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Vermont Legislature
Follow VPR's statehouse coverage, featuring Pete Hirschfeld and Bob Kinzel in our Statehouse Bureau in Montpelier.

Community-Based Health Care Providers Want In On Looming 'All-Payer' Discussion

Peter Hirschfeld
/
VPR
Michael Hall, executive director of the Champlain Valley Area Agency on Aging, warned lawmakers Thursday that community-based providers need to be fully involved in the administration's health care reform plans.

Any day now, the Shumlin administration will unveil the proposed terms of a federal waiver that could overhaul the health care system in Vermont. But community-based providers say they’re feeling iced out of the negotiations, and they’re asking lawmakers to make sure they have a prominent seat at the bargaining table.

The federal Medicare waiver would enable one of the most drastic health care reforms in state history, and could fundamentally change the way money moves through the $5 billion medical industry.

“I would argue that this might well be one of the most fundamental policy issues that you will encounter during your legislative careers here,” Michael Hall, executive director of the Champlain Valley Area Agency on Aging, told lawmakers Thursday.

He's describing an initiative, called the “all-payer” model, to reward providers for patient health, as opposed to the volume or type of procedures provided.

Hall’s organization is one of dozens of community-based providers that offer services like home care, substance-abuse counseling and mental health. On Thursday, he told lawmakers that they’re getting short shrift in the reform conversation.

“We have heard that we just need to have faith that hospitals will just know the right thing to do. We have heard that this is too complicated, that we don’t know how we would integrate these systems,” Hall says.

"I would argue that this might well be one of the most fundamental policy issues that you will encounter during your legislative careers here." — Michael Hall, executive director of the Champlain Valley Area Agency on Aging

He says the people spearheading the reform initiative – namely the Shumlin administration and the Green Mountain Care Board – have wrongly placed hospitals at the “center of the health care universe.”

“A huge reason for why we pay so much for hospitals is because we do a terrible job of keeping people out of hospitals in the first place,” Hall says. “And yet for years, we have been under-investing, and actually divesting, in the very services that would reduce hospital expenditures and keep people out of nursing homes and would get better outcomes.”

Mary Moulton is executive director of Washington County Mental Health Services, one of 12 so-called designated agencies across the state. She says people with mental health and substance abuse issues account for 40 percent of all health care expenditures, and that community-based providers are in the best position to intervene in their lives in ways that improve outcomes, and save costs.

"We shouldn't proceed, I don't think, with the expectation of great savings unless we're fully able to enable our community providers to do their jobs." — Mary Moulton, executive director of Washington County Mental Health Services

“We shouldn’t proceed, I don’t think, with the expectation of great savings unless we’re fully able to enable our community providers to do their jobs,” Moulton says. “And we’re ready, and we’re able, and we’re very, very willing. But given our current funding, we’re working with one arm tied behind our backs.”

Moulton and Michael Hall say they’re worried that the reform model won’t include the funding necessary for community-based providers to realize their cost-saving potential. And they're looking for assurances that existing community providers - as opposed to new organizations - will be used to provide the home care, mental-health counseling and other services being performed by agencies like theirs.

Al Gobeille is chairman of the Green Mountain Care Board, the five-person panel that oversees just about every aspect of health care in Vermont. Gobeille says he appreciates providers’ concerns.

“However there’s a gap. There’s a gap in information,” Gobeille says.

Once he’s able to fill in those gaps, Gobeille says he’s confident that community-based providers will gain confidence in the path forward. As of now, though, Gobeille says federal regulations require waiver negotiations to be conducted in private.

“And the Green Mountain Care Board lives on transparency, so it’s very unnatural for us to have some that we’re working on that we don’t share,” Gobeille says. “And so I want to get it out as soon as possible.”

Lawmakers are now grappling with the question of how forcefully to insert themselves in the all-payer reform process.

The Vermont Statehouse is often called the people’s house. I am your eyes and ears there. I keep a close eye on how legislation could affect your life; I also regularly speak to the people who write that legislation.
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