The chair of the regulatory board that decides hospital budgets and health insurance premium increases in Vermont is stepping down at the end of September, Gov. Phil Scott announced Friday. 

Scott appointed Owen Foster as the Green Mountain Care Board’s chair in 2022 and reappointed him to serve through September 2030. But Foster has decided to cut that term short, saying he wants to spend more time with his children and focus on other professional pursuits. He intends to remain on the board as one of the four regular members, filling a vacancy created by the departure of board member Jess Holmes, whose term ends this year.

The decision was “entirely mine,” he told VTDigger in an interview. “I have young children. I’m a lawyer. I want a chance to focus on my family and my other professional interests a little bit more too.”

In a press release posted Friday, Scott wrote “I appreciate Owen’s willingness to continue serving the people of Vermont. He’s been an effective leader as we work to make healthcare more affordable for Vermonters, and I believe he’ll continue to be a valuable member of the board in this new role.”

Under Foster’s leadership, the board has taken a tougher stance on reining in hospital budgets and insurance premium increases. He leaves his post as hospitals across the state struggle to stay out of the red and Vermonters pay some of the highest rates in the country for Affordable Care Act marketplace plans.

The Green Mountain Care Board was created in 2011 as part of Vermont’s effort to create state-funded healthcare for all. It is an independent government regulator tasked with approving hospitals’ annual budgets and ACA marketplace plans’ annual rate changes, among other authorities.

The board’s hospital budget review for the coming fiscal year begins Aug. 3. Foster intends to remain as chair through the whole budget process, until the end of September. The board is already reviewing next year’s rates for the two insurers that sell plans on Vermont’s ACA marketplace — BlueCross BlueShield of Vermont and MVP. This year, Foster has recused himself from participating in the board’s review of BlueCross BlueShield’s rates, citing personal reasons, though he declined to provide more details when the state’s healthcare advocate requested an explanation.

Under Foster’s tenure the board has shifted from being a body that largely rubber-stamped hospitals’ and insurers’ requests to one that put serious pressure on both to reduce expenses.

Mike Fisher, the state’s health care advocate, has watched the evolution of the board since its early days: the original idea to combine the regulatory authority of approving hospital budgets and insurers’ premium increases came from a need to make sure that the costs of hospitals’ healthcare services stayed in-line with the amount of money insurers raise through premiums to pay out those claims.  

“That hasn’t always happened,” Fisher said. “More and more in recent years, the board has responsibly aligned both the spending and revenue side.”

He also sees this moment of Foster’s tenure as one of much more urgency, one that the board has met “responsibly.”

In an interview, Foster said that one of the board’s defining points of progress under his leadership has been a push to move care into less-expensive settings if it does not need to occur in a hospital — for example, outpatient surgery, imaging or lab work. 

During his tenure, he said, the board has also brought a high level of scrutiny to how much Vermonters are paying for administrative services in healthcare.  

“Since I’ve been here, (the board has) very, very much focused on ‘let’s stop spending on healthcare administration and let’s start spending on the fundamentals of a good healthcare system,’” he said. 

When Vermont ran its all-payer model of healthcare funding, the care board also regulated the Accountable Care Organization responsible for coordinating those payers and payments.  

In his early days as chair, Foster brought a similar skepticism to the ACO’s budget and its executives’ compensation that he has brought to the state’s largest hospital group in recent years.

“When we cut (the ACO’s) budgets, what we did was we redirected the money from spending on healthcare bureaucracy at an ineffective ACO, and we literally took the dollars and said, ‘Give this to primary care,’” he said. 

In the early days of Foster’s tenure, when the state still had the all-payer model, Vermont saw itself as more of a leader in innovative healthcare, even as costs mounted and health outcomes plateaued for many Vermonters, Foster said.

“When I started, it was not widely understood or accepted how fragile and distressed our healthcare system was,” he said. “I do think a big part of what the staff and the board has done the last four years has focused on educating the Legislature, (the Agency of Human Services), the governor’s office and the public, that we are in a tough situation, and we need to make changes. And now I think everyone really recognizes that.” 

But he suggested that the biggest changes ahead for healthcare need to come not from the care board, but from hospitals, the state, and private and public insurers working together to take a serious look at how hospitals can cut spending without cutting services for Vermonters who need them.  

“There are different leaders for different moments,” Foster said. “And I do think my role as a leader was to look hard at what we’re doing and evaluate if it was working. The next stage is a different stage.”

This story will be updated.