Lawmakers press Green Mountain Care Board on work plan

By Alan Panebaker, Jan. 20, 2012

The Shumlin administration and the Green Mountain Care Board introduced road maps Thursday for how they plan to implement health care reform.

The board’s annual report and the administration’s Strategic Plan for Vermont Health Reform shed light on the specifics of how the state will maneuver to a health benefits exchange in 2014 and into a single-payer system in 2017.

Download the GMCB Annual Report

Last week the board approved its work plan, identifying high priorities for 2012. Anya Rader Wallack, chair of the Green Mountain Care Board, fielded questions from legislators Thursday that have become somewhat of the norm: How will the board maintain its independence from the Shumlin administration and how is a reformed system going to control costs?

Sen. Kevin Mullin, R-Rutland, pushed both Wallack and Director of Health Care Reform Robin Lunge on the issue of containing costs through tort reform. A report by Harvard economics professor Dr. William Hsiao last February recommended moving to a no-fault medical malpractice system similar to New Zealand. Act 48, last year’s health care reform law, requires a report to the legislature on the costs of reform. It was due this week, but the administration requested an extension until Jan. 30.

Mullin, who is vice chair of the Senate Committee on Health and Welfare, told Wallack that he thinks analysis is the most important issue for the board as it designs what will be a new health care system for the state.

“We should be looking at the best results from all different health care systems in world,” Mullin said. “We need to see if they work.”

Mullin said the board’s analysis should address what impacts other systems have on factors like patient safety and quality of care then make a decision based on all available information.

“What I’m afraid we’re going to hear is it’s a political compromise rather than a reasoned analysis,” Mullin said.

Wallack, who has been working on health care reform efforts since the 1990s, assured Mullin that the board is working to make sure it does the necessary research.

“In terms of having analytic capability moving forward, that’s absolutely what we’re moving toward,” Wallack said.

Currently, the board has 13 staff members, and it is in the process of hiring three more full-time.

The board’s work plan includes a plethora of tasks for analyzing data for evaluating quality and performance in the health care system, implementing pilot payment programs, and dealing with a host of issues involving insurance rate review and hospital budget oversight. The board has also submitted a grant application to the Robert Wood Johnson foundation for a payment reform project. Vermont was one of 15 sites invited to submit a proposal for the $500,000 grant out of 120 applicants.

The annual report also outlines the board’s estimated expenditures, which total around $2.1 million for 2012 and nearly $2.5 million for 2013.

Legislators also pressed Wallack on the recently-withdrawn request for proposal for a communications consultant. The issue became a political hot potato when Gov. Peter Shumlin expressed dismay that the the board was trying to hire what appeared to be a public relations firm.

Rep. Patti Komline, R-Dorset, asked Wallack why the board decided to back off so quickly amid criticism.

Wallack emphasized that the decision to withdraw the RFP was not in response to the governor and that the board will likely go back to the drawing board and make more clear what it is looking for.

“It’s not about PR,” Wallack said. “It’s about communicating with the public and engaging the public.”

With somewhat of an overlap between the administration’s mandate to implement a health benefits exchange dovetailing with the Green Mountain Care Board’s mandate to lay the groundwork for a universal health care system, Rep. Chris Pearson, P-Burlington, said he was concerned people are becoming confused and losing sight of the ultimate goal of single payer.

“We’ve really got to keep our eye on the prize,” Pearson said.

The focus on a health benefits exchange, which is a federal mandate, has become a point of frustration, he said.

“People are deeply interested in seeing a real health care system that is effective, and there’s a lot of anxiety about that,” Pearson said. “It’s all geared to this goal, but we can’t talk about it in a way the public understands if we’re not talking about the goal. Nobody is mentioning Green Mountain Care.”

The exchange is a step toward single payer, however, and transforming health care involves lots of moving parts.

“Just focusing on single payer and saying that’s going to be the silver bullet would be very naïve,” Wallack said.

Rep. George Till, D-Jericho, commended Wallack and the rest of the Green Mountain Care Board for their efforts.

“I’m impressed with the work they’re doing,” Till said.

He echoed Wallack’s point that health care reform involves more than the single payer concept where one government-run organization accepts all the health care fees and pays out all the health care costs.

“It’s really about the clinical and payment reforms that will control the health care costs which is the real aim in addition to providing health care to everybody,” Till said.

Despite his commendation, Till said he thought the board missed a tremendous opportunity to establish its independence from the governor when it decided to withdraw the request for proposal for a communications specialist.

