Shumlin signed the contract in his ceremonial office with watery eyes, and thanked his administration, the Green Mountain Care Board, hospitals, and community health centers for cementing the agreement.
“I‘ve had the privilege of being this governor for almost six years now,” Shumlin said. “Sometimes you do things that are big that you think are little, and sometimes you do things that you think are little that turn out to be big.”
“Many folks think this is kind of a little thing that I think will turn out to energize our economy, improve our health care system, and improve our quality of life for Vermonters,” Shumlin said.
The agreement is the last major health care initiative of Shumlin’s administration, which has been hampered by the 2013 rollout of Vermont Health Connect and the governor’s abandonment of single-payer health care in late 2014.
The administration and the Green Mountain Care Board have been negotiating the deal with the U.S. Centers for Medicare and Medicaid Services since early 2015, and revealed the details to the public on Sept. 28.
The other signatories on the contract are Hal Cohen, the secretary of the Agency of Human Services; Al Gobeille, the chair of the Green Mountain Care Board; Sylvia Burwell, the secretary of the U.S. Department of Health and Human Services; and President Barack Obama.
The deal is the first of its kind in the nation, and sets Vermont on a six-year track to put almost all doctors under the same umbrella organization, called the Vermont Care Organization, which would pay doctors based on the quality of their care, not the number of procedures they perform.
The U.S. Centers for Medicare and Medicaid Services is treating the agreement as a test to see whether combining Medicare, Medicaid, and commercial insurance monies to pay for health care costs leads to cost savings and healthier patient populations. If the model is successful, the federal agency wants to enter into similar deals with other states.
The federal agency will consider the experiment successful if Vermont can lower growth in certain health care costs to 3.5 percent per year, reduce drug overdoses, reduce suicides, manage chronic diseases, and increase the percentage of residents who have primary care providers.
Vermont will receive $9.5 million in startup costs—$2 million to set up the Vermont Care Organization, $4.5 million for Supports and Services at Home, $1.6 million for the Blueprint for Health, and $1.4 million for community health teams.
At the press conference, Shumlin and his administration said they did not know how many primary care doctors are practicing in Vermont or how many more they will need to recruit in order to increase access to primary care.
Dr. Harry Chen, the commissioner of the Vermont Department of Health, said the ability to find a primary care provider depends on where a person lives. “If you’re in Chittenden County it’s probably much easier to get primary care,” he said.
Chen said the Department of Health’s role in the all-payer deal was to work with the Office of Health Care Reform and the Green Mountain Care Board on population health goals, such as managing chronic diseases.
Hal Cohen, the secretary of the Agency of Human Services, said the agreement “is going to push us really in the direction of making sure that people have adequate housing, that people have the right foods to eat, that people are warm.”
Attendees at the ceremonial signing included representatives from Blue Cross Blue Shield of Vermont, the University of Vermont Medical Center, the Vermont Association of Hospitals and Health Systems, OneCare Vermont, and the Vermont Medical Society.
HealthFirst, which represents independent doctors, did not endorse the all-payer model and did not attend the event.
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