State Gets Green Light To Overhaul Health Care Payment System

Sep 28, 2016

The Shumlin administration has won preliminary approval from the federal government to change the way health care providers are paid, from a system that reimburses for specific procedures to one that pays based on patient outcomes.

Administration officials say the goal is to both improve quality and slow the increase in health care costs.

Gov. Peter Shumlin says the current system has to be replaced.

"One reason that we spend more money than anyone else in the world on health care and have less good outcomes is because ‘fee for service’ drives an inefficient delivery system that doesn't put quality first," Shumlin said.

The new system is dubbed the Vermont All Payer Accountable Care Organization Model, or "all-payer" for short.

Green Mountain Care Board chairman Al Gobeille says the plan will reward providers for comprehensively addressing the needs of patients with chronic illnesses.

“Eighty-six cents on the dollar for chronic disease management and care is what's driving this conversation. That's what's eating up the dollars,” he said.

Officials say the state has a verbal agreement with the federal government – which controls a large portion of health care spending through Medicaid and Medicare – to change the payment system.

They say that under federal law, Medicare benefits will not change under all-payer. Medicare patients would still be able to choose their health care providers, for example. 

The Green Mountain Care Board will hold public hearings on this plan over the next few weeks.

The current public hearing schedule is as follows:

  • Monday, Oct. 3, 5:30-7:30 p.m. Montshire Museum of Science, One Montshire Road, Norwich (Nonprofit Community Room)
  • Thursday, Oct. 6, 4-6 p.m. University of Vermont Recital Hall, 384 South Prospect St., Burlington
  • Tuesday, Oct. 11, 4-6 p.m.  CVPS/Leahy Community Health Education Center, Rutland Regional Medical Center, 160 Allen Street, Rutland