In addition, my work with Vermont Businesses for Social Responsibility led to my appointment on the Medicaid and Exchange Advisory Board. Our role is to advise and inform Vermont’s Department of Health Access on policy development and program administration for the state’s Medicaid-funded programs, and the Vermont Health Benefit Exchange that is being developed.
The board is made up of 30 Vermont residents, evenly divided between beneficiaries of Medicaid or Medicaid-funded programs, individuals, self-employed individuals, and representatives of small businesses, large employers, insurance carriers, brokers and agents, advocates for consumer organizations, health care professionals, and representatives from a broad range of health care professions.
As the only person to sit on both advisories, my goal is to facilitate communication between the two groups as well.
Currently Vermont spends approximately $5.3 billion per year on health care, and it does not reach all Vermonters equally. Both GMCB and DVHA are charged with helping Vermont do a better job; GMCB by creating a path to health care for all Vermonters, DVHA by creating the Health Care Exchange as a step on that path.
Our current “fee for service” system rewards volume over value, often problematic with over-diagnosing, over-prescribing and over-treatment. Without knowing the costs of various tests and procedures ordered in the name of preventing malpractice lawsuits, providers do not have the opportunity to weigh options and find the path that leads to the best health outcomes. With this system, there is no intrinsic need to coordinate care.
GMCB is investigating and evaluating alternative systems including those of other states, other countries, and Vermont’s own IBM. The focus of 2012 is to review both hospital and insurance rates, and establish pilot projects testing different methods to pay for and improve the quality of health care in Vermont. These methods include “bundling,” “global budgets,” and “population based payments” as well as Accountable Care Organizations.
Bundling is the process of having one fee for all costs associated with a procedure. Rather than paying the surgeon, anesthesiologist, hospital, physical therapist, all follow-up care, etc., separately for their part in a hip replacement, there would be one fee, period. This would incentivize the group of practitioners to collectively do their best for the patient.
Population-based payment gives a budget to a hospital, for example, for the number of people it serves with outcomes on limited services that must be met. The hospital can then manage its funds accordingly.
GMBC is poised to submit a State Innovation Model grant application next month for federal funds to implement and test some of the above stated methodologies.
The full focus of GMCB, DVHA with the assistance of GMCBAC, MEAB, and others, is to assist Vermont in developing a culture of care by moderating cost and improving health.
It is a balancing act between making quality health care available to each Vermonter, and paying providers fairly. It is also a process of changing our collective vision to focus on positive health outcomes rather than procedures performed or drugs prescribed.
With various opportunities for Vermont residents to participate in Vermont’s emerging health care system, people should get involved. Personally, I am more than annoyed at the number of people complaining about our evolving system without bothering to find out what they are talking about.
Right now there is an opportunity to comment on the Green Mountain Care Board’s Hospital Budget Review prior to finalization. The hospital budget review process typically evaluates how much money was spent providing health care the previous year and projects into the next. The GMCB goal is to ask, instead, how can better health care be provided next year? This year a 3.75% target was set to signal the need to moderate cost. Get involved, make your own opinions and priorities known.
The publication is available for download at http://gmcboard.vermont.gov/hospitalbudgets. GMCB is seeking public comment until August 31. Please check it out, add your comments, concerns or ask your questions. Alternatively, email Sam Lacy, GMCB administrative assistant at Sam.Lacy@State.VT.us,
GMCB is also working to establish Essential Health Benefits, per the federal Affordable Card Act, that will be universally available to all Vermonters once the Exchange is in place. Vermont’s Department of Health Access is making recommendations regarding EHB that include hospitalization, maternity and newborn care, mental health, prescription drugs, etc. There is room for the public to comment on this as well. Be sure to do so, or don’t. The bottom line: get involved or don’t complain. There are ample opportunities for both, but only one makes Vermont stronger.