improved quality, better care coordination, healthier people, and smarter spending,” said Patrick Conway, M.D., the principal deputy administrator and chief medical officer for CMS.
Shumlin will sign the agreement 2 p.m. Thursday in his ceremonial office.
Opponents to the plan
The board issued a press release Monday citing “numerous letters of support from health care providers, insurers, businesses, and consumer advocates” and “asked that key components of this feedback be incorporated into what would be a final agreement with CMS.”
The board did not mention negative comments from advocacy organizations, members of the public, or from HealthFirst, which represents 135 independent doctors.
Lawrence Miller, the chief of health care reform for the Shumlin administration, asked HealthFirst to write a letter of support. Instead, the group responded Tuesday citing “significant concerns that have not been addressed in the current proposal” and asked the board to delay its vote on the deal.
“We strongly encourage the board to take the necessary time to address how the all-payer model will ensure that there is price transparency for patients, that there is pay parity among physicians whether independent or employed,” the response letter said.
The Vermont Coalition for Disability Rights complained that there was an “extremely short time between posting the all-payer model summaries for public comment and the deadline for submitting comments.”
The disability coalition said it was concerned that the Vermont Care Organization, an accountable care organization that is a major feature of the all-payer model, would have high administrative costs that “will take funding that is needed for essential health and disability services, both in health care settings and community programs.”
Dr. Marvin Malek, a hospitalist at Springfield Hospital, wrote that the Vermont Care Organization will “add greatly to administrative costs and has not been shown effective in controlling health care costs.”
Malek said the model “is forcing a centralization and industrialization of medical care delivery, with power being agglomerated into hospitals, especially the University of Vermont and to a lesser extent, Dartmouth.”
Supporters of the plan
The board cites more than 20 letters of support from the Bi-State Primary Care Association, Blue Cross Blue Shield of Vermont, OneCare Vermont, the UVM Health Network, the Vermont Medical Society, and the Vermont Association of Hospitals and Health Systems, among others.
“Together, we are writing a new prescription for the health of Vermonters: pay health care providers for keeping people healthy instead of just treating them when they’re sick,” wrote Dr. John Brumsted, the CEO of UVM Health Network. “This is a change the UVM Health Network is committed to making.”
Jeff Tieman, the CEO of the Vermont Association of Hospitals and Health Systems, wrote that the model “has the potential to help us better align Vermont’s health care system” because it will reduce health care costs, maintain access for everyone, and allow patients choose their providers.
“I believe that the negotiated agreement is the best current opportunity for us to redesign and improve health care in Vermont,” wrote Arthur Mathisen, the CEO of Copley Hospital. “As we move forward, we must be very deliberate and thorough with our analysis of the model to ensure hospitals and all other providers are able to maintain key services and remain financially viable.”
Many of the letters, such as one from Vermont Legal Aid, support the concept of the all-payer model, but say that the Green Mountain Care Board needs to do additional work in order to make the model successful.
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