Health care forum highlights challenges

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DOVER -- When it comes to plans for moving to a single payer, universal health care system in Vermont, there is still a lot up in the air.

"This is a process. When you change any big system and you're moving to a really different way of providing coverage for folks, you have to take it slow and it has to be a process," Director of Health Care Reform Robin Lunge said. "You have to make sure you're not rushing things and that you're taking your time to do a good job because it's important. These are people's lives you're talking about."

Lunge, who graduated from Brattleboro Union High School in 1987, spoke at Monday night's health care forum at Dover Town Hall.

The state is currently moving towards implementing a universal health care system. The goal is to have that system in place by 2017 at the earliest. The exchange will be known as Green Mountain Care.

"In order to move forward with Green Mountain Care, we need to show the federal government that we're not showing less good coverage than what's currently covered under the Affordable Care Act or what some people call ObamaCare," said Lunge. "We're also looking at the cost of expanding the coverage sources to other sorts of coverage."

Right now, officials are hard at work determining a financing plan for the new system. They are hopeful that by January, a proposal will be up for public comment. The administration will then likely bring it to the Legislature.

"(Health care) becomes a public good or public service, kind of like the roads or schools and we would be shifting from paying the way we pay today, which is largely through private premiums," said Lunge. "We would move away from that to a publicly financed system, where we would all contribute based on our ability to pay. And that would cover the coverage for everyone."

Financing the system should not be reliant on one thing, she added.

"We don't want to over rely on one tax source rather than another," Lunge said. "So we have to find the right combination to ensure that we can have a sustainable system."

Officials are also looking at how benefit packages will be set up. Lunge expects to start this phase in the fall or early winter. She said determining how money is appropriated is another item that will be addressed.

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Lunge told attendees the reasons for health care reform are to assure all Vermonters have access to and coverage for high quality care. It is also to reduce health care costs and cost growth, assure greater fairness and equity in how health care is paid for and improve the health of Vermont's population.

"In the last decade, Vermont's wages have essentially been flat. And that's because any additional growth in the economy has actually gone into health care. So, that means it's very challenging for small business owners," said Lunge. "It's harder to continue to cover your employees with the way that insurance premiums go up every year."

Lunge pointed out more spending does not equate to better health.

"There's better ways that we can approach the financing of health care," she said.

Currently, the independent five member Green Mountain Care Board has authority to allow or deny proposed changes in insurers' rates. The board also regulates hospital budgets and major capital expenditures, which covers anything over $1 million.

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Director of Payment Reform Richard Slusky noted a significant drop in the rate of hospital budgets over the last two years.

"We're looking at our current health care system. It's basically a fee-for-service system. Basically, providers are paid for the work they do," he continued. "One of the problems we find in the fee-for-service system is that sometimes, we do too much of what we don't need to do and there's a high cost for services that really don't have great value."

According to Slusky, the board is looking at moving towards a value-based payment system. It would involve changing incentives offered to health care providers.

"Everything that was revenue to a hospital under fee-for-service becomes expensive if they're under a budget," Slusky said. "And so they really start to think about how they're spending their time and their dollars."

The three models being evaluated include a shared savings program through Accountable Care Organizations, an episodes of care program and a pay-for-performance program.

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According to a slide at the forum, ACOs "are composed of and led by health care providers who have agreed to be accountable for the cost and quality of care for a defined population. These providers work together to coordinate care for their patients and have established mechanisms for shared governance."

Participation for these organizations in shared savings programs is voluntary. The programs include "payment reform initiatives developed by health care payers" offered to health care providers "who agree to participate with payers to promote accountability for the care of a defined population, coordinate care, encourage investment in infrastructure and care processes and share a percentage of savings realized as a result of their efforts."

Slusky said participation in an episodes of care program is rare. Through it, a hospital receives one payment but is responsible for all care provided to a patient throughout a given time period, which could be 30, 60 or 90 days.

"That's very unusual but again, that makes them think about how well they're doing the procedure," he added. "It's encouraging to see the providers thinking much differently than they have in the past."

Pay-for-performance programs would give providers incentives for adhering to certain standards of care.

"They may be eligible for some additional bonus payments from the government or through commercial payments," said Slusky.

While facilitating the forum, state Rep. John Moran mentioned Chief of Health Care Reform Lawrence Miller could not make it for the event.

"(Miller) has canceled meetings everywhere for the time being so he can stay at the helm, steering us towards health care for all," said Moran. "His commitment to success is reassuring."

Lunge said Miller was charged by the governor to get the state's current exchange system, Vermont Health Connect, back up and running. The website was taken off-line in the middle of September. Officials are hopeful repairs will be made in time for November, when open enrollment allows new customers to sign up on the exchange.

Chris Mays can be reached at 802-254-2311, ext. 273, or Follow Chris on Twitter @CMaysReformer.


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