He emphasized, also, the importance of moving to a no-fault medical malpractice system where patients who are injured would receive government-funded compensation rather than suing physicians for negligence. This type of system, which the Hsiao report recommended, reduces defensive medicine, which can really contain costs, according to the report.

State releases report on single-payer plan

By CHRIS GAROFOLO / Reformer Staff
The Brattleboro Reformer, Jan. 24, 2012

BRATTLEBORO, Vt. -- Officials in the process of overhauling Vermont's "unsustainable" health care system released a 21-page report on how the state will implement a single-payer plan within the next three to five years.

Anya Rader Wallack, chairwoman of the Green Mountain Care Board, said the report relates to Vermont's health care delivery system and reform aimed at controlling rising costs in the state.

"One of the things I tell audiences when I go around the state and talk about our goals on cost containment is; you take current trends, which is about 6 or 7 percent increase per year in health care costs, trend it out to about 2020, if you reduce that by two percentage points, you save about $3 billion dollars between 2014 and 2019," she said.

The Green Mountain Care Board and governor's administration released its Strategic Plan for Vermont Health Reform last week. It proposes a guide for the state to implement the plan of Gov. Peter Shumlin, a first-term Democrat, to expand and improve health insurance coverage in Vermont.

"I think there is an important distinction to be made between what is proposed in Vermont and, for example, the Canadian system or United Kingdom where the government owns the delivery system," Rader Wallack said.

"The financing would be public so the government would run the financing and have responsibility for raising funds that are now privately taken into the system," she said. "The health care delivery system in Vermont is private and will remain private even under this plan."

With the help from the state Legislature, the governor pushed through an ambitious measure to reduce health care costs while assuring Vermonters have access to coverage.

Lawmakers created the five-member care board within its bill to craft a cost containment system and design a plan on how to deliver health care to all Vermonters.

"It's not a matter of spending new dollars on health care, it's a question of where the dollars come from, and the main impact will be on people who pay premiums, because we'll have to raise that money some other way," said Commissioner Stephen W. Kimbell with the Department of Banking, Insurance, Securities & Health Care Administration.

Kimbell and Rader Wallack met with the Reformer Monday morning.

According to Kimbell, the state spends about $5 billion annually on health care. Vermont's higher insurance costs and aging population are the major factors in the skyrocketing health care figures.

"We're not talking about reducing overall expenditures, we're talking about reducing the rate of growth. We've got a system of $5 billion now and we're talking about growing it 2 or 3 percent instead of 6 or 7," Kimbell said. "The most hopeful thing we've seen is that the provider community, hospitals and doctors, they sense the unsustainability on the path we're on. They are working with us very closely."

Said Rader Wallack: "Our whole thrust is how to change the whole framework for how we pay [providers], how we measure quality of care, but really we need health care providers to figure out what's the best way to be more efficient."

The strategic plan lists the responsibilities moving forward, specifying tasks and deadlines for different Vermont agencies.

Currently, the Green Mountain Care Board is working with BISHCA and the Department of Vermont Health Access to develop a health care budget that reflects the principles embodied in the legislation.

The health access department will implement simplifications to reduce administrative costs by 2014, two years after the board reviews payment and benefit design to encourage providers to drop expenses in care.

But the largely unanswered question of how the state finances such a health care system ultimately falls into the office of Vermont's administration secretary, Rader Wallack said.

"They are supposed to come back with a more detailed plan around the single-payer financing and for how it would operate," she said. "The question is, the portion that is now paid for through employment, can we divorce that from employment and have a system of financing where people don't have to worry if their income changes, if their job changes, if they don't have coverage ... and also to relief employers, especially small employers of the burden of having to deal with choosing health insurance."

Both the health access department and GMC board have the ongoing task of reducing cost-shifting between the public and private sectors by incorporating the effect on hospital budget processes, the state funding and rate-setting by insurance companies. All the payment reforms the state is currently reviewing have strong quality measurements.

"It's really important to have a public-private conversation about, ‘We're designing this new financing system and we intend to make sure the rate of growth in it is sustainable relative to our economic capability, how can we work with you private providers to make sure that's not just a false promise,'" Rader Wallack said. "We are working with them to design a payment system and support delivery system changes that will actually lead to some efficiency and allow us to say something's different in Vermont."

The board will measure success over the next three years by checking enrollment numbers, the percentage of Vermonters underinsured and the rate of growth in health care expenditures.

Chris Garofolo can be reached at or 802-254-2311 ext. 275.