[B]URLINGTON — A former member of the Green Mountain Care Board says state regulators should be forcing hospitals and health care reform companies to invest in primary care, mental health, and community services.
Dr. Allan Ramsay, a family doctor, said “every other country in the world” has been making those investments, and study after study has shown that such investments reduce health care costs.
Ramsay sat on the board, which regulates hospital budgets and health insurance prices from 2011 to 2016. He made the comments as a member of the public at a forum Tuesday night organized by Attorney General TJ Donovan.
Donovan said he organized the event because health care costs are a consumer protection issue, and the public should understand in plain English why health insurance premiums keep going up.
Donovan moderated the panel with representatives from the Vermont Association of Hospitals and Health Systems, the Green Mountain Care Board, Vermont Legal Aid’s Office of the Health Care Advocate, the Visiting Nurse Associations of Vermont, and HealthFirst, which represents private doctors.
Ramsay, who continues to practice medicine at a free clinic in Barre, said the state is spending just 6 percent of all health care expenditures on primary care, and another 5 percent or so for mental health and community health services.
“We know every piece of evidence proves the more money you spend in primary care, mental health, and community based services, the more money you save,” Ramsay said. “Those studies quit being done five years ago because they were all positive.”
“So I want to know how our regulating entities are going to insist that we do like every other country in the world—spend more on primary care and mental health, including community services,” he said.
Jeff Tieman, the CEO of the Vermont Association of Hospitals and Health Systems, told Ramsay: “I agree with everything you just said. I think it’s right.”
Ramsay said the Green Mountain Care Board, which is undergoing a process to regulate new health reform companies called accountable care organizations, should use that process to mandate that the companies invest in primary care, mental health, and community services.
Ramsay said the Board also could use its longstanding process for regulating hospital budgets to force hospitals to spend more money on primary care, mental health, and community services, as opposed to acute care and specialty care.
“Is there a rule?” Ramsay asked the panel, referring to a regulatory rule being set by the board. “Is the ACO regulatory rule that’s being written by the Green Mountain Care Board—does it include an exact target for primary care, mental health, community-based mental health services?”
Judy Henkin, the general counsel for the Green Mountain Care Board, represented the board on the panel. “I don’t think anything like that is in the rule,” she said, because the rule being developed is more about the regulatory process.
Henkin said the state could meet the terms of the all-payer model—the health care deal with the federal government signed in October—using what Ramsay suggested. “I agree with you also,” she said. “Those are areas where the state needs to address, and it has been recognized.”
Patrick Flood, who once ran Northern Counties Health Care in St. Johnsbury, said Ramsay was getting at the major problem in health care. “Looking at where we’re spending the money and where we need to spend the money is exactly the point,” Flood said.
“One of the very first things that people brought up here are the non-medical determinants of care,” he said. Those issues—such as poverty, mental health, addiction, and housing—are often called social determinants of health.
“If a hospital says, ‘This person really has a problem with food or this problem really has a problem with the heat in their house, we need to fix this or they won’t be healthy.’ They’re going to turn to community agencies,” Flood said.
He said those could include the area agency on aging, home health agencies, or poverty-focused community action agencies. He said, “They’re going to say, ‘You gotta get in here and fix the problem,’ and you know what, those agencies don’t have the money to fix that problem.”
Donovan said in an interview Wednesday that the event went well. He said that while he originally planned the event to be about health care costs, the conversation morphed into something broader that included social issues like poverty, mental health, and addiction.
Donovan said those are issues that he focuses on with regard to criminal justice reform. “We’re talking about the same stuff these guys are just a couple rooms down” the hall, he said. “I think we’ve got to get in the same room. And I think if we integrate and collaborate, that’s where the savings are.”
He said it is appropriate for him as attorney general to hold these types of forums because residents often view him as “the people’s lawyer.” He said he accepts both the title and the responsibility, even though he doesn’t know much about health care.
Donovan said he plans to hold another forum on health care at an undetermined date.